Help….starting to feel tired again

[Internetstranger]

I was doing great from day 1 although you guys helped especially in the early days tweaking settings.  Titration in December recommended fixed pressure of 12 and it’s been going well.  Recently I’ve started to feel tired and not waking up rested. I haven’t changed any settings and the daily reports on Oscar all look pretty similar. AHI is around 3 (sleep study in November was 53.3).  My Garmin watch has a body battery thing and reflects my feelings of not being adequately recharged at night.

It could be simply that I’m not getting enough exercise during the day as I tore my calf muscle a couple of months ago and, although I’m no longer using a cane, I’m still having some trouble walking any distance.

Is it worth switching back to apap with 12 as minimum?  I’m comfortable so not struggling breathing out or anything like that just not feeling well rested anymore.

[PeaceLoveAndPizza]

I suggest using the machine to titrate your pressure to find out what works best. Once that is done you can decide on whether to go back to a fixed pressure or not.

Try the following:

Mode APAP
Min pressure 8
Max pressure 15
EPR 3 full-time
No ramp

After a few nights we should have a good idea of whether it is working for you or not. It will also tell us what a good 95% is which may be used for fixed pressure. Or you can just reduce the pressure range to be close to a fixed pressure but with a bit of room for handling apnoea’s.

[Internetstranger]

I should be better educated on this but I’m not so I’m going to ask because I’d like to understand the why

Why put the minimum down? I’ve never had an average pressure that low.

My understanding is that EPR is a comfort feature, I’m not feeling uncomfortable at all why put it on?

[PeaceLoveAndPizza]

You needed a higher fixed pressure due to your flow limitations in order to get a decent AHI. If we use EPR to manage the FL’s, then you can use a lower, and hopefully more comfortable, pressure. They likely only looked at your AHI, not the rest of the data.

Fixed pressure is fine, I use it myself. You do have to know what the proper pressure range is for you, which we learn by letting the machine titrate to find the best min-max-EPR settings.

[Internetstranger]

I’m pretty sure the main focus of the titration in December was my oxygen levels because prior to treatment they were pretty bad. Doc wanted to ensure that pap was fixing that.

I’m still much better than before treatment but now I know how good I can feel I’m not satisfied with just ok, I want good.

I’ll give it a whirl and see how it goes, I will admit to struggling with understanding the flow limitation stuff but can’t hurt to try it for a bit

[PeaceLoveAndPizza]

Here are a few good wiki page on FL’s. 

https://www.apneaboard.com/wiki/index.ph...limitation

https://www.apneaboard.com/wiki/index.ph...imitations

[Internetstranger]

I tried your suggestion but wasn’t coping with a minimum of 8 so bumped it up to 11, I felt starved of air on 8. 
I do think I’m not as tired (there are of course always other factors at play)

I’ve got the last 3 nights, flow rate does seem improved. There were a couple of centrals last night which is pretty unusual for me

 Thanks for help

[PeaceLoveAndPizza]

The lower pressure feeling strange is understandable. No issues with bumping it up as the exercise was to see how you did with the flow limitations with EPR. You still have quite a bit of FL’s going on, but there is not much we can do with your current machine beyond trying different pressure.

The CA’s are from the use of EPR. You can either drop it back to EPR=2 or keep using it and see if they reduce or go away. You may need more pressure support which would require using a bilevel, but for now keep cracking on with what you have and let’s see where it leads.

Your OA and H events while not typical positional apnoea, do have some elements of PA in a few spots as they are clustered. For now try a flatter pillow, but it may be worthwhile trying a soft cervical collar to see if it reduces them.

Also, try modifying the pressure range from 11-15 to 12-16. FL’s are causing the pressure to rise, which hit the limit of 15, so adding a bit more should help.

[Internetstranger]

I do go to sleep on my side and wake often on my back. I’m aware of waking to move so positional issues are involved however the cervical collar doesn’t appear to be an option I can explore currently short of pulling out the sewing machine as I’ve yet to find one that will fit (it’s been recommended here before).

CAs have only been one night so will just keep an eye for now and see what happens

Thanks again

[PeaceLoveAndPizza]

Do you have any issues with nasal congestion? If so have you tried an OTC nasal spray like Flonase or other fluticasone propionate spray? Even a neti pot or other nasal rinse can help. 

I have attached a chart showing proper measuring for a soft cervical collar. It may help.