Hank68 Treatment Thread - Seeking Help and Support Please!

[Hank68]

   

Hello Apneaboard members,

This is my second post here, after doing my best to sort out OSCAR data and CPAP settings. I love how kind and helpful everyone is on here. Thanks for that.

I have been trying CPAP on and of for many years now, and I cannot get comfortable, nor do I feel rested after CPAP use. I had an oral device that worked well for 3 years, but now it doesn't alleviate my symptoms anymore, in spite of showing an AHI of 4 when used.

Below I have included an OSCAR chart and my two sleep studies, 2022 (untreated) and 2023 (treated with oral appliance. I am not sure if I am doing this right, as it's my first attempt. I recognize that I have other sleep issues (PLMD), but I really feel like its my breathing that's creating fatigue, brain fog, headaches, sore throat, and a feeling of suffocating when I wake up. I should also mention that I have mild COPD but am relatively healthy and active. 

Can anyone help me or advise me on ways to improve my CPAP treatment? I am happy to share more or different information as needed, and please let me know how to best get help from ya all.

Thank you kindly,

Hank68

[Hank68]

        Hello,[attachment=57520]        

Hello,

After managing 2 hours on CPAP last night, I am posting my OSCAR chart and some zoomed in graphs, in hopes someone will comment with advice or support. I feel like its the out breath that's really hard for me, and no matter what settings I try, I just can't seem to make CPAP work for me. Could it be my COPD that makes breathing out harder? Any comments or insights would be greatly appreciated !

Thanks,


Henrik

[Hank68]

   

Here is my OSCAR chart from last night, without Zoom.

[Nightynite]

Need an expert to help Hank ! Bump

[gainerfull]

Hi Hank,

Welcome to the board! Have you ever tracked your blood oxygen while on cpap? What about sleep stage / quality via apple watch?

Are you sleeping in an elevated position given your COPD? Are you still taking the 3 medicines mentioned in your latest sleep report?

[Gideon]

welcome

On the surface you look good. Digging maybe a different story. PLM, what are you doing about it? You are having a PLM event nearly every 31 seconds, PLM's are arousing you every 6-7 minutes. Total arousals are every 2 minutes. These reduced somewhat with the appliance.
Make your zoomed views 3-minutes, 48 seconds is a bit short, and shift to the advanced view so we can see what your Tidal Volume and Minute vent are doing. View->Reset Draphs->Advanced That should let us see if the COPD is impacting you (I think it is as I see somewhat shallower breathing deeper into your night)

Im thinking a BiLevel may be in order for you.

[Hank68]

Hello, and thanks for responding to my post,

Nightynight, thanks for bumping my post!


Gideon, thanks for your reply. PLM I have tried pregabalin but currently taking 0.5 clonazepam, which seems to help keep me sleeping through PLM. With my alliance, it says my arousals are in the "normal" range, so I am hoping hats ok? Do you have any other advice for the PLM? It seems to that the options are mostly pharmaceuticals treating the symptoms? I am trying to stay away from the dopamine parkinsons meds. 

I am away for Christmas right now, so when I get home I will post a few 3 minute advanced views of OSCAR, as per your suggestions. I will get on that before New Years, when I get home and I look forward to getting more feedback then. 

gainerfull - Thanks for your response. Yes, my 02 during sleep is reasonable with an average of 94-95% and no significant desaturations when treated with oral appliance. I use a well ring and I get a few 3% or less desaturations, but my sleep doctor says that my 02 is ok and should not be an issue. I am not sleeping in an elevated position. Does this help for COPD?

My partner tells me that my breathing is very laboured at night, like I am breathing through a straw and it's taking lots of effort, but there are very little direct apneas or hypopneas present. In my sleep studies it states that I get no N3 sleep but I get adequate amounts of rem etc. I really suspect I'm dealing with the effects of COPD, some UARS, and often I have mild chronic congestion of my sinuses, making it harder to breathe. 

My Doc prescribed BiPap and a new oral alliance to see if that will help. I appreciate all your feedback and I look forward to engaging more, closer to new years!

Happy Holidays,

Henk68

[Gideon]

You describe your breathing as breathing through a straw. A BiLevel (A BiPap is a registered TM of Philips, IMHO do not get one of those) will provide a higher differential/PS and should improve your ventilation. The question becomes which one.

If your volumes are not diminishing thru the night a VAuto should be fine. Otherwise you would need one that stabilizes your volume such as IVAPS mode of the ST-A.

[Sleeprider]

The Resmed Aircurve 10 Vauto with more pressure support would solve the flow limitation that is the source of your problem with "breathing through a straw". As an immediate solution, raising minimum pressure to 8.0 may provide some relief. With EPR at 3 your exhale pressure drops to 4.0 cm with minimum pressure 7.0 and that is probably too low.

[Hank68]

Hey, thanks for the advice and insights.



Sleeprider - I will try raising my min pressure to 8 with EPR 3.

Gideon, just to clarify. I am not sure what this means - "If your volumes are not diminishing thru the night a VAuto should be fine. Otherwise you would need one that stabilizes your volume such as IVAPS mode of the ST-A."

Do you mean my O2 saturations when you say volumes?

And is there more than one type of resmed bi level machine? 

I will be trialing a bilevel soon and I don't know anything about them. Should I ask for a Resmed Aircurve 10 Vauto ?

Sorry, I am totally new to bi-level machines. If it helps, I can post more specific advanced and zoomed OSCAR data once I get back home from my Christmas trip? Either way, I just want to figure this out so that I can get a good nights sleep soon.


Please explain more is possible, as I am still learning.

Thanks!