Help! 40 days CPAP no symptom relief. What's wrong?

[cpapmj]

Hi Apnea Board community, 

I've been suffering from symptoms of sleep apnea for the last ~10 years. Symptoms are the typical ones: fatigue, sleepiness, depression, poor memory, attention, etc. 

I got diagnosed with sleep apnea 1 year ago with an AHI of 22 and RDI of 30. I've been using CPAP on and off, with no symptom relief. I've just started looking at my Oscar data, and I'd love some help figuring out what could be causing my lack of progress. I've attached the following Oscar data: one representative daily view, summary stats for 30 days, and a graph of my typical flow pattern.

Open to any and all suggestions! Thanks a ton :-) 

Extra context: 
- Sleep surgeon thinks apneas are mostly caused by my tongue (small jaw/mouth). 
- Have nasal congestion problems when sleeping (100% blockage in one nostril, 10-75% in other) 
- I move around a lot in my sleep (due to chronic muscle pain from another disease) 
- I use a medium thickness pillow 
- I use mouth tape, but no chin strip

               

[Deborah K.]

I can make two suggestions that should help you feel better.

1.  Turn off ramp.  You are getting no real therapy while on ramp.

2.   Set EPR to full-time at 3.

You have some leaks but I don't know how to determine whether they are from your mask or your tape.  I'm guessing they are from your mask unless you use one-inch tape instead of two-inch, or are not using a long enough piece.

Good luck!

[Expat31]

I would like just to add a few extra points:-

It appears that your leaks could be actually mouth leaks. As you are using tape, make sure corners are well covered. Maybe fold your inner lip under the top lip before afixing tape. This should stop the pressure from prising them apart and alllowing air to escape. 

I am curious why you are on a fixed pressure of 10? Could be overkill as your events seem to be well controlled. Something indicated  by your doctor, or your sleep report? 

It could be interesting if you tried settings of a minimum of 8, maximum of 10, to see if you get better quality of sleep and continue at tbesame timd to have good control over events. 

These settings can only be established by trial and error and may take some weeks to get right. . 

The central apneas should reduce from Deborah 's suggestion of EPR at 3, accompanied with greater therapy comfort.

A note on a simpler graph presentation.

For future postings, all we really need are the following graphs:-

1. Events
   
2. Flow rate
   
3. Pressure
   
4. Leak rate
   
5. Flow limitations
   

Also please eliminate the calendar for better visibility. 

For detailed graph organising, please see here.