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+--- Thread: CPAP Adjustments - Waking Unrefreshed (/Thread-CPAP-Adjustments-Waking-Unrefreshed)
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CPAP Adjustments - Waking Unrefreshed - climbercpap - 07-09-2020
Hello. I've been using my CPAP machine for about 3 years now and about a year ago made an adjustment to taping my mouth and increasing the pressure to around 10 and have since backed off to 8.8. This change dramatically helped my ability to sleep through the night and was a pretty significant QoL improvement as I no longer wake up with a extremely dry mouth.
Since the start of my CPAP therapy, I have felt an improvement in my afternoon fatigue and brain fog, but still rarely wake up feeling refreshed, even after these changes. I was curious if based on the screenshots from OSCAR attached below, there were any changes worth trying (slowly of course) or any obvious points of investigation. I'm a 24 year old active male (Rock Climb ~3-4 days a week with some hiking) and even on weeks I take breaks completely from climbing I still struggle with waking unrefreshed. This is much, much worse on days I sleep without the CPAP (~once or twice a year when I forget to charge my battery camping) which is why I'm curious if there is an adjustment I could make with my CPAP to get some more benefit.
Thanks!
[attachment=24394]
[attachment=24395]
RE: CPAP Adjustments - Waking Unrefreshed - ardenum - 07-09-2020
The only QoL improvements I can think of would be in form of settings: Trigger, Cycle, Rise Time etc. which aren't available on the Autoset. You'd need to switch to VAuto or S/ST.
RE: CPAP Adjustments - Waking Unrefreshed - Gideon - 07-09-2020
Let's start with EPR, Try EPR = 1 / FullTime. This is to address your flow limits. I would also like to see a couple of 2-minute views to see what is really happening flow limit wise.
This will lower your EPAP pressure by 1, let's see how you do without increasing your pressure before we compensate by increasing your pressure by 1 to maintain the same therapy level.
Is there a reason that you have EPR off?
RE: CPAP Adjustments - Waking Unrefreshed - climbercpap - 07-09-2020
Hey! Thanks for the suggestions. I'll try switching EPR on to 1 and see what that does.
W.r.t why I turned off EPR, when I upped the pressure initially I had read about the possibility of Central Apneas that could be exacerbated by EPR being on (I have no real clue if this is true or not). This was about a year and a half ago right before I started a new job so I think out of desperation of just wanting to feel better I turned it off just in case. The changes I made back then definitely have improved my sleep, but I'm beginning to realize I don't really have a great understanding why it helped, which is why I made this post.
Some additional information:
1. I've had septum and tonsil surgery to help with breathing and wouldn't be able to sleep with my mouth taped without the CPAP, I'm curious if this has an affect on flow limit. With my mouth taped and CPAP on I don't have any issues breathing before I go to sleep/wake up and love waking up without my mouth extremely dry.
2. I've been up to around 12-13 on the pressure and am generally pretty tolerant of high pressure (this was without EPR active). I start to get aerophagia here and have also been woken up while trying to fall asleep on my back due to leaks and/or mouth inflating from my chin tucking when the pressure was at that level. Part of me is curious if this chin tucking is happening at some point during the night when I'm asleep, but I don't know of an easy way to fix this if so.
I'll try and post some more photos of the 2-minute views tonight! Thanks again for the help.
RE: CPAP Adjustments - Waking Unrefreshed - climbercpap - 07-09-2020
2 minute period of increased flow limit from last night:
[attachment=24426]
Longer period from back in may when I was using increased pressure:
[attachment=24427]
RE: CPAP Adjustments - Waking Unrefreshed - climbercpap - 07-10-2020
Update! So last night I read about the use of a soft cervical collar for preventing chin tuck. Eager to see if that would help I decided to try sleeping with a soft collar I've used for a neck strain in the past, very loosely ofc. I figured because I've slept with it before it would be fine to do with the EPR change. In reading more this morning, I really appreciate the concept of developing a treatment plan and sticking with the process, so I'll try and take things slower.
I did get lucky though in that I actually made a mistake and only enabled EPR through the clinical settings and not the patient menu, this resulted in EPR not being active and so the only change was wearing the soft cervical collar. I know it's only 1 night but I felt better this morning, I was woken up in the morning in the middle of a dream and haven't been able to remember a dream for quite some time (years it seems like). Below is the data from last night and even with less sleep I'm surprised with how good I feel.
Would it be okay to make the EPR adjustment to 1 in addition to continuing to wear the soft collar or should I stick with only the soft collar or only the EPR change for a week before trying the 2 together?
I also just wanted to acknowledge how amazing this community is. Reading through these posts have given me so much hope and its really inspiring and reassuring to read about other peoples experience wanting to improve their sleep/life and taking initiative of that process through adjusting/learning about their CPAP therapy with the help of the community. Cheers!
[attachment=24434]
RE: CPAP Adjustments - Waking Unrefreshed - SarcasticDave94 - 07-10-2020
I don't see a reason not to add EPR 1 full time.
RE: CPAP Adjustments - Waking Unrefreshed - Gideon - 07-10-2020
With your numbers your target is comfort. VERY important to note how you feel and how the change impacts you.
Otherwise no problem wit EPR=1 Fulltime
RE: CPAP Adjustments - Waking Unrefreshed - climbercpap - 07-13-2020
[attachment=24556]
[attachment=24557]
Hey! Quick update, from last night with neck collar and EPR of 1. I included a screenshot of two "clear airway" events that I was curious about. Are these anything to be concerned about/would they affect my how I feel waking up? Subjectively, on the night I posted where I didn't have anyone clear airway events I woke up feeling much more rested and I am curious if the lack of clear airway events recorded by the machine has anything to do with that.
Thanks again for the help.
RE: CPAP Adjustments - Waking Unrefreshed - Gideon - 07-13-2020
Your numbers are awesome. They should not be troubling to you. At this level, comfort is far more of a concern. Where are you on the comfort scale?