Is it still working?

[Johnboy]

When i started my CPAP treatment over 2 years ago the immediate results were dramatic. That first thing in the morning feeling of exhaustion, that we are all aware of, left me and i did not need to nap during the day However, as time has gone by i think the effect is lessening and whilst i dont have the same feeling of morning exhaustion, i am finding that i am getting more tired during the day and will fal asleep any time i sit and relax (watching TV etc). What is others experieince of ongoing treament?

I haven't moved from Sleepyhead yet. But the daily machine readings are usually,

An AHI of less than 2
Mask Fit between 97 & 100%
90% pressure of around 16.5
Only occassional periodic breathing, and when it occurs, less than 3
Most nights at least 7 hrs of treatment.

Being in the UK dont have a sleep clinic/consultant to quickly liaise with and was diagnosed via oxymeter readings only.

Any thoughts appreciated

[Sleeprider]

I think it is important to realize that many of the symptoms of daytime fatigue may be external to cpap therapy. The real question is not, "Is it still working?", but can I make it better. The answer to that question requires that you share a bit more detail here. I wo uld suggest you update your Sleepyhead to OSCAR and consider posting a chart. Most of us do better than 2 AHI, and that gives us no insight into arousals which may be much more important to how your feel.

[Johnboy]

Sleeprider - thanks i will upgrade to OSCAR and post image.

[Johnboy]

    Hi I have now replaced sleepyhead with Oscar and attached the screenshot. This might need to be zoomed to make any sense and I can upload whatever you require. Appreciate any thoughts.

[Damiansd]

Hello Johnboy,

What mask do you have?

Regards,
Damian.

[Johnboy]

Amara View

[Sleeprider]

Now you know. It's not AHI, it RERA and flow limitation, and your Philips Dreamstation honestly sucks at dealing with it. If I could put you on a Resmed Airsense 10 Autoset, or even better, a Vauto, I could give you back that transformative experience you knew back when. It is pressure support that correct flow limitation, but with the Dreamstation Auto CPAP, your only tool is pressure. With your current machine, I would up CPAP minimum pressure to 15.0 or possibly 16. But I could reduce your pressure with a Resmed using EPR (exhale pressure relief) or pressure support (bilevel). There are often deals on used machines. Anyway, yoru RERA is nearly 3/hour and that is probably under-estimated.

If you want to open a dialog with your doctor, the discomfort and sense of fatigue on your CPAP are valid reasons to increase therapy to bilevel. The target device is a Resmed Aircurve 10 Vauto. If you want to go out of pocket, check out Craigslist, Offerup, Facebook Marketplace, Dotmed and others for good prices on used. For a lightly used Vauto with warranty at $719, or new at $799, Supplier #2. There is a reason I use the Vauto and will never look back at the Philips Auto CPAP.

[OpalRose]

Hi Johnboy,
If you can, turn off the VS2 flag in your event charts. These have never been determined to be actual snores, and really clutter up the graph. Leave the VS flag in though, as they are actual snores.

Your AHI is good, but you show a lot of RERA's and Flow Limitations, which aren't added to the AHI, but can play havoc on your sleep. You are probably experiencing many mini arousals that you wouldn't be aware of, but they manage to disrupt sleep. This could be one reason for daytime sleepiness.

You probably are having some leaking from you mask, but it doesn't appear to be affecting your machines ability to do its job.

You could try raising your minimum pressure a little at a time, and see if it helps with the RERA's and FL.

[Gideon]

Sorry, I'm late to the party.

My first impression is UARS or a lot of Flow Limits. There is no way to manage this with your current machine, you need, as stated above, a BiLevel such as ResMed VAuto

[Johnboy]

Guys - thanks for the response. Clearly i need a different machine but hold out little hope of getting that through the NHS without a detailed sleep study and that could take an eternity to organise.

I must admit that once the detail moves beyond AHIs i am totally lost - Flow limitaions and RERA's sound like a foreign language and i have no idea how to read or interpret the relevant graphs. Could you advise a good resource that i could learn from? I know that there might be loads of info embedded info within posts regarding this but it would be helpful to be able to read an authoritive book etc.

Again many thanks and when i get a new machine i look forward to assistance setting it up.