[Treatment] UARS Diagnosis - Need Assistance with Self Titration

[shanicher]

Hello everyone! 32F recently diagnosed though a WatchPat and online service after years and years of un-refreshing sleep, daytime fatigue, jaw clenching and griding, ADHD, subsequent insomnia due to un-refreshing sleep and a multitude of other symptoms that I never added up to sleep apnea that have all been present since childhood. 

WatchPat Results:

AHI: 1.8 (3.7 in REM)
RDI: 9.5 (11.7 in REM; 18.9 in supine)
O2 desat to 83 at one point in the test, average was in the 90s

Official diagnosis was REM related and positional Obstructive Sleep Apnea

Was prescribed APAP therapy, I did my HW and purchase the ResMed Autoset for Her. Dr prescribed 4-20, but I felt air hunger so I changed it to 6-20.

Been sleeping on it for about a week, honestly its going pretty rough. Having a hard time falling asleep on it, have had to use a sleep aid every night otherwise I stay awake for hours trying to fall asleep. Also have been waking pretty frequently, I feel like the mask is relatively comfortable (P30i) and I tape my mouth because Im a terrible mouth breather. Been using a breathe right strip every night and nasal rinse a couple of times if I feel any congestion that night.

I asked for some advice on Reddit after a few days and was given the idea to change to a constant pressure vs the autoset for her setting, and increase EPR to 3 to combat flow limits.

I don't feel like its getting any easier (Ive only been able to keep the mask on for 5 hrs a night), nor do I feel any more rested. In fact, I think I feel worse, to the point Im considering taking the night off of the machine.

As far as I can tell with oscar, my charts look pretty good. I changed the settings a bit over the days I am attaching.

I guess Im wondering if there is anywhere I can improve my treatment? I know many of you are way more experienced at reading these charts and may see some areas I can improve. I also have 30 days to return my machine, so if I need bipap, Im trying to consider that as well. I know my case isn't considered severe, but the symptoms seem otherwise. its becoming so invasive to my life.

I really want this treatment to work, I cant live with the daily exhaustion anymore. Even the stimulant I am prescribed for ADHD is barely keeping me energetic enough to take care of my 2 small children. I am also supposed to be going back to school for nursing in the next couple months, and I cant see how I am going to be able to handle it all with this level of fatigue.

Thanks so much in advance! 




           

[staceyburke]

Your numbers are not good they are great. Usually people complain about fatigue with good numbers have high flow limits or large leaks. Your are fine - no problems. 

The only thing I see is the time you are user therapy is very low. The longest time shower is 5 1/2 hours. If that were me I would be the walking dead. 

Everyone is different but I NEED around 9 hours or I feel drug out and no energy. I just think you need more sleep under therapy (Cpap on and sleeping)

[shanicher]

Thanks for responding! 

The problem is I cant sleep on it. If I dont take something to knock me out, I spend an hour or two trying to fall asleep. And then when I wake up in the middle of the night, I cant go back to sleep with it on, I just stay awake and toss and turn until I ultimately take it off so I can sleep before my alarm goes off. 

Its not uncomfortable to breathe on, I can inhale and exhale just fine. The mask is okay I think comfort wise, I dont know how I would improve upon it, Im assuming they are mostly relatively hard to get used to. I guess Im just questioning the APAP as effective treatment for me because the numbers look good but I cant sleep and Im even more tired.

[staceyburke]

Many people have the problem. Try wearing it while watching tv or reading a book. That will take your mind off of it and you can get comfortable with it on. Don’t give up on it. It takes a while and soon you won’t want to sleep without it.

[Gideon]

Use your system while watching TV, reading a book, playing games with 2 small children, anything enjoyable to help your body learn that this is normal.

Also let's see if you handle a higher pressure better.
Set pressure to 9
Note that the min pressure that you are comfortable with may be higher than what you need to achieve good numbers. For myself I need a min pressure of 10 to breathe comfortably.

Please critically tell us which settings you prefer and why. This is between pressures of 8 and 9. you may need to trial these pressure for a few days but it is how you feel that have much to do with which settings to keep.

Setting EPR = 3 took care of the flow limits you were having. Keep it there.

[2SleepBetta]

Please provide representative expanded ("zoomed?") views of your flow rate curve that are about 2 to 3 minutes wide, in total. This will give a better view of the tops of your inspiratory flow rate curve. Those may show air flow restrictions that are below the level your Autoset flags in any way. 

It would help if you clicked on and dragged the bottom of the flow rate window slot to increase the total height of the flow rate wave to about 1 to 1.5 inches top to bottom.

[SarcasticDave94]

Can't add anything not already covered. Yes definitely use the PAP while awake and reading or similar. It will help you get used to it. I mean let's face it. An alien face grabbing monster hanging on your face with a long tail attached to the mother PAP ship isn't quite normal. Best to ya on success.

[shanicher]

Thanks to you both! Im going to up the pressure to 9 tonight (I was on 8 the last 2 nights), and put it on now and try to distract myself. I'll let you know how it goes in a couple days.

Just to double check, a kind person on reddit suggested I switch to constant pressure a few days ago instead of the auto, his reasoning being maybe it was the pressure variability waking me up or making it uncomfortable. Thats when I switched to a set pressure of 8. Does this sound right? Is there any benefit to having the variable pressure? I "think" the constant pressure feels better, though its hard to say for certain since Ive been having issues sleeping with it anyway.

[SarcasticDave94]

Set it where you are more comfortable. Variable can be fine but if fixed pressure is more comfortable or gives better well rested state that's a perfectly fine reason to choose it.

[JoeyWallaby]

Numbers are good but you probably have flow limited breathing when you view the individual breathes