Need Advice Tired

[southerntoon]

Hello

45 year old male. Obese in weight. Diagnosed with sleep apnea about 2 years ago. Before that I was tired all the time and nodding off through out the day during routine activities. After I started cpap Everything was going great for awhile. However in the past six months I go through times of just feeling exhausted and wiped. Still better overall then I was before I started using a cpap but a different kind of tired... My machine software says everything is great but I have been told that I have been tossing and turning a lot and snoring some. I use nasal pillows and have noticed that my mouth is real dry. So I have been using a chin strap and it has helped some but still probably an issue.

So my symptoms are low energy.. just feel wiped and also low libido.

Using a Phillips Respironics Dreamstation with attached humidifier and nasal pillows. My machine is set to start at 10 and go up to 20. My average range according to the monitoring software is 11-16.

Any advice and or thoughts would be greatly appreciated.

[Gideon]

Welcome to the Apnea Board.  

The first step is to see what is really going on.
Download OSCAR
Make sure you have an unlocked SD card in your Dreamst6ation Auto to collect detailed data
Organize the OSCAR charts per the Organize link in my signature.  This exposes the important data, If we need more we will ask.
Post the nightly (daily charts) here and we will see what is going on.

If you have copies of your sleep studies redact your personal data and post them as well, we like the full copies as the summaries often leave out important info.

You are Mouth Breathing which is not helping your therapy From the Mask Primer http://www.apneaboard.com/wiki/index.php/Mask_Primer
Mouth Breathing
Mouth Breathing is when you open your mouth and the air pressure from your PAP is venting out your mouth typically showing on your charts as a large leak which can substantially negate the effectiveness of your therapy. It is generally not good. The solution varies depending on the person
With OSCAR look at your Leak Rate graph where it is shaded (large leak/ LL), flat tops on this graph suggest mouth breathing. In OSCAR right click on the left header of the Leak Rate graph and click on Dotted Lines then select "Leak Rate Upper Threshold" to get a line across the graph for ResMed. Manually set the value for Philips Respironics. Severity depends on how much over this threshold and for how long it is in the Large Leak territory.
How to manage Mouth Breathing, not in any particular order.
Tongue Trick. Place the tongue on the roof of the mouth, Practice during the daytime. The idea is to train the tongue that this is a good place to be, does not happen overnight, but it works for some. The tongue trick is where you want to be but it takes a lot of time and some people just cannot get it. Place the tongue on the roof of your mouth and breathe with your mouth shut. Breathing thru your nose, right? Now leaving the tongue where it is open your mouth, you should still be breathing thru your nose. Now that you have that down move your tongue, breathing thru your mouth right? OK, put your mask on, under pressure, and repeat the above. Expect to need to turn your machine off when you start to repeat. Add talking while under pressure, It takes a while to get any of this down. It took me months. The exercises above are to help you understand the positions that cause the issue and how to correct it. For all this to become automatic will take a while.
Cervical Collar. A "soft" Cervical Collar (Releaf is popular). This helps support and align the neck and keeps the jaw/mouth from dropping. This is becoming a very popular option. Rarely used prior to mid 2016. Users are posting a high success rate with this device. When OA tends to occur in clusters at different times of night. It's an indication that an obstruction may have occurred when the chin tucks towards the chest. It's common, and the solution is either an ergonomic pillow or soft cervical collar that prevents the neck and head from being out of alignment and cutting off the airway, but they can be comfortable, prevent leaks and prevent an airway from closing up due to tucking your chin to chest and other issues. An Anti-Snoring collar or Sleep Collar, which has a small strap in back also works. (Dr. Dakota is popular)
It's a very small investment that has worked very well for some people. More pressure may solve the obstruction, or it might go away with positional therapy.
Chin Strap. A chin strap is to manage mouth leaks from a variety of causes. Most result from the jaw-dropping or opening either partially or wider. The chin strap is to gently keep the jaw closed. If you have to crank it shut to make it work this is not the correct solution. Note that your jaw is strong enough to open if it wants to. There is one chinstrap that is notably different than others, Knightsbridge Dual Chin Strap which pulls up instead of back. Search for it if you desire.
Ergonomic Pillow or CPAP Pillow, The purpose is to maintain a proper head and neck alignment while allowing for the mask maintaining the seal in multiple positions.
Mouth Guard The concept here is a closed mouth guard to keep the air from leaking out.
Taping. Definitely the most controversial. The purpose of taping is to seal the lips and prevent mouth leaks/mouth breathing. It is not to stop the mouth from opening. I make sure that I can easily open my mouth when taped, if I need to.
FFM – Full Face Mask or Hybrid Mask. This is a very traditional solution and it is generally effective.
Dry mouth is a symptom mouth breathing that is uncomfortable. It can and does occur with some users of a Full Face Mask.

• Many users use a product called Biotene to get relief from this symptom.
  

[DeepBreathing]

G'day southerntoon. Welcome to Apnea Board.

First, we should recognise that all fatigue or tiredness is not necessarily apnea related. There may be an underlying disease (eg thyroid insufficiency), vitamin deficiency, environmental factors preventing a sound sleep (noise, light pollution, room too hot or too cold, lumpy mattress, etc etc). So we need to think about eliminating as many of those issues as we can. This might entail a trip to the GP and organise some broad blood tests for all the normal suspects.

In relation to apnea, the commonly used apnea-hypopnea index (AHI) is a very crude tool to measure the effectiveness of your sleep. It happens to be easily understood and measurable so that docs and insurance companies don't have to think too much. However there may be all sorts of things happening which do not directly affect the AHI but which can cause poor sleep.

Can I suggest you get hold of OSCAR software, download the data from the machine and let us have some screenshots of the daily chart. That will let us identify any breathing problems which are disturbing your sleep.

• Get Oscar here: https://www.sleepfiles.com/OSCAR/
  
• Format your chart according to these instructions (this is important): http://www.apneaboard.com/wiki/index.php...ganization
  

Let's see the charts and then we can proceed from a basis of evidence. Good luck, and again Welcome.

Edit: Looks like Bonjour posted while I was typing. He has provided some excellent information.

[3rdMarDiv]

I went through the same dilemma. Getting used to CPAP is the first hurdle and learning how to obtain a good nights sleep while on CPAP is the next. I poured myself into learning as much about obtaining quality sleep as possible. There is a lot of great information on this site as well as on the Internet. If you are feeling groggy then you are likely not be getting enough deep sleep. I was not getting much at all and learned that much of my problem was due to sleep preparations and sleep conditions.

Do you check your SPO2 levels? If not then pick up a Pulse-Oximeter (under 20 dollars), such as a "ZacUrate" and check it.

Listen to the advice the experts offer here. They know what they doing and really improved my (and many others) quality of life.

Peruse this site as well as google "good sleeping habits" or "How to sleep better".

Start developing a ridged sleep routine and environment and you will improve your sleep in general, no matter what other circumstances exist.

[southerntoon]

Thank you! Hopefully I have gotten the correct information for review

[southerntoon]

Attached the charts has thumbnails above