Feeling Worse After Successful CPAP Use

[kaizer989]

Hello everyone,

I've struggled for a bit with being able to successfully sleep with CPAP as well as keep my mask on. After figuring out why I was taking my mask off in the middle of the night (mask was actually too tight, recorded myself trying to scratch my nose, but the tightness made me rip my mask off in my sleep), successful usage of the CPAP leads to me feeling worse the next day. I feel like I didn't get nearly enough sleep, worse than not using the CPAP. My mind is muddled throughout the entire day and around 3pm I start yawning very heavily. Around 5pm I feel like could pass out and take a nap for hours.

My AHI seems acceptable (under 5), so I'm seeking some advice on possible CPAP configurations to iterate on.

Details:

Machine - AirSense 11 AutoSet

Mask - Airfit Resmed F20

Mode: APAP

Pressure: 5.00 - 15.00

EPR: Full Time

EPR: Level 1 cmH2O

Ramp: Auto

Ramp Pressure: 4 cmH2O

As far as sleeping goes, I tend to sleep on my side or stomach, but honestly, I rotate around all night like a spitroasted rotisserie chicken. Been that way as long as I can remember.


Any advice would be greatly appreciated. Let me know of any other metrics, settings or pictures that may help. Thanks!

[G. Szabo]

Your minimum pressure is low. It should be 7 cm with EPR=2 or 3.

[kaizer989]

Thank you for the response, I will increase the minimum pressure along with the EPR tonight.

[Big Guy]

I started out CPAP Therapy using a ResMed AirFit F20. It was okay, but then I went to an F30. It doesn't cover the nose like the F20 does. I do much better using the F30 than the F20, although I now have the F20, F30, and the F40 on hand. 

I still have issues with itching but it is what it is. Give some thought to the AirFit F30. It was a big improvement for me. 

[quiescence at last]

I will try F30 myself, reading B. G. recommendation. You scores are not bad, I don't see the things people normally experience, so great. I noticed that the pressure is vaulted as various times, and when it is, it is generally in the 5.0 to 6.0 pressure range (before the machine reacts). So, a min of 7.0 makes sense, but you might want to sneak up to it and can definitely bump up to 5.6 or to 6.2 as increments toward the 7.0. It is your comfort and restorative sleep we are hunting.

Good luck, and you are definitely on your way!

QAL

[kaizer989]

Ah, I see the design of the F30 now, and it certainly seems like it could be an improvement with respect to the nose itching, which is honestly my last comfort-related issue. I appreciate the recommendation, look forward to trying it out!

"I will try F30 myself, reading B. G. recommendation. You scores are not bad, I don't see the things people normally experience, so great. I noticed that the pressure is vaulted as various times, and when it is, it is generally in the 5.0 to 6.0 pressure range (before the machine reacts). So, a min of 7.0 makes sense, but you might want to sneak up to it and can definitely bump up to 5.6 or to 6.2 as increments toward the 7.0. It is your comfort and restorative sleep we are hunting.


Good luck, and you are definitely on your way!

QAL"

That makes sense, I appreciate the recommendations. Thank you for taking the time to look at my scores and the encouragement! 

[kaizer989]

I updated the pressure setting to be minimum 7 and an EPR of 3. 

The next morning I did feel a bit better! My mental clarity in the morning was significantly better, but my sleepiness actually felt a slightly worse. I would feel sleepy for longer in the morning and I would start to feel tired earlier in the day. I had a thought to review my sleep study results, and I found they recommended 8 cm pressure... which is odd because my followup appointment had my sleep doctor recommend my previous ranges of 5-15.

So I upped the min pressure to 8 for the next two nights, keeping EPR the same. I'm a little mixed on the results. The mental clarity is still better, but less so, and I'm slightly more tired in the morning. Looking at the data, I've recently had an increase in CA's, and last night I hit over 5 AHI for the first time while using the CPAP. My sleep study recorded hardly any CA's, just 1 throughout the whole night, so I believe it's treatment emergent. 

Any advice would be greatly appreciated. Screenshots attached (9-13 I left my SD card in my computer, so it doesn't have the granular data).

[G. Szabo]

Because your FL is excellent at an 8 cm minimum pressure,  I suggest setting EPR=2 to mitigate CAs while maintaining the 8 cm minimum.
It would be better to turn the RAMP off because you have no treatment during ram periods.

[quiescence at last]

ditto. And, if you feel you need the ramp, try setting it to begin at 6 or 7.

QAL

[kaizer989]

Thank you both for the suggestions. I applied the suggested settings, EPR:2 and removed the ramp period. 

Today I feel similar if not slightly better, but still overall not well, probably a 6/10 in sleepiness during the day, 10 being the most sleepy possible. Posting the data for the night for any obvious issues.

Another question I have in general: During this process I find it difficult to know when I should change something versus when I should keep everything the same over an extended period of time. The argument for the latter is this concept of maybe.. sleep debt that I'm paying off? That there is going to be some period of time where, even though I feel bad, my body is somehow still progressing positively with sleep and one day I will wake up and everything will be fine. Is this a real thing (sleep debt, or very delayed benefit)? If so, how long do you think I should wait until I start looking into root cause issues again?

I've heard all sorts of experiences with CPAP ranging from, the very first night it was used it was life-changing, to "I didn't feel results until 3-6 months" to "It was a complete waste of time and nothing worked for me". These ranges of experience is what makes it difficult to know exactly when to stick it out, when to tweak something or when to try something else entirely. 

Hopefully that makes sense.