[Diagnosis] On CPAP for 3 months and still exhausted please HELP!!

[Willrule88]

Hi, my name is Will

I have been diagnosed with Upper Airway Resistance Syndrome (UARS) with an RDI of 33.3 events per hour.

I have been using the ResMed AirSense 11 with the N20i nasal mask and taping my mouth to ensure it stays closed sense I am a mouth breather when I sleep. Occasionally, I also use the F30i, which is a hybrid full-face mask(I don't tape my mouth while using this mask).

For the past three months, the MyAir app has consistently shown scores between 90 and 100 each night, with events never exceeding 4 per hour.
 
Nevertheless, I am still exhausted and feel no improvement in my wakefulness. Please help me.

Attached some photos of my OSCAR sleep data.

Summary:

• Diagnosed with UARS, RDI of 33.3 events per hour
  
• Using ResMed AirSense 11 with N20i nasal mask
  
• Current pressure settings: 7-14
  
• No EPR
  
• Consistently using therapy every night for 3 months
  
• MyAir score consistently 90-100
  
• Still feeling exhausted
  
• Following a healthy sleep schedule
  
• I am a healthy 18-year-old, 5'10", 175 lbs, exercising daily.
  

[Crimson Nape]

Hi Willrule88! -
I would recommend you set the EPR to 3 - Full-Time, and either switch to CPAP mode, setting your pressure to 12 cm or leave it in Auto mode and set both the minimum and maximum pressure to 12cm. Try this to see is you feel better rested. The pressure settings will probably need to be adjusted further, but this is a starting point to see if we are going in the right direction.

- Red

[Willrule88]

Thank you I will try that,

Why do you recommend EPR, I heard that can cause more central apneas.

Does it help?

[Crimson Nape]

It can, but we will worry about that if and when it occurs. Two reasons for an EPR of 3. You said you were diagnosed with UARS and you have some elevated flow limits. The flow limits go with the UARS. Setting a bi-level pressure should help reduce the flow limits and decrease the possible flt tops of your flow rate.

- Red

[AshSF]

I would recommend going to a fixed pressure of 12cm in either CPAP mode or APAP mode (min=max=12).

I would keep EPR to 0.

If falling asleep is uncomfortable due to too much pressure on the onset, I would recommend you use a ramp to get to 12.

[Dormeo]

AshSF, why do you recommend an EPR of 0? As Crimson Nape notes, EPR is an excellent tool for reducing flow limitations (provided that they don't originate in the nose). I agree that it's well worth-while to try EPR of 3. If "treatment-emergent" CAs are your concern, they may or may not crop up, and if they do, they will often resolve on their own.

[Willrule88]

I’m attaching data from two nights: one from two nights ago and one from last night.

On the first night, I adjusted the pressure to 8-11 (previously it was 7-14), with no EPR. My flow limitation was high at 0.42. I lowered the maximum pressure because I was having more central apneas (CA) than regular apneas. However, lowering it to 11 didn’t help much since my 95% pressure that night was 11 cm. Previously, when I was on 7-14, my 95% pressure was 11.4 cm, so I decided to lower the maximum even more for the next night.

Last night, I changed the pressure range to 7-9, hoping to reduce CAs, which helped—my CA events decreased from 2.37 to 1.54. I also turned EPR on to 3 full time. This reduced my flow limitation from an average of 0.3-0.4 to 0.11, so EPR definitely helped.

The problem is, I’m still having a fair amount of central apneas and still feel tired. I think 7-8 cm might be a good minimum pressure since I’m not having many regular apneas at that level.


I’m not sure what to do next and feel a bit lost. Do you think I should try using a BiPAP? Someone actually gave me one for free, so I have it if needed. I know EPR helped, as my flow limitation is now at 0.11.

Let me know where to go from where and what to try tonight, let me know if you need extra data as well thank you~

[McMartin]

I have no idea if this is relevant to your situation. but my apnea was hiding a co-morbid problem with hypersomnia. My CPAP/ASV is doing its job reducing apnea events, but I still suffer from episodes of daytime sleepiness.

[alemon]

Hi Will - one thing that helped me immensely was setting a straight-pressure with EPR-3 rather than APAP. What happens is all the pressure changes were subtly waking me up, and when I did straight-pressure, it cut my AHI in half. I see a few points on your graphs where a CA seems to follow a pressure spike, you could give this a try.

Additionally, slightly elevating the head of my bed cut my CA's down as well. I'm not at 0, but straight pressure lowered my average from ~5 AHI to ~3.5, and the slight slope to the mattress cut it down again by 1, with a night or two even below 1. This hasn't fully fixed my tiredness, don't get me wrong, but we attack what we can

Could be you need bi-level, but I might give a few nights at the settings with your higher EPR, let your body get used to them - easier said than done, I know.