Technically Treated - To my core Tired

[Geologeek]

Just a big   in advance for any help or input you kind people can offer.

I am UK based and covered by the NHS - so appreciate things are a little different to most of the users on the site. As it stands my sleep clinic are of the opinion that as my AHI is below 5 that i am treated and only need a yearly phonecall from them to ask if i am being compliant and if i need a new mask.

The only condition i have been set is that i am to have a minimum of 4.5 hrs on the CPAP if i am to drive the following day - Which is perfectly fair enough.

Now the issue is that even though i have managed to get my AHI to be consistently below 5, i am to my core exhausted.  I mean that from the moment i wake up.......I am tired!

I have been on treatment now for 1047 days having started treatment in October 2016 and would have thought by now that i would have a noticable improvement in how i feel.

I was hoping someone with a bit more of a clue than i have right now could help me figure out if this is because of the apnea or whether i need to start looking elsewhere for the cause of my constant fatigue.

At the begining and for most of my treatment I have noticed that my apnea events were nearly always an equal split between obstructive events, hypopnea and clear airway (central) events but since January of this year i felt the need to increase my pressure settings as i was finding that i was unable to get enough air and was taking the mask off through the night and not getting my minimum of 4.5hrs.  Since then my obstructive events have reduced and my evenings are then largely consisting of hypopnea and CA events.

Sleep clinic have no interest in the breakdown of my events only if my AHI is below 5 and if i actually fall asleep during the day........which i dont........i just get through the day as best i can till i beat insomnia and get to sleep.

With regard to my attched OSCAR data, i have tried to give an overview and a close up of several events to see if you can help me see if there is an issue i can try to resolve.

I think i can narrow down my pressure range from 7-17 down to 7-12 - But would there be any benefit in this?

Would i be better off increasing my EPR?

I only just noticed that RAMP is on, would turning this off be of any benefit?

Are my leaks the cause of the events or the events causing my leaks?   

Thanks for any input you can give this tired soul.........

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heres a few more screenshots of last night

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and finally for now.....

[Sleeprider]

The data provided is less than 1 AHI and the only notable feature is a period of higher flow limitation at 06:00 and what appears to be a disruptive amour of leaks from your mask. It would help to know what the composition of your AHI is when you have higher rates of events. For comfort, and to help reduce flow limiitation, RERA and hypopnea, you may benefit from a higher setting to EPR. Obviously, controlling leaks is a top priority to avoid sleep disruption. You might want to read the Mask Primer in my signature links. I'm impressed that NHS gave you an Auto CPAP. They seem to have a preference for fixed pressure machines. The lack of contact and follow-up is pretty common.

[Geologeek]

SleepRider, thanks for the reply.

With regards to the supply of the machine, i think it really is a case of postcode (ZIP) lottery as to the service you get. Luckily my hospital is a major teaching hospital and they as a matter of course give out this machine.

I need to go back a few months to find higher AHI - and these appear to be only when i have a short night sleep.

I have attached some oscar data of one of these.

It looks to me then that my sleep disturbance is probably not related to apnea and therfore something else is in play??

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and finally


Off to read Mask Primer now.....

[Sleeprider]

AHI is good and in the second example, we see mostly CA events. These can be an indicator of sleep disruption or stage transition rather than a cause. Your zooms are a bit too tight to be useful, and backing off to about a 2-minute segment tells us a bit more.

Your statement about sleep disturbance not being related to CPAP therapy is very likely. We get people at the forum complaining about fatigue and other complications that connect everything back to CPAP therapy, so it's refreshing to hear you are open to the idea that there may be external factors. Factors like sleep hygiene, diet, nutrition, exercise, hormone imbalances, and many other possibilities need to be considered. It can be very difficult to track down a cause/effect with any certainty.

[Geologeek]

My bad sorry......added two more screen shots a little less zoomed!

Looks to me that i need to start looking elsewhere for my problem.

I think first port of call is to video myself at night to see what i am doing positional wise and see if my movements are causing the leaks in the first instance.

I have for the last fortnight been using a sleep tracker and it shows that i am not getting any consistent deep sleep, too much light sleep and what appears to be more than 10 sleep cycles per night........in addition i appear to have bradycardia during the daytime and my blood pressure swings from prehypertension to hypertension.......this is probably the route i now need to chase.

With regard to my mask fit, i am unable to get enough breath through my nose so i was given a full face mask as nasal pillows would not have suited.  The only other option i was given when we discussed my leak rates was to have a fisher & pykel (??) dooby firkin that was like a mouth piece/gum shield thing with the pipe connected, but this was bad for my TMJ so i had to go back to the Quattro FFM.

I think i will need to record myself to see what is causing the leaks........at the least it will help improve my CPAP treatment.

Thanks for the help SR - very much appreciated. At least i know its my GP i have to go bother rather than the sleep clinic.

[Crimson Nape]

Your first image is displaying the Resmed's FOT (Forced Oscillation Technique). This is an oscillating airwave that is akin to sonar. Resmed uses the pulse to aid in detecting whether it is a clear or an obstructed airway.

[sheepless]

I'm starting to feel like the boy crying wolf, but I don't do it without reason. look for periodic limb movement as a possible reason for your continuing fatigue. it's been my bane & I see suggestions of it in your flow rate.

[Geologeek]

Thanks sheepless - I will try to set up a camera and record my evenings and see if i can get any evidence of this

[Crimson Nape]

I don't believe that anyone has mentioned it, but your Tidal Volume looks low to me. Increasing your lower pressure can help to increase this value. Below is a Wiki link on the subject of Positive end-expiratory pressure (PEEP).
http://www.apneaboard.com/wiki/index.php...y_pressure

[Geologeek]

Thanks for all the helpful replies.

First things first i shall turn off ramp this evening and then progress onto increasing EPR

then i will see about increasing the pressure.