Still feeling fatigue during the day even though using CPAP device regularly

[JukkaKV]

I have used my CPAP device for 2,5 now, but still does not really relieve the fatigue at all.
I feel very exhausted during the day. The sleep is not refreshing and I wake up several times at night, sometimes with very high heart rate (even 130), body heat and sweating.
There is also excessive mucus in my throat when I wake up. This tends to cause the arousals.

I attached my latest graphs and data from OSCAR here. 
I would need some advice of how to adjust my CPAP's settings. During the measured night I had pressure min 6 and max 12. I have tried also max 14/16 but it did not help.

[2SleepBetta]

Welcome to the Forum Jukka,

I was looking for a post about 3 pages down, noticed your post and Finnish first name, opened your post and saw you never got a reply. Please accept my apology for our not noticing your post earlier. It's surprising that happened. 

The gaps in the pressure curve you show is unlike what I've seen. For a starter, I suggest you raise your minimum EPAP pressure to 8 or 9-cm H20. An A10 user alone, I'm not familiar with the A11 controls, but assume you know how to change pressures, given that you show another higher pressure you tried. 

Let's get you on your way to better therapy.  If I can't do it, others will chime in.

Personal notes explaining why your post drew my eye:

My grandmother, whom I got to see and visit in the early 1950's, came to America from Hailuoto at age 20 in 1900. My grandfather and a couple great aunts—Finns—came from Kukkala on Sweden's side of the Torne River, he in 1888 and his sisters earlier. Last I knew, on grandmother's side, there were descendants of my great aunts and their brothers living in Tapiola. Little was made known to us about any of grandfather's family. 

Wish I could write Finnish like you do English. 

2SB

[SeePak]

2sleep betta

I am curious, Why are you increasing pressure?
There are no OA events, only CA, which to me is over pressure for this person.
prescription was 6 cm to 12 cm , i would adjust max lower, maybe 8 cm and see what happens....
So 6 cm min. and 8 cm max

The Resmed Auto OVERSHOOTS and that is happening here.

Juuka.
Lets tame that first and see how you feel first.?

[SarcasticDave94]

There's flow limits that can be addressed, that's one thing that needs either an increase in pressure, adding in EPR full time, maybe both.

If you want EPR 3, min pressure needs to be at least 7.

You're using soft response. Might want to try standard response.

ResMed 11 series, access to clinical menu is tap the touch screen to light it, tap hold blue and purple squares for about 5 seconds. I think the screen gets a white background with it enters clinical menu. After edits, click exit.

CA/Clear Airway/Central Apnea at a rate of 0.99 AHI shouldn't be controlling what the therapy settings are. It's too low to be given a ruling vote in my opinion.

PS, therapy even when set and dialed in excellent will take time to help you sleep begin adding to better rest. Most of us had undiagnosed Apnea for years before CPAP therapy. Years of injury can't be fixed in days, weeks.

[SeePak]

Hey Dave.

As far as CA not needing addressing, but flow limits do need it.....

I wake up every day not tired, but i do get fatigue, sometimes, later in day, and/or tiredness.
Not always, but often happens and is lately been a problem too.

However, my flow limits are terrible as far as this board is concerned, and yet i feel great, so for me, that is NOT an issue. ( who knows, maybe if i was to chase this with auto cpap etc. it might change, but more than enough people out there have this same situation.

Also, it is at least suspected that treatment emergent CA events started at same time as EPR.
Also, seems to me, there are many people here that have way higher pressures than what i am used to seeing.

And it seems to me that whenever someone shows a chart with low pressure, most advisors here ask them to increase.

So, 

I am asking, what harm could there be to try what i am suggesting?
I cannot believe that a sleep study could possibly be as far out there as it is made out to be here.....

Why not see that a tight control range could possibly get events down AND give relief and  much needed sleep?

And, if experience here suggests otherwise, please show me the data if possible.

Thanx,

[SarcasticDave94]

Each person's Apnea therapy has some things that work for about everyone, like guidelines. However, settings need to be personal. Set the CPAP however it works best for you.

[JukkaKV]

Many thanks to everyone for your replies. 

I could give it a try with min 7 or 8 cm. I am still a bit unsure what should be set for the max value.
I have had also some doubts Resmed Auto is overshooting, as suggested by SeePak.

My Sleep View in Airsense 11 device shows the pressure has been around 12 cm (average for a longer period). 
As far as I understand this includes also the time while I am awake with the mask on my face and device running. Thus the actual pressure has been even higher than 12 cm.

I could try it with different max values. However, I feel that if I set max pressure too high, I wake up several times per night due to the leaking mask. This makes the sleep fragmented.

I forgot to mention regarding my OSCAR graphs for November 8th that I was mostly awake between 03.20 and 05.40. This explains the gaps in pressure graphs (as mentioned by 2SB).

Quote from Dave's post:  "If you want EPR 3, min pressure needs to be at least 7."  
This is something I could try as well (with EPR full time).

I apologise if I could not express myself clearly enough in English.

[SeePak]

Hey Dave, yes Sleeprider has recently said about the same thing, everyone different.

And  i agree.

I think another way for me to make my point is....

Instead of proving someting works

Prove that it does not.

So.....

In this case, i implore......

Try 6 cm min,  8 cm max and see what happens. this is NOT a shot in the dark, it is a very plausible prescription. 

I believe this will do no harm, as i'm pretty sure it follows most basic principles for sleep therapy using CPAP.

And as many here suggest, give this a few days.

I believe there is a chance for spontaneous results, will see.....

[SeePak]

Hi Jukka, sorry just saw your response that came before my last one.

The higher pressure that the machine is giving you, in my and others opinion, is way above what you may need.

You show no signs of OA events, so machine is supposedly reacting to other factors, such as flow limits, breath wave shapes etc. etc.

When you keep your pressure within a confined narrow band, you will have much more idea where to go from there.
It takes out all the FALSE assumptions and untimely decisions that can be made by the pap machine.

I really hope you give my idea a shot.
It is not radical at all.
I have used CPAP, no auto for 35 years.
It works ( for awhile LOL )

Peace

[SeePak]

sorry Juuka i usually start by asking....

Did you have a sleep study ( sorry, i assumed you did )

What was their prescription?  Pressure

Do you have obstructive, central or mixed apnea?

And how long have you had therapy?  sorry, i see  2,5 not sure what that means?