Newbie Struggling with Exhaustion

[hookedonstitch]

Hi Everyone

I've been struggling along though my first month of CPAP, adjusting pressures, blocked sinuses, mask leaks, wrong frame sizes etc.  The past 3 nights have been the best in terms of feeling (actually sleeping) more comfortable with the machine/mask/air but I have honestly never felt so awful in my entire life!

I am waking up exhausted, I have a headache all day that gets worse as the day goes on and I have been having really vivid dreams.  

The Dr. has prescribed a pressure of 7.0 and I have the EPR set to 2, ramp is now turned off.  I was initially prescribed APAP pressure of 6-12 but I think that was more to see what my average pressure was.  My OSCAR results look OK to my untrained eye so I'm wondering if anyone can see something that I don't which might explain why I feel like a member of The Walking Dead.

Last night towards early morning I decided to see what it would feel like if I turned up the pressure to 7.6 to see if I noticed a difference.  

[staceyburke]

I think your main problem are your flow limits. Flow limits ARE apnea they are smaller (see the bottom of the post for they classify apnea). But although being smaller you have a lot of them and they will disrupt sleep.

We use EPR (exhale pressure relief) to treat flow limits. Settings on your machine can be 1, 2 or 3. I cannot see what of if you are using EPR. BUT to use it you have to set your min so there is room to use EPR. 

Your machine can go NO lower than 4.  So set your min to 7 and EPR TO 3.  That will greatly help your flow limits and you should have a much more restful night

[hookedonstitch]

Thanks staceyburke for offering some input.  I initially had my EPR set to 3 and then someone mentioned to change it down to 2, I don't notice a difference while using the machine and how tired I am feeling during the day.

I will try it at 3 again tonight.  Does this mean I have UARS?  Looking back I've probably had OSA for years before getting a diagnosis.

Will this correct itself with time?  Or does this mean that CPAP therapy isn't going to help me?  I'm feeling so down and confused.

[staceyburke]

Using Cpap is not like turning on a switch - it takes a while for you to recover of maybe many years you had apnea and did not know it. It’s more like one day you well say to yourself I’m feeling better an you will continue to improve. 

Remember your min has to be set to 7 (min 7 - EPR 3). Your min was at 5 and that would just 1 cm of pressure of change.

[Sleeprider]

I think the suggestion for EPR at 3 is a good one, but I also want to see pressure put to Autoset for her or Autoset mode, and allowed to have a maximum pressure of 10.0. Your events are obstructive and 7.0 may be producing a good AHI, but it's not solving your fatigue from arousal that arises from the flow limitation. You need higher maximum pressure. We will be able to see your response to higher pressure as the need arises, and make a better judgement on a range. A fixed pressure of 7.0 is all fine and well if it works, or if you're not using it when it doesn't. I have no doubts you will feel a positive difference. In support of your doctor's prescription, my suggested change gives you a maximum pressure of 10/7 (inhale/exhale). That is perfectly consistent with the fixed CPAP pressure you have been prescribed, because it is the exhale pressure that holds the airway patent against obstructive events.

[hookedonstitch]

Hi Sleeprider

I'm not sure why my pressure is being shown on Oscar as 5 to 9.4 but I am on a constant pressure of 7.0 because I would find that I would be waking up numerous times per night to fluctuations in my pressure from the autoset settings.  I found that everytime I woke up my pressure was always quite high.  Not sure if it was an event that led to waking me up or the pressure going up that would wake me up but it was awful.  I find that on a constant pressure I am not waking up as much (that I know about).

I'm a little confused over the settings you are suggesting for me to trial.  Are you suggesting I go back to try the autoset for her and set minimum pressure to 7 and maximum pressure to 10 with an EPR of 3?

I'm so tired I'm willing to try anything at this point in time.

---

I understand it's going to take time to see changes but I wasn't expecting to feel so much worse first.  I'm already struggling with anxiety and depression as it is but having to feel like a zombie every day is just making things feel worse.  I'm frustrated and confused.

[mesenteria]

Your machine's response to flow limitations is to raise pressure...well...flow really.  So, if you are awakened during rises in pressure, it is probably due to leakage or to some other response to the raised pressure.  Your machine needs to be afforded the range it will take to treat you, but also one that doesn't have you startled out of sleep repeatedly as your machine adjusts upward.  Sleeprider is asking you to raise your maximum pressure setting so that you get the full comfort of the just-suggested 3 cm range of EPR.  This range seems to be indicated for your comfort, but it can't drop more than what the minimum pressure setting is.  So, if you have 7 as your agreed-to minimum, you'll need a maximum of at least 10 cm if you also want the pressure to back off during exhalation by 3 full cm.  You could go higher for the max pressure, all the way up to whatever seems right, right up to 20 cm for most machines.  But it needs at least 3 cm of 'head room' above your minimum setting.

[hookedonstitch]

I think I understand a bit more now.  Since I have a minimum pressure of 7 and an EPR of 3, then the maximum should be set to 10 which would allow the machine to keep me at a constant  pressure of 7?  I'm honestly so tired and confused but I really appreciate the guidance.

[Gideon]

Not quite.

The Max of 10 will allow the machine to increase pressure. This will provide info to better treat you. The indication is that you need more pressure in addition to the EPR.
If you NEED a constant pressure we will get back to one. The theory is if we treat what we think is bothering you, you will not have as much of a problem. Give it a chance.

Get a glass of water and a straw. Put the straw 4 inches into the glass. Now blow bubbles. The pressure you generated in order to blow bubbles is the max pressure, 10 cmw, that Sleeprider is suggesting. This is just to give you a practical idea of how much pressure we are dealing with here.

[hookedonstitch]

So should I try a constant pressure of 10?  or a range of pressure from 7-10?  I'm sorry that I am so confused