wickedsleepy - Sleep Therapy Analysis

[wickedsleepy]

I’ve gone back to the F30.  Dreamwear FFM is even more prone to leaks, and it doesn’t feel like I can breathe as easily.  So back to F30 and turned EPR up to 3.  I seem to be doing okay with it, but I’m very tired during the day. Like struggling to find motivation for work.  Is that at all related to higher EPR or coincidence?

[wickedsleepy]

Hi everyone,

My relationship with EPR has changed a bit since first starting this whole journey back about four months ago.  I could not tolerate EPR at the beginning because I was having central apneas.  So, I turned it off and did my best to "get used to" it without EPR.  I had some okay nights, and at least I was able to avoid the ton of CA's, but overall it's been horrible trying to get used to this whole CPAP thing.  I started out with nasal and pillow masks but moved to the Resmed F30 FFM because I got tired of playing with chin straps and mouth tape.  That was hard to get used to, but I more or less got accustomed to the FFM, with the frequent leaks and "burps" around the edges of the mask.  

I noticed I was having spikes and much higher pressures come after about a few weeks of committing to the F30, however.  Using the advice in this forum, I put EPR back on to handle what was presumably "flow limits" causing the pressure on the Airsense 10 to go very high, making it impossible to stay asleep through the night.  I was able to do EPR of 1 and then 2, but even though that helped somewhat with the pressure spikes, I was SO TIRED.  Like the number on MyAir were more or less perfect.  AHI's of 2 or under.  But man, just sooo exhausted feeling.

Last week, I switched to the Evora FFM.  I have to say that mask is the best mask I've had so far.  Leaks are almost nothing, and for a hybrid FFM it's not horrible comfort-wise.  I started out back with EPR of 1 and did okay, but still I was roused in the night from various events. Its not horrible, and my scores are great, but I'm just exhausted and wanted to see if I could improve on things by raising EPR. Last night, I attempted to move EPR to 2 to see if that helped with those things, hoping for a more restful kind of sleep.  Within 20 minutes of dozing off and waking up, I had 27 events -mostly central apneas.  I was dozing off, not breathing, and then waking up again.  I guess EPR toleration depends somewhat on the mask?  Just weird to me. So, I turned EPR off so as not to be clicking a bunch of buttons while my wife was trying to sleep.  That was a disaster, with pressures spiking up into 18 and 19, waking me up from the sheer force of the mask on my face. I finally turned EPR back on at 1 and did okay, but I'm still pretty wiped out. So, my main question is... if the scores are generally pretty good (low AHI, consistently under 2) then why am I dragging so badly? Is it the EPR that is making me tired?  I'm using this thing for 8 or 9 hours a night, and my scores are usually good, so why do I feel completely and utterly exhausted every day? 

I also notice that I'm getting huge puffy bags under my eyes when I wake up in the morning.  I use heated tube with pretty high humidity, otherwise my sinuses get dried out and I feel stuffed pretty bad.  My guess is that the bags are from pressure going too high, or mask being too tight, and somehow preventing lymphatic drainage?  I don't know.

[Crimson Nape]

I see your profile shows that you don't use OSCAR. I would highly recommend it so we could see your sleep pattern.

The only thing I can guess is you have your CPAP set to auto and have too wide of a pressure range. You might try setting it to a reasonable static pressure and see what happens.

- Red

[SarcasticDave94]

With CA being the main complaint, or part of, it depends on what your diagnosis was.

[UnicornRider]

You still have an open post from Nov 17th, it would provide for continuity of assistance if you stick to the same post. It makes it easier, for those providing assistance, to follow along with you progress.

          Please post a current OSCAR Report, with conditions you are concerned about, and we can assist you with adapting to your therapy or suggesting possible changes to your therapy.

[wickedsleepy]

I do have OSCAR now.  I just need to update my profile.  I've attached charts from last night and the night before.  I still do get some pressure spikes with EPR on, it seems, but it generally feels less harsh.  I was diagnosed with moderate OSA, no mention of CA's.  

These are for last night, which was split into 3 pieces -first with EPR 2, second with no EPR (turned off and turned on the machine once in the middle), and then back on with EPR at 1.
       

This was from the night before
   

[MrIvanDrago]

Very interesting you have had this experience with EPR. I have been using CPAP/BI-LEVEL for about 9 months now. For the first 6 months I did not use any pressure support or EPR. My numbers were ok, but still having events and after plenty of research, starting using CFLEX on my first machine, the Dreamstation 2. After terrible nights, I bought a ResMed machine, an Aircurve, which my doctor said would be much better to dial in my therapy. This was on September 30th. I started at a pretty high pressure like the Dreamstation but found out that a lower pressure on the ResMed and their algorithm is much better.

I was using a pressure support of 4.0, but the symptoms you say are exactly what I have been feeling for over 2 months. In the past few weeks I lowered the PS to 3.0 and tonight I am going to try 2.0, which as I have it set up is similar to EPR 2. The heavy eyes and fatigue has to be related to something with pressure support /EPR. I have got alot of great feedback from this board, I lowering my PS has helped me a bit with symptoms, and trying 2.0 tonight for the first time while upping my minimum pressure. 

Curious to others thoughts on this subject and /or experiences. I was researching low CO2 symptoms and other things just don't really know until I continue trial and error.

[wickedsleepy]

Here's the second part of Saturday night
   

And here's Friday night.  Not sure what made things look so much more active.  I had some whiskey earlier, but hours before bed.  
       

[BoxcarPete]

Looks like your events are mostly clustered. What are you doing to prevent positional issues? The most common problem is chin tucking, which can kink your airway in a way that CPAP level pressures can't undo.

[SarcasticDave94]

On the nights you have events, CA and others, there's seeming to be a cluster pattern. Has there been any discussion about the possibility of positional apnea, within the board I'm meaning different than your doc would refer to positional. With doc they mean sleep body position, here I'm referring to the head and neck positioning that kinks the airway much like what occurs in a garden hose.