annabellecx (Therapy Thread)

[annabellecx]

        Hi there,

I'm a 21-year-old female in the UK, at a healthy BMI. My symptoms before treatment included headaches in the morning, considerable daytime fatigue, never feeling rested, ADHD inattentive type (all blood tests fine). I did go to my doctor but was pretty much brushed off, so decided to buy a machine, as the waiting time for a study is many months here. I figured there's little risk, and I may as well see if I get some symptom relief. I got a Resmed Airsense 10 Autoset.
I know my AHI is low which is great, however, I'm trying to figure out how to stop aerophagia. I want to see if the machine helps with my symptoms but I'm feeling less rested due to waking up sometimes in the night with awful stomach cramps and gassiness, or I'll take my mask off occasionally as I hate the bloating feeling. I do have nasal congestion and am a mouth breather. I use a full face mask and have tried a wedge pillow, chin tucking (I don't ever stay in the right position once asleep), I tried mouth taping once but woke up with my mouth resisting the tape and trying to open. My EPR is at 3, and I've changed my pressure settings a few times but I'm not sure if that's something I could improve. Or should I give mouth taping another go? If anyone has any advice based on my OSCAR or otherwise, that'd be massively appreciated!

Thank you for any help

[desaturator]

I'm sure there are more expert folks around here who could advise on the machine set-up. My concern, though, is that sleep-disordered breathing is pretty rare in a healthy person of your age. I get the impression that you've had tests for the really common causes of the symptoms you describe (anaemia, chronic sinus infection...) but there are many other possibilities that aren't often tested -- vitamin D deficiency is a particular problem in a UK winter. I would suggest that you remind your GP whose taxes are paying his/her salary.

I can see from the OSCAR results that the machine is doing something, but you're in the same position I am -- I don't think it's possible to diagnose sleep-disordered breathing from these machines. You could try setting your machine to its lowest possible pressure, and see if you still have a low AHI, but that isn't conclusive (I still have low AHI on minimum pressure).

My suggestion, for what it's worth, is that you try to arrange a home sleep study from a commercial provider. You probably won't get the NHS to fund it, but it will be a lot cheaper than an Airsense

Even those WatchPAT tests (about £150, from companies like Intuit) will give you some idea if you really have a SDB problem. More importantly, perhaps, they'll give you at least some notion of your sleep quality. Stress and anxiety, for example, are common causes of disturbed sleep that are not breathing-related.

Best wishes, DS

[Sleeprider]

Your pressure rises with increased flow limitation (good job with the chart), and we can help your aerophagia by limiting the range of pressure. You have a minimum pressure of 7.0 and can probably reduce the maximum to 10 to help increase comfort and reduce any bloating. Give that a try and see if it helps. If more pressure reduction is needed, we can probably accommodate that without increasing AHI a great deal.

Your flow rate appears to be flattened on the inspiration side, while expiration looks uneven and spikey. Also your inspiration time is considerably longer than expiration in the statistics. It would help to get a zoomed image of your graph, focusing on a 3 to 4 minute segment so we can clearly see the respiratory wave. I have considerably more flow limitation than is suggested by the statistics, and that would be associated with an upper airway restriction (UARS). This is pretty common, and more-so in females of normal weight, complaining of the kinds of symptoms you describe. Let's get a look at the close-up of flow rate and get a better idea of what is going on. Since the more severe flow limits are intermittent and clustered, we will also look at your sleep position and the use of more than one pillow or sleeping in an inclined position or any position that can promote chin-tucking.

[annabellecx]

Thank you for your response DS! I really appreciate it. I've been taking 4000IU vitamin D + K2 daily for a few months now as I thought that might be the issue, but it didn't make much difference, unfortunately, and yes I've done the tests you mentioned.
Yeah, you're right about the at-home test; I've been debating it but I think it would be useful to know for sure. 
I am generally an anxious person so I'll look into that; not sure why I never thought of that impacting the quality of my sleep so thanks for the suggestion!


Many thanks

[annabellecx]

    Hi Sleeprider,

First of all, thank you for taking the time to look at my graphs, I really appreciate that! Okay, sounds good about the pressure; I've attached the zoomed-in graph- please let me know if I've sent the wrong section! I had heard of UARS but wasn't sure how to tell if that was the case so that's interesting. Regarding the sleep position, I do sleep with a bed wedge pillow + regular pillow on top and still seem to move out of the chin tuck position. That being said I've only tried it a handful of times so I can keep on with trying that. 

Thank you again

[Sleeprider]

The flow limits and inspiratory effort shown in this graph are significant and will affect how you feel.  It's a lot of work to inhale against airway restriction and it is disruptive to sleep.  This example starts off with significant and increasing flow limitation ending with an arousal. This is an unflagged RERA (respiratory effort related arousal).  During this arousal there is amplified recovery breathing and it appears you may have shifted position somewhat s breathing is improved until 00:42:45 when the cycle begins to repeat, and you have another RERA at about 01:20 based on your full-night chart. 

This explains why you experience fatigue and a feeling of ADHD you mentioned previously.  You don't breathe well all night and experience a lot of arousals.  Your sleep position is mostly to blame as you are on a wedge with a pillow, the combination of which forces your chin toward your chest. This flexes and obstructs your airway whether you are on your back or side.  CPAP with EPR is helping to make it better, but we are going to need to add another tool to counter-act the forces of gravity that are causing the problem.  If you can tolerate a lower wedge or thinner more flexible pillow that will likely help, but a supportive soft cervical collar (SCC) is likely to be your long-term solution.   We have written some wiki articles on this common problem with Oscar examples of the potential improvement that comes from using a SCC.  There are hundreds of our members that benefit from using this solution. Please read the wikis, and understand that finding the right fit and firmness for a SCC takes some trial and error. You may not hit it on the first try. 
Positional Apnea:  http://www.apneaboard.com/wiki/index.php...onal_Apnea 
Soft Cervical Collar:  http://www.apneaboard.com/wiki/index.php...cal_Collar

[Gideon]

The grouping of flow limits often indicated a cervical alignment issue, mostly a chin tucking.

Question: why the incline/Bed Wedge? Any other conditions you have other than apnea/UARS?

Try a flatter, less firm pillow. Can you sleep without the bed wedge?

[annabellecx]

Ah that’s so interesting! Would that be typical of UARS then? I’m interested in reading more about this. I always slept without a wedge until the aerophagia started with the CPAP, and started using it to try and get rid of that, so I think the SCC is something I should definitely try. 
Thank you for the detailed explanation I find this all fascinating.

---

Hi Gideon,

Thanks for your reply. The wedge pillow I started using for air swallowing with the CPAP as that seemed to be the recommended solution. I’ll go back to the flatter pillows now!

[modest811]

I'm curious Annabellacx,

Can you post your respiratory rate on oscar as well? I believe during those times of high FL your rate will come up very high.

[annabellecx]

    Hi there, thanks for the response!
Yes, I've inserted it here. Do let me know if that's what you wanted/you'd like any other details.
Many thanks