[Symptoms] 1 Month of use, still experiencing fatigue/brain fog

[Vincesleep]

Hello,

I have been using my Resmed Airsense 10 for about 35 days now. I wake up feeling much better than before, but usually by 9 am. (3 hours after waking) I relapse into a state of fatigue, mild headache, difficulty concentrating and some memory problems. These symptoms are often accompanied by neck pain. This happens nearly every day between 3 and 5 hours of waking. Laying down for a nap will often help, but not always.

In some ways I feel worse now on the APAP because I get those few hours of "normal" at the start of my day. In comparison to those few good hours, the afternoon symptoms feel like torture. I know I am better off now, but sometimes it doesnt feel that way.

I have attached a few charts because I have swapped masks a few times since receiving the machine. I was initially issued the Airfit N20 with the machine but swapped to the F20 due to mouth leaks. However, both the N20 and F20 "Large" masks are too small for my face (I have a very long nose) and cause moderate pain and lasting marks on the bridge of my nose. Additionally, I experienced rain out with both models. 2 days ago I swapped to the Dreamweave gel nose pillows to avoid the rain out and nose pain along with tape over my mouth to avoid leaks.

So, due to the mask swaps I will include a few screen caps of my OSCAR data. 

The first is from last night, using the nose pillows with mouth tape.
The second is from a few nights ago using the nasal mask with tape.
The third is from about 10 days ago with the full face mask.

My AHI on APAP has consistently been below 5, usually in the 2 - 3 range most nights. I generally get at least 8 hours of sleep each night and take a nap for 25 - 60 minutes each day to dispel the onset of fatigue.

Any advice is welcome, I am currently able to nap without issue due to corona induced telework, but once I go back to work in an office setting naps will no longer be an option.

[Sleeprider]

You have no obstructive events, and very low flow limitations, even without using EPR. Your pressure is relatively low, but swinging wildly and unnecessarily due to occasional flow limits that you did not include on the charts. Leaks appear to be very well controlled. From what I'm seeing here, I think we need to turn off Ramp, increase minimum pressure to 5.0 and decrease maximum pressure to 6.0. This is going to give you a very narrow range of CPAP pressure and should help remove some sleep disruptions, and reduce the CA events. I would like to see flow limits in future graphs, and we don't need the AHI graph, so just swap those out.

Your respiratory statistics look very good as does time in therapy. As far as a mask is concerned, take a look at hybrid masks. These are masks that provide nasal pillows that you liked, but they cover the mouth without covering the outside or bridge of your nose. These have the same benefits as a full-face mask, but with less bulk, and help people that have your problems with a full nose covering. Some examples are Mirage Liberty, Innomed Hybrid Universal, Philips Dreamwear full, Resmed F30, etc.

[Vincesleep]

You have no obstructive events, and very low flow limitations, even without using EPR.  Your pressure is relatively low, but swinging wildly and unnecessarily due to occasional flow limits that you did not include on the charts.  Leaks appear to be very well controlled.  From what I'm seeing here, I think we need to turn off Ramp, increase minimum pressure to 5.0 and decrease maximum pressure to 6.0. This is going to give you a very narrow range of CPAP pressure and should help remove some sleep disruptions, and reduce the CA events.  I would like to see flow limits in future graphs, and we don't need the AHI graph, so just swap those out.

Your respiratory statistics look very good as does time in therapy. As far as a mask is concerned, take a look at hybrid masks.  These are masks that provide nasal pillows that you liked, but they cover the mouth without covering the outside or bridge of your nose. These have the same benefits as a full-face mask, but with less bulk, and help people that have your problems with a full nose covering.  Some examples are Mirage Liberty, Innomed Hybrid Universal, Philips Dreamwear full, Resmed F30, etc.

I have attached last night's graph with flow limit included.

[Sleeprider]

As you can see the pressure is moving on flow limits that are not too meaningful in your case. I’d like to add some EPR, but with the CA events it’s probably not a good idea.

[Vincesleep]

As you can see the pressure is moving on flow limits that are not too meaningful in your case. I’d like to add some EPR, but with the CA events it’s probably not a good idea.

I have attached my graphs from last night which account for the changes you directed me to make.

[Sleeprider]

Let’s be clear, I will never “direct” anyone to make changes in therapy, but I often want to try or may recommend a change. While the event rate is higher wit the higher minimum pressure and lower range of pressure, it is all CA.

Let’s turn on EPR full time at a setting of 1. If this increases events, I will recommend ASV therapy.

[Vincesleep]

Let’s be clear, I will never “direct” anyone to make changes in therapy, but I often want to try or may recommend a change.  While the event rate is higher wit the higher minimum pressure and lower range of pressure, it is all CA.

Let’s turn on EPR full time at a setting of 1. If this increases events, I will recommend ASV therapy.

Fair enough, recommend is likely the better word here. I will set the EPR to 1 tonight.

[Vincesleep]

Good news, probably. Last night my AHI was .96 for the night. Since starting therapy, my AHI has never been below 1.6. 

I know the side bar says EPR is off, but I shut it off at 3 a.m. and had it on before then (as you can see from the charts). I wanted to see if I slept better with it off. The answer was... a little bit, but not really.

However, I slept poorly last night due to muscle soreness from dead lifts and squats. It is possible that the AHI is only so low because I was extremely restless and woke several times throughout the night, thus logging over an hour of wakeful no event periods. Granted, I've had restless nights a few times since starting therapy and my AHI was never that low on those nights.

Also, an obstructive snuck in there. I don't have obstructives every night on therapy, but they are not unheard of.

[Sleeprider]

Well that looks a lot better. Since CA can be inconsistent, I think keeping this setting is certainly the way to go for now and see if this becomes a trend. You had a lot of low limitation without EPR and this significantly reduced it, and resulted in much less pressure variation by the Autoset algorithm. Hopefully it felt as good as this looks.

[Vincesleep]

It felt fine, seemed like there was no pressure at all. I even pulled the mask away at one point to verify it was actually pushing pressure.

I turned the EPR off at 3 am only because I was curious if the change to settings was contributing to my restless sleep.

Thank you for your recommendations. I will continue with these settings for a few days and report back. Hopefully these are my ideal settings!