Low API But lots of arousals? Still Exhausted, OSCAR Help

[JadeThreads]

So I have noticed that even when I have a night with very low API, it still looks like I am waking up a few times an hour. I have been using CPAP for 14 days. While I am not waking up with headaches anymore, I am waking up with huge bags under my eyes, feeling like death most mornings. I am getting 100% on MyAir most days now- I have made adjustments to the machine based on previous advice here (turning min pressure to 8, turning off the ramp, turning EPR to 3 full time).

I have also noticed, I don't think I dream while wearing CPAP, the only times I remember dreaming since getting it is the two times I have woken up, taken the mask off and fallen back asleep without realising. My mood has also tanked, I am anxious, low etc. I am starting to worry I am not hitting REM sleep with it on for some reason. 

I can see my flow limit isn't great, I tried a Soft Cervical collar and this went great the first night, then the next two nights my flow limit was worse and apneas up so I stopped using it. Never figured out why it worked so well once then throttled me the two nights after! 

Screenshots are an example of what I mean- low API, still waking up a bunch. Close-up of a cluster in case that helps. 

       

[G. Szabo]

Your inhalation peaks are plateaued, indicating that your inhalation pressure support is not enough. Interestingly, your "for her" algorithm responds way too slowly to flow limitations with pressure increase compared to the NOT "for her" system. Therefore, I suggest increasing the minimum pressure to 11 cm.

BTW, If you have some previous suggestions, it is better to continue that thread.

[dwedward]

I had a similar situation with low AHI, but high levels of flow limitations, and the feeling that I didn't sleep well. e.g. fatigued the next day, etc...

I finally correlated the flow limitations to wakenings during the night by using the Apple Watch and SleepHQ software.  Further, I had identified that the FLs were causing my O2 levels to drop to low 90s/high 80s, and I had limited amounts of Deep Sleep.

Through combinations of cervical collar, new pillows to adjust my head and airway were aligned, increased pressures to keep the FLs down and airways open, I managed to increase my deep sleep to more than an hour every day, and more than 2 hours of REM.  Ultimately though I had to move to a bi-pap to get the higher pressures, and more importantly the higher pressure support.

Some of my issues were upper airway restrictions (e.g. deviated sceptum and turbinates), and I plan to have those reduced through septoplasty in the hopes that I can return to lower pressures and very few FLs.

I'm not a charts expert, but looking at yours, I would suggest that the FLs are causing wakenings that are impacting your sleep.  Start the investigation with cervical collar and pillows, but you may want to see a pulmonologist or ENT to make sure that there aren't mechanical issues preventing your sleep.  But you can start by looking at your pillows.  Correct alignment of the head is important to make sure your airways are open.  Cervical collars help, but if your head is not aligned the cervical collar won't fix that.  Just makes it easier to keep everything in place... that may be why you had one good night, but then two bad nights with your collar...

[PeaceLoveAndPizza]

You have significant flow limitations going on that need some method of remediation. Our typical steps would be to increase EPR (you are already at 3 which is max for your machine), soft cervical collars (which you tried and gave up on), flatter pillows, nasal rinse/sprays, different masks, and eventually a switch to a bilevel which can provide more pressure support.

Have you seen an ENT or other doc to investigate the flow limitations? Could be something going on so worth getting it looked at. 

Go back to the soft cervical collar and give it another go. If it helped one night something changed that was not the collar. You need to try and figure that out.

This is not something we can fix with pressures, but we can try to make it more comfortable.

Try this:

Min pressure 12
Max pressure 15
EPR 3 full-time

We can limit the pressure rise and see if that makes a difference in comfort and sleep quality. We can even try a fixed pressure to remove the swings and focus on comfort.

Bottom line is if you cannot resolve the flow limitations you either have to live with them or get a bilevel. A good discussion to have with your sleep doc or to buy a used one out of pocket if you can. Keep in mind you have likely been flow limited for a long time, so it will take some time to figure out.

[JadeThreads]

Thanks all. I am DIYing because the waiting list for sleep clinic is endless and last time I had a sleep study I hardly slept and the result was that I don't have apnea.  I absolutely do- my partner has shown me videos, night after night. I know what it looks like, my Dad has it. Ultimately he needed surgical soft palate correction before CPAP worked for him so it's possible I do too- just trying to do the best I can helping myself until I can actually get the attention of a Dr (I am on the waiting list again). 

I use a flat cpap side sleeper pillow. I can try a different collar, see if that helps again and will try the setting adjustments suggested in this thread. 

Someone mentioned 'for her' is slow to respond, pretty sure I can switch to the normal autoset mode in the menu.

[Deborah K.]

Yes, you can switch it. I had that model and I switched off the for her part and it worked better for me.