Feeling even more tired with bipap

[skyuser37]

Hi all,

After a period of sleeping with my Resmed Aircurve Bilevel for only 2-3 hours, I have managed to sleep with it for about 6-8 hours for the past 2+ weeks. Most of the days, my numbers are good.

However, I have been feeling even more fatigued throughout the day.

Have tried changing the pressure support from 4.6 to 6 (which gave me a bunch of central apneas, which my sleep study said I did not have, on 11 Nov) and back to 4 (which reduced my AHI to good numbers, but I dont feel much better)

Could it be sleep debt or something else like leaks? I notice myself breathing through my mouth tape in the night.

Thank you!

[skyuser37]

More pictures (with a bad AHI night in between, but in terms of fatigue its about the same)

[Dormeo]

I looked at your earlier thread, and it sounds as though you continue to wrestle with mouth leaks. If you're aware of them during the night, they may well be waking you up and also preventing you from sleeping as deeply as you should.

Are you using Somnifix (with the little gap in the middle)? You might consider covering the gap with a little piece of tape or switching to tape like BSN Medical Cover Roll. I get a four-inch wide size. You could use the four inch dimension horizontally, cutting off pieces about an inch tall. Be sure to fold back a piece on one side so you can remove the tape easily.

Some people avoid full taping, for two reasons. (1) If you suddenly need to vomit in the night, the tape could lead to your aspirating some vomitus, which would be bad. I'm willing to accept this risk; I have never suddenly needed to vomit during the night. (2) If there is a power failure and your machine goes off while you're sleeping, you won't be able to do the natural thing and open your mouth to breathe. As for that, I've put a circuit alarm in a plug on the same circuit as my machine. It will wake me up immediately if I lose power to the machine.

You say you feel "fatigued." Are you depleted of energy, or sleepy, or some of each? If you're not simply sleepy, I wonder whether you've talked with your primary care physician about your fatigue. It could be valuable to rule out some other possible medical issues -- or better still, to find them and treat them successfully.

[skyuser37]

Hi Dormeo, thanks for your reply!

I'm currently using the BSN Cover roll. I think its porous, so when I purse my lips, some air does flow out. Just received the knightsbridge strap and I might use it soon. Im also currently using a neck collar.

Regarding the fatigue, I'm not too sure if its sleepiness or fatigue but usually in the afternoon Im too drowsy to focus on work. I have done a basic blood test that has tested a few things (e.g. blood count, thyroid tsh/T4) and it came back normal.

Last night, I slept for 8 hours ish on EPR 3 with a low 1+ AHI and felt tired enough upon waking to sleep another 2+ hours w/o bipap. Still dont feel good..

Regarding my mouth leaks, I dont notice it all the time. Could it still be a problem even though the leak level in my oscar is relatively low?

Thank you!

*btw, I dont mind merging the thread with my older one, can I do it myself or does an admin have to do it?

[Dormeo]

No need to merge the threads.

As an experiment, try using two layers of tape. Your leak levels don't approach large-leak territory, but they're frequent and could be somewhat disruptive to sound sleep. That's why I think it's worth trying to resolve them -- to see whether that helps you get better rest.

I'm curious how you arrived at your settings, and I wonder whether you'd do better with a minimum EPAP higher than 4 (to address OAS) and a PS lower than 4.6 (to address CAs). It might be worth trying a minimum EPAP of 5 (as you did for at least one of the nights you posted) and PS of 4. What do you think?

I'm glad to hear you've had some basic blood tests. One other area to explore -- sleep "hygiene" (awful term). How many of these guidelines do you follow?

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
* Reduce your fluid intake before bedtime.

I was sure these didn't apply to me until, in desperation, I tried following them. Lo and behold they helped.

[skyuser37]

Hi Dormeo,

Thanks for your advice! I'll try taping with 2 tapes, but if that doesnt work, would using a full face mask be helpful? I was thinking of taping with a full face mask to make sure that any leaks through the tape still get "caught" by the full face mask.

Regarding my settings, they are quite random, just based on how I feel the next day. Recently I raised my minimum IPAP to 11-12ish and I find myself more awake, but strangely my brain still feels quite off - I blank out during the day quite a bit.

My sleep hygiene isnt that good, I use my phone near bedtime and I eat quite a bit at night too. Still working on these issues as they're kind of a habit for me now.

Thanks again for your advice!! much appreciated

[Dormeo]

Many people use full-face masks successfully, so you could try one. But we're on the trail of leaks only to rule out the possibility that they are disturbing your sleep. Otherwise your leak levels are well within the machine's ability to compensate.

Was it your minimum EPAP that you raised? (You typed "IPAP.") Did you leave the PS at 4.6? Could you post a chart showing the results?

In general, it's best not to make random changes based on one night's experience. If your current settings are yielding good results as measure by AHI, and are comfortable, stick with them for at least a week. Make changes after that only if you have a specific reason to try an adjustment.

It's good your working on the phone and food issues.

[SarcasticDave94]

Something that might help out, comparing these 2 sets of charts, higher PS seems to increase your Central Apnea/CA. With PS 6 these CA were higher than PS 4.6. Is it possible you don't need PS even as high as 4.6?

[skyuser37]

Hi all, thank you for your replies again, been busy the last few days so havn't had time to reply.

@Dormeo, yup sorry i meant that i raised my epap. I have recently tried switching to a full face mask, and attached my OSCAR screenshot below. I noticed that even with my P10, i was breathing through my mouth through 2 layers of mouth tape, so I decided to give my FFM a try. I feel slightly better(not sure if im imagining it?) although i did fight with leaks with my FFM all night long.

@Dave, yup that is possible, might try to lower my PS if this trend continues.

Will update again soon after trying the new settings!

[Sleeprider]

Skyuser, I see you are using 8.0 to 16.0 pressure with PS 4.0. I'd like you to go into the settings and set the Trigger Sensitivity to high. Try that without other changes and post again.