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3 Months on CPAP, still tired despite Dr saying my apnea is controlled
#81
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
(02-14-2022, 01:56 PM)highwaystar86 Wrote: I'm curious if anything else sticks out other than the flow rate still not being a smooth curve yet.

If you think your breaths should be more rounded I am not sure you will see that. Some people with strong cardiogenic oscillations (which you have) have them show up even during inhalation and I think that might be effecting flow rate more so than flow limitation. 

Although your inhalation peaks are not the prettiest the longer pause between exhale and inhale (near 0 flow rate where cardiogenic oscillations are present) is an indicator that your body is receiving adequate ventilation (or at least believes it is). Your inhalation time is good, not long and drawn out like it would be if you were struggling with severe flow limitation. Your respiration rate is normal/not elevated and you are having the odd central apnea due to extra ventilation. Imo all of these signs point to adequate ventilation and I would just stick with the settings for a while (weeks) to allow your body to keep adjusting to new breathing/ventilation support.

If your remaining symptoms are still breathing related you may not notice full benefits until your body has adjusted to the extra ventilation it is now receiving and that could take weeks/months. Signs of body adjusting would be central apnea reducing, exhalation time reducing, respiration rate and minute ventilation increasing. Those would be signs that your body is adapting to a lower CO2 level and allowing more ventilation to occur rather than just reducing its breathing effort to maintain previously low levels of ventilation. Gotta remember that if this is all breathing related your body probably spent years/decades adjusting to its current point and it may take a while for body to be retrained. For whatever reason improvement seems to occur more rapidly in patients with severe apnea and more gradually in UARS cases.
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#82
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
In addition to the helpful post from Geer1, I’ll add that some people have the quality of their sleep affected by FLs, and others don’t. The presence of small FLs may or may not matter to how rested you are during the day.
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#83
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
Geer1, thank you for that informative and insightful post. I will be sticking with these settings for awhile and will keep an eye out for changes in the metrics you listed.

I obtained copies of the initial sleep study report from my GP today which I will attach below. One thing that sticks out to me that WAS NOT ever discussed with me by the sleep clinic doctors is that I had 14 central apneas vs 2 obstructive and 98 HYPOPNEAS. The second thing is there were no RERA's which might suggest UARS is not a culprit here?

I'm interested to hear some more well read thoughts on the report especially with all of the info on this thread already. Thank you!

   
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#84
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
Hypopneas can be either central or obstructive in nature, so it's hard to know what to conclude from the study. And of course for everyone, the conditions that make the study possible may confound the results. Plus a study looks at just one night.

As you say, sticking with your present settings is a good idea. Change may come gradually, which is frustrating, but patience will be your friend.
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#85
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
If I remember right ahi was low on autoset and only increased once switching to vauto and higher PS. Flow limited breaths were noted on autoset and also now improved on vauto. That is a sign the pressure has helped alleviate most breathing issues. The odd central apnea before was likely idiopathic but perhaps one of the reasons you are seeing some more central apnea with higher PS.
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#86
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
I’m feeling a little frustrated because it’s been a couple of weeks and I haven’t seen any improvement. Maybe I just need to be more patient

But my AHI is still hovering around 1-3 since switching to BiPAP and I feel like I wake up more during the night. The past couple of days gas/burping during the night has been a problem which is confusing because I thought that BiPAP is supposed to decrease the likelihood of aerophagoa.
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#87
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
You could revised your settings downward a little bit -- maybe by .4 -- to see if that helps with the aerophagia. Your AHI is pretty good, so the goal continues to be for you to have restful sleep and feel better during the day.

It's funny, I know someone who has bad aerophagia with a maximum of 10 and avoids it completely with a maximum of 9.8. Those tiny increments can make a difference sometimes.
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#88
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
Fascinating that our bodies can be that sensitive to it. I guess too much pressure could also be a strain on someone too. 

Thanks I’ll try reducing it by even 0.2 for a bit
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#89
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
It could also be the higher PS if still using 5+ cm.
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#90
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
I have been sticking with PS 5 but never really had issues until the past few days
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