Months of CPAP use and feeling more fatigued

[senseisaitama]

Hey all! I've been using my CPAP for over 8 months now and I've gotten quite used to using it daily.

For context, I have this separate sleep disorder called Idiopathic Hypersomnia for which I'm taking this FDA-approved medication called Xywav. Xywav has not provided me with any symptom relief at all, which is extremely rare when you read about other people's experiences.

I'm suspecting that maybe my CPAP is still causing me to wake up throughout the night and I want to see if there's anything I can improve. My AHI looks fine, but I noticed that I'm still leaking considerably.

Thanks for your help!


   
   
   

[staceyburke]

One the top set of charts you had some positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…   Because this was not shown on the other nights, it is something to keep track of and make changes when you see it.

On all nights you had mostly centrals.  Did you have centrals in your sleep study?  If you did then you may need a different type of pap machine to fix them but if you did not have many then they are what we call treatment emergent central apnea.  If they are treatment emergent your body will adjust to the therapy and they will lessen as it the body gets use to the therapy.

In some people EPR can increase your centrals.  I would turn off the EPR and see how your centrals are effected.  If they are helped when you stop EPR then we would try to get your body adjusted with 0 EPR and as you get adjusted raise the EPR to 1 and adjust to that setting, then set to 2 and adjust, then 3 and let the body adjust.

So to sum it up turn off EPR and let's see if it helps.

[senseisaitama]

One the top set of charts you had some positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…   Because this was not shown on the other nights, it is something to keep track of and make changes when you see it.

On all nights you had mostly centrals.  Did you have centrals in your sleep study?  If you did then you may need a different type of pap machine to fix them but if you did not have many then they are what we call treatment emergent central apnea.  If they are treatment emergent your body will adjust to the therapy and they will lessen as it the body gets use to the therapy.

In some people EPR can increase your centrals.  I would turn off the EPR and see how your centrals are effected.  If they are helped when you stop EPR then we would try to get your body adjusted with 0 EPR and as you get adjusted raise the EPR to 1 and adjust to that setting, then set to 2 and adjust, then 3 and let the body adjust.

So to sum it up turn off EPR and let's see if it helps.

Hey, thanks for your response!

Regarding the positional apnea, I haven't changed my sleeping position (at least to my knowledge). I always sleep on my back with ~2 pillows. Is it better to sleep on 1 pillow then, to make it less likely that my chin will block my airway? What are other ways I can solve positional apnea?

If I'm reading my sleep study correctly, had 3 central apneas, 10 seconds each during my sleep study where I had a sleep period time of 432.9 minutes. Is that enough to warrant a different type of PAP machine? I will say that Xywav (the med I'm taking) is known to exacerbate or potentially cause Central Sleep Apnea because it is a central nervous system depressant.

Alright, I'll turn off my EPR! How do I know if I'm adjusted at 0 EPR (1, 2, and 3) - is it a length of time or are there indicators I can take a look at?

Lastly, in turning off my EPR, do I need to adjust my pressure? Thanks again for your help!

Honestly a bit confused on what to do because someone recommended lowering pressure in increments of 0.6 cm before turning EPR for the same exact reason you mentioned (majority central apneas). Someone else recommended increasing the pressure to 10.6.

   

[staceyburke]

The first night you had at least 23 Centrals.  2nd Night 24 centrals, and the 3rd night 10 centrals.  All of them are 10 seconds or longer – that is the min about of time for them to be counted.  So right now they are a problem but your sleep study shows that they are treatment emergent.  Your body needs to adjust to the cpap therapy and you do not need another machine.
It may take several days to a couple weeks and you can turn the EPR on 1.  Then a couple more weeks to adjust to level 2 and so on.  Turning off the EPR will make it a little harder to breath out.  I would try it before bed so you can see if it bothers you.  If so you can lower the min and max setting but try it first before decreasing your settings.
As I said, you only had positional apnea one night.  You can try one pillow.  Back sleeping causes positional apnea by dropping your chin to your sternum.

[SarcasticDave94]

Your study also has 11 mixed Apnea, which I'd call partial Central. Taken with no Obstructive Apnea, maybe they should try treating these at minimum with the VAuto and High Trigger. Or ask for a Titration including ASV mode to see if the Centrals and Mixed will respond to treatment.