Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

1 year on CPAP. Still tired
#1
1 year on CPAP. Still tired
I've been using CPAP for > 1 year. I think I see some improvement, but still quite tired every day. It's frustrating because I'm told I have very mild apnea, I'm not fat, don't seem to have narrow craniofacial structure, but I still feel the symptoms. Please let me know if there are any Sleepyhead results I can post to paint a better picture.

Here's my background:

Sleep studies

I've taken 3 sleep studies. The first 2 times, they said I didn't have sleep apnea. The 3rd, done at Stanford, with Dr. Guilleminault, said I had mild apnea (5.5 AHI).

ENT

I've had turbinate reduction done, since I have enlarged turbinates, but I think they've come back recently.

Also, at Stanford, Guilleminault speculated that I had a recessed chin and told me to do myofascial exercises. Later, an ENT did a nasal endoscopy and said everything looks fine and no signs of narrowing.

Sleepyhead results
Over many months, I generally have an AHI of 0.5-1.5 every day while using CPAP of around pressure 8-14, and maybe 80-90% of events are central apneas, according to sleepyhead.

Here are some past results:
   
   
Post Reply Post Reply






Donate to Apnea Board  
#2
RE: 1 year on CPAP. Still tired
G'day katultra. Welcome to Apnea Board.

On the numbers shown, you're doing ok, but obviously you're not feeling the benefit so we have to help you optimise. The first thing I'd ask you to do is reformat your charts so they show the most useful information. Please turn off both the calendar and pie chart, the put the graphs into the following sequence: Event flags, Flow Rate, Pressure (not mask pressure), Leak, Flow limitation and Snore. Before taking the screen shot be sure to maximise the Oscar window (F11). All the instructions are here: http://www.apneaboard.com/wiki/index.php...ganization

You're experiencing some central apneas and very little else. I notice that most of them are clustered after 8:30 am, so they could just be "sleep wake junk" - irregular breathing during the period when you're dozing before you wake up fully. They may also be treatment-emergent central apneas, which are often seem with new users, though by 12 months they'd normally disappear. These can often be treated by reducing the expiratory pressure relief (EPR) It looks like your EPR is at 3 (judging by the epap and ipap pressures) so try dropping it to 1. After that, you might also raise your minimum pressure to maybe 6. But only make one change at a time.

I assume you've had all the relevant medical factors excluded (especially thyroid, vitamin D deficiency etc)? And have you considered external factors which might be disturbing your sleep - noise, light, lumpy mattress etc?

Glad you found us - I hope we can make your sleep more refreshing.
Post Reply Post Reply
#3
RE: 1 year on CPAP. Still tired
Thanks, @DeepBreathing.

I've attached new screenshots below.

And yes, I'll try reducing EPR to 6. The reason I lowered my pressure range from 8-14 to 6-8 recently is because I seem to be really gassy in the morning (from swallowing air).

I've had thyroid checked (normal), and Vitamin D was low but I constantly took pills.

       
Post Reply Post Reply
#4
RE: 1 year on CPAP. Still tired
katultra,
Your EPR is set to 3.  I think you will see a difference in clear airways if your set it to 1 or simply turn it off.
And it doesn’t appear you need too high of a pressure, so if you are still experiencing aerophagia, use the lower pressure range you previously had set, with a minimum of 6cm, again with EPR at 1 or off.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com
Dreaming


https://www.sleepfiles.com/OSCAR
OSCAR Chart Organization
Mask Primer
Machine Choices
Soft Cervical Collar


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply






Donate to Apnea Board  
#5
RE: 1 year on CPAP. Still tired
Do you have any sense of whether mask leaks are causing you to wake up or sleep lightly? And are you trying all of the "sleep hygiene" guidelines (hate that expression -- we're not DIRTY sleepers!) :

https://www.sleepfoundation.org/articles/sleep-hygiene
Post Reply Post Reply
#6
RE: 1 year on CPAP. Still tired
Yes, I follow all the hygiene guidelines.

Yes, I just tried EPR of 1 last night.

And looking at some of the "Central apneas," it seems that they're just maybe from post-arousal? I remember reading a thread somewhere that said if you see flow rate go up right before a "central," that it's probably not a central. Can anybody comment on if that's the case in my attachment?

I'm more frustrated that I'm not sure what the root cause of my "apnea" is (it's not obesity), since I'd really prefer to not be using CPAP. Would it be worth doing any other tests?

   
Post Reply Post Reply
#7
RE: 1 year on CPAP. Still tired
I imagine you realize that your sleep doctor was one of the best in the world. Your numbers are good, except for the centrals which should be monitored and possibly look into an ASV one day. I kept my centrals to around 1.5 for years but then they crept up and there's no dial winging on your current machine that can fix those. But I never felt tired at low numbers.

I guess you can tweak things some, but it after a year you are still feeling tired, there might be something beyond sleep apnea.

Do you get good sleep or do you feel that you never really fall into a deep sleep? Those night that I just can't really sleep usually give me great numbers, but I don't feel very good. If I were to string a number of those days together I'd really feel terrible.

John
Post Reply Post Reply






Donate to Apnea Board  
#8
RE: 1 year on CPAP. Still tired
Nocturnal Oxygen Desaturation can occur without sleep apnea and results in similar sleepiness symptoms. 
Personally I would invest $50 or so in a recording pulse-oximeter and have a look see at what is happening to your oxygen numbers at night.
Post Reply Post Reply
#9
RE: 1 year on CPAP. Still tired
Quote:And looking at some of the "Central apneas," it seems that they're just maybe from post-arousal? I remember reading a thread somewhere that said if you see flow rate go up right before a "central," that it's probably not a central. Can anybody comment on if that's the case in my attachment?

I don't want to get into the protracted and ultimately useless argument about "fake" central apneas. Look at your chart - your breathing flatlined for 20 seconds. Whatever precipitated the event (seems to be an isolated leak) YOU STOPPED BREATHING! That is an apnea. Look also at the chart immediately following the event - see how the amplitude waxes and wanes before it settles down to a steady rhythm? The is also a sign of central apnea - when taken to extremes it's called periodic breathing or Cheyne Stokes respiration. You're nowhere near that stage, but it does indicate to me that you have a genuine central apnea issue.

Having said that, you experienced 15 apneas in nearly nine hours of sleep - that's not a lot. Your AHI is consistently below 2 - that is considered clinically treated. You had 3 minutes 51 seconds in apnea, which if my math is right gives an average length of around 15 seconds, which again is not a lot but enough for your body to wonder what's going on.

Looking again at the chart I see your respiration rate is slightly elevated and your tidal volumes is a little lower than expected in a healthy adult male. These numbers do vary with age, weight and height, so that might be normal for you.

I think the next step would be to turn off EPR completely and see if that helps
Post Reply Post Reply
#10
RE: 1 year on CPAP. Still tired
Have you tried constant pressure with EPR off.
The change of pressure can knock you off deeper sleep stage into a shallower one. Consequently your sleep quality and architecture suffers. So your ahi May be low but you are very tired still. I had this issue and I fixed it by going to 7cm fixed. You can try this for 7+ days and see if this helps.
PRS1 Auto & Dreamstation Auto w/ P10 and straight pressure of 7.5cm
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  Good reports (I think), yet extremely tired ppca 26 2,275 09-23-2020, 11:50 AM
Last Post: Chequebook
  Sanity check on next steps (still tired) TSomm 55 1,279 09-17-2020, 09:35 AM
Last Post: DaveL
  [CPAP] Over 2,5 year Ahi Increase arkadyan 1 82 09-09-2020, 10:20 AM
Last Post: staceyburke
  [Diagnosis] new to forum, inexperienced, always tired, forgetting, cris2371 30 2,137 08-23-2020, 12:09 PM
Last Post: staceyburke
  [Treatment] Two Year Treatment, Recent Lurker (OSCAR screenshots within) HeyHolland 12 489 08-17-2020, 04:16 PM
Last Post: HeyHolland
Rainbow [Symptoms] 1 year High bad AHI jquintero 9 277 08-03-2020, 07:23 PM
Last Post: BB63
  [Treatment] 1 year High bad AHI jquintero 1 146 08-03-2020, 08:27 AM
Last Post: jquintero


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.