Flow limit. and UARS ? Help needed

[weuw]

Hello there

A few weeks I wrote a post about tinnitus problems.
I met a Doctor whom gave me treatment (nose washing) which improved my ears.

But I still have a problem with my CPAP setting I think. Sometimes I wake up exhausted despite CPAP use and good AHI numbers it seems.

This is a screen shot of Oscar with a lot of flow limit two days ago. (with EPR 1 on my Resmed machine) :
   

I 've red on internet that flow limit. can be the consequence of Upper airway resistance syndrome.
And that is more difficult to find good setting on CPAP machine. One thing to try is to set EPR at 3.
I tried it last two nights and I feel better. Here's a screenshot of Oscar for last night :
   

As you can see flow limit. are less.

What do you think I could do to improve my treatment, modify some setting or keep it like it is now ?

Regards
Serge

[Ratchick]

Glad to hear you got your ear issues sorted out!

I'm not sure what to suggest regarding treatment at this stage. The problem is that your apneas now are all central, and I'm not sure if that's what's making you feel worse, or the flow limits (or both). The trouble is, the treatment to help flow limits can worsen centrals and vice versa. I think it would be good to give it a few more days with these settings, for now, to see if you feel better after some good nights of sleep, and what happens with your centrals and flow limits (especially as centrals can be tricksy, inconsistent things).

[Dormeo]

I agree with Ratchick -- stick with these current settings for a while to see how it goes.

You may be close to your "apneic threshold," which means that just a little deeper breathing can wash out enough CO2 to mess with your "breath now" neurochemical signaling. The body can adjust over time if that's what's going on.

It may also be that the CAs represent "sleep-wake junk," which is to say partial arousals during which your breathing is less regular than sleep breathing and includes some 10+-second pauses. If that's part of what's going on, as you have fewer mini-arousals, the CA flags will drop in number. The real benefit here would be from not having mini-arousals in the first place.

[weuw]

Thanks for your advice...

I think my problem is a mix between depression and apnea + insomnia, it is vicious circle. 
I take benzodiazepines and antidepressants which may affect my CPAP treatment.

Regardless these problems, if I understand your comments on my charts, numbers are rather good, and it may be difficult to improve them ?

What do you think of continuous pressure I used, versus automatic pressure ?
What is the most important : less CA ou less flow limit ?
Do you think a collar may be useful ?

I am looking for what is causing arousals at me (preventing deep sleep), but maybe I make a mistake and I feel often exhausted at wake up because of depression and not CPAP settings.

Not easy to understand...

[Dormeo]

Yes, these things can be very hard to sort out. Is the doctor who prescribes the benzodiazepines and antidepressants aware of your sleep problems, CPAP treatment, and continuing daytime exhaustion? Some adjustments to your medications might be in order, but only you and your doctor can figure that out.

Your numbers are decent. An AHI of under 2 is good; under 1 is excellent. Given the predominance of CAs for you, and the different ways they may be happening, your numbers are not very useful as a way to gauge how you're doing.

I see no reason for you to try a collar. You are not having clustered obstructive events, clustered flow limitations, or serious mouth leaks, as far as I can see.

Some people have ferocious flow limitations and aren't in the least bothered by them. Others find that FLs keep them from sleeping soundly or deeply. And the CAs may or may not indicate a lot of arousals. So there's no clear-cut, general answer to the question which is more important.

I use a fixed pressure too, because pressure changes would wake me up. If you set a range with a higher maximum, you'd probably find that your pressure would go up and down in response to your FLs. ResMed machines do that; it's build into their algorithm, though I don't myself ever see clear evidence that this actually helps to reduce FLs.

I well understand the desire to make frequent changes -- I would always think maybe a great night's sleep was just one tweak away. But often patient experimentation, with multiple days at each new setting, will have the better results. So give your current settings some more time. If nothing changes, we can consider some new experiments.

[weuw]

Mille merci to take up so much time with my questions, your answers are very useful for me. And yes my doctor knows I have apnea and exhaustions. She increased treatments yesterday.

[Gideon]

Hans Christian Andersen wrote a story about sleep disturbances, he called it "The Princess and the Pea".
little things can matter.

[redvinesfamily]

Hans Christian Andersen wrote a story about sleep disturbances, he called it "The Princess and the Pea".
little things can matter.

And there's yet another lightbulb moment for me. Since I was tiny, I have thought about and talked about that story and related to that character. 

Weuw, I hope you can find some relief. I am not experienced enough to offer advice, but I can tell you about my recent experience. I was waking up exhausted every day as well, for a very, very long time. I did try the CPAP for a short time and then decided to try a BiPAP. Having increased pressure support did help lower the flow limited breathing. With some help on the settings I was given here, I am now waking up feeling good. I am not suggesting that is the answer for you, but I wanted to encourage you to keep trying and provide some support. 

[weuw]

Hello there,

My mood is improving with more antidepressants last days.

But about my cpap settings, I am not sure to have made right choices. I keep going on feeling very tired at wake up (it improves during the day).

I've exported in CSV format all my Oscar datas for the last months, for the purpose to find which numbers are the best. 
What do you think of simply finding which settings gave me the less numbers of apnea ?

For example I found that these 2 nights were amongst the best :

Here a snapshot of April 24 (Apap 7.6-11.8 EPR 1) 
   

Or 

Here a snapshot of Mars 26 (CPAP 10 EPR 1) 
   

What do you think between both ?

Maybe my approach is simplist but I so much want to feel better... 


Regards
Serge