Seeking Advice on Optimizing CPAP Settings for Persistent Grogginess

[venkatasunil]

Hi Everyone,

I hope you're all doing well. I wanted to reach out to this community for some advice and insights regarding my ongoing struggle with CPAP therapy.

Last year, I underwent a sleep study where my Apnea-Hypopnea Index (AHI) was found to be 14, prompting me to start CPAP therapy. Initially, I saw improvements as my AHI dropped to consistently low levels (<2). However, despite these promising numbers, I've been feeling persistently groggy and fatigued, and it's been challenging to find the right settings that work well for me. I've experimented with various pressure settings ranging from 8 to 14. Anything higher than 12 seems to cause bloating and discomfort, while lower pressures fail to alleviate my symptoms. As a result, I started trying out EPR and increased the pressure maintain a good EPAP.

Here's a breakdown of my recent CPAP settings and experiences for the last 2 days (attached the screenshots):

May 2:

Mode: CPAP
EPR: 2
Pressure: 14
EPAP: 12
Unfortunately, I couldn't tolerate using the machine for the entire night as I woke up due to discomfort from gas in my stomach. It took me around 30 minutes to feel better, and I went back to sleep without using the CPAP. I also use a neck brace/cervical collar to assist with maintaining proper alignment.

May 3:

Mode: CPAP
EPR: 2
Pressure: 12
EPAP: 10

While I felt marginally better compared to the previous night, I still experienced significant grogginess and difficulty focusing throughout the day. It feels like my mind and eyes are constantly tired, and I struggle to keep them open. This is my experience with any settings below 12!

I use a heated tube, humidifier, and a full face mask, and I have no complaints regarding their comfort or fit.

I'm reaching out to seek advice on how to fine-tune my CPAP settings to optimize my therapy. I have MAD device as well, they were helpful but really started to hurt my jaw and don't want to take any risk further. I firmly believe that CPAP has the potential to help me, but I haven't been successful in finding the right configuration yet. I'm at a loss and would greatly appreciate any suggestions or insights on what I might be missing or doing wrong.

Any suggestions or insights would be greatly appreciated. Thank you in advance for your help!

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[PeaceLoveAndPizza]

Good job with your pressure trials. I suggest you either stay with the fixed 12 with EPR 2, or go back to the 9-14 settings from 1 May and add EPR 2. 

One thing I do recommend is turning off ramp unless it absolutely necessary. You get no therapy during the ramp time.

A point on your aerophagia. It takes time to adapt to the CPAP pressure and aerophagia happens to many. Most time it is caused by fighting the CPAP pressure and swallowing it as a result. It takes time to learn to relax when the machine is turned on, so don’t worry about it happening. There is nothing wrong with starting with a lower pressure that is comfortable and slowly creeping up pressure by 0.2 every few days.

https://www.apneaboard.com/wiki/index.ph...Aerophagia

So, basically choose from

Mode CPAP
Pressure 12
EPR 2 full-time
No ramp

Or

Mode APAP
Min pressure 9
Max pressure 14 (or use 12 if the 14 proves to be too much and creep it up over time)
EPR 2 full-time
No ramp