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

Brain fog, lack of energy -- why did dropping my EPR make such a difference?
#31
RE: Brain fog, lack of energy -- why did dropping my EPR make such a difference?
Thanks to all who are looking at these results.  

My OSCAR report from last night (9/22/21) is appended.    "Clear airway" events (the treatment-emergent central apnea events, for those reading this thread as nerbies) are way down.    [Remember, the CA events almost disappeared when I dropped EPR to 1, even with Min Pressure at 5.6.]    But obstructive airway events are higher than they were when I had an EPR of 1 and a Min Pressure of 5.6.

I slept better last night than the night before but my sleep was still not great -- kind of broken, woke up about an hour before the alarm and couldn't go back to sleep successfully.    Had a bit of a headache in the a.m.   Am a bit foggy in the brain today.    I do remember dreams from last night, so I am getting beyond light sleep.   Was woken up during two different dreams, alas, so I gathered this evidence through sleep broken by OA's.

The past few days, I've had Mn Pr inching up (7, then 8) and had EPR at 3.   Maybe I should not have made any changes at all.  I made the changes following the advice of StaceyBurke (posting earlier in the thread).   SB thought that, "what we need to do is raise the min and keep the EPR at 3 to help with the H events and flow limits.  Flow limits are small but for most people they interfere with sleep by not allowing you to get into deep sleep and sometimes waking you up.  Also the machine reacts to the flow limits by raising the pressure (max) to stop them from becoming larger events (H and O)."    This seemed reasonable to me.   I had been doing better with the EPR 1/Min Pr 5.6 (with very low AHI's) but was hoping to feel more refreshed by sleep.   So, I gave it a try.    After only two nights (EPR 3, Min Pr 7 and then 8), I am feeling worse than with the EPR 1/Min Pr 5.6 setting.    But I don't have a good idea of how long the experiment should run.

I append an OSCAR daily overview for one night last week (EPR 1, min pr 5.6, no ramp):   as you can see, there are almost no OA or CA events.

I also append the overview that OSCAR provides, broken out by month and by settings.     AHI isn't the best indicator of how I felt, although it clearly varies with the settings.    Basically, I was on the verge of a nap all of the time for about the first four month:  just exhausted, always sleep-stunned, like a teenager who'd slept for 12 hours and then just couldn't wake up.    After about four months, I started to be less obviously tired.   BUT I was not rested and my consciousness was still not right.   I was without energy, without much ability to get anything done, "foggy" in the brain (everything seemed far away and distant, thoughts fluttered around and I couldn't focus well -- kind of like an unpleasant version of being drugged), prone to cognitive confusion (unable to recall things that I has previously recalled with ease, unable to remember a number once I lifted my eyes from the page on which it was written).  I just wanted to sit in a comfy chair and stare into space.

I didn't feel better until the magical date of Wednesday, August 17.  I dropped EPR from 3 to 1, with Min Pr was 5.   Like a miracle!    For the first time in months, I felt refreshed and clear-headed -- or, at least, I felt refreshed and clear-headed compared to how I had been feeling.

Any additional comments/input from those of you who are reading this?    Should I continue with the EPR 3/Raise Min Pr (to 9, tonight) experiment?

Thanks so much.


Attached Files Thumbnail(s)
           
Post Reply Post Reply






Donate to Apnea Board  
#32
RE: Brain fog, lack of energy -- why did dropping my EPR make such a difference?
Ok let's take a look
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#33
RE: Brain fog, lack of energy -- why did dropping my EPR make such a difference?
Is it safe to say your chart with lower flow limits is more comfortable and adds more to being well rested? If so, you're definitely headed the right direction.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#34
RE: Brain fog, lack of energy -- why did dropping my EPR make such a difference?
Comparing the 2 nights. Centrals were the same but flow limits were much better in the first chart (EPR3). By the charts the EPR at 3 was a more restful night. Is that what you experienced? If so you may need time for you to start feeling the effects.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
Post Reply Post Reply






Donate to Apnea Board  
#35
RE: Brain fog, lack of energy -- why did dropping my EPR make such a difference?
(09-21-2021, 08:39 PM)Geer1 Wrote: Geer 1 writes:   " Step one: find minimum EPAP that stops majority of obstructive apnea from occuring. With an APAP machine you can leave pressure a bit low and allow it to adjust but you don't want to set it too low. They key to remember is these machines only increase pressure after your breathing has been an issue, they aren't proactive nor do they use old data to determine where an effective minimum EPAP is. That is your job in this first step.

Step 2: Use higher EPR to treat flow limitations or lower EPR to reduce centrals. Find the point where you maximize EPR without inducing too many centrals and then over time if centrals become less common you can continue to try raising EPR to further treat flow limitations. Remember when you adjust EPR is also affects EPAP setting so you want to adjust both in tandem once you have determined ideal EPAP levels
."

So far, I've felt best with the EPR 1/Min Pr 5.6 that I stumbled on back in August.   But I did sometimes feel a bit as if I wasn't getting enough air, which would have come from the 5.6-1=4.6 pressure which some (like StaceyBurke) have advised is too low.    My centrals are gone with EPR 1/MinPr 5.6 and also with EPR 3/Min Pr 7 or 8 -- but my OA's go up and my sleep is less restorative w/ EPR 3/Min Pr 7 or 8.

I am still struggling to understand flow limitations.   They've been brought up by a couple of commentators.  SevereApnea points out that my "I feel so much better" first night (8/18/21, EPR 1/Min Pr 5) had a higher median EPAP than my "I am miserable" (8/17/20, w EPR 3/Min Pr 5) because the lower EPR was upping my flow limitations.    95% flow limitations was .06 on my "bad night" of 8/17 and .17 on my "this is my best night ever" of 8/18.   

SA was pointing out that flow limitations could also disturb sleep.    I have only used EPR 3/Min Pr 7 or 8 over two nights, w/ 95% Flow Limits at .15 for EPR 3/Min Pr 7 and .05 for EPR 3/Min Pr 8.

So, should I continue with the experiment and push MinPr to 9/EPR 3?   Should I stay where I am for a bit and see what happens?  Opinions, advice, insights -- whatever you've got.....
Post Reply Post Reply
#36
RE: Brain fog, lack of energy -- why did dropping my EPR make such a difference?
I would set the Min pressure to 9 and run a test.

Also check to see what Mode is set on the machine
Look in the clinical menu for
Mode: For Her or AutoSet

If its in For Her you might try just AutoSet.

Lots of Ladies prefer the AutoSet mode.

Make these changes slowly over a few days. Dont change to much.

Always post a new screen shot after changes.
Thank you,
Brent aka Factor

Just a Regular guy.
My untreated AHI was 87.  You can do it hang in there.
"You can if you will"   Jerry Kramer

Got OSCAR?
Organize Charts
Optimizing Therapy

My Story
Post Reply Post Reply
#37
RE: Brain fog, lack of energy -- why did dropping my EPR make such a difference?
(09-22-2021, 03:19 PM)staceyburke Wrote: Comparing the 2 nights. Centrals were the same but flow limits were much better in the first chart (EPR3). By the charts the EPR at 3 was a more restful night.  Is that what you experienced?  If so you may need time for you to start feeling the effects.

I'm not sure which nights you mean by "the 2 nights" but I think you mean the last two nights:   EPR 3/Min Pr 7 and EPR 3/Min Pr8. EPR 3/Min Pr 8 was a somewhat better night of sleep than EPR 3/Min Pr 7.

Neither of these nights of sleep was as good as what I was getting with EPR 1/Min Pr 5:  with those settings, I was more rested and restored by sleep and had less brain fog.     With EPR 3/Min Pr 7 or 8, I didn't feel rested in the morning and I had lots of brain fog.    With both of them, I woke up with headaches.    

With EPR 1/Min Pr 5, I had very few CA events and very few OA events.

With EPR 3/Min Pr 7 or 8, I had very few CA events but more OA events than EPR1/Min Pr 5.    

Is there a reason to believe that the distruptive events (presumably, the OA events) will go away if I stick with EPR 3/Min Pr 8 for a few days?     I do not understand why am getting more obstructive events with EPR 3/Min Pr 7 or 8.    Any guesses?  The 95% flow limit number for EPR 3/Min Pr 8 is the lowest that I've had in a long time but that doesn't seem to make up for the disruptions caused by the increase in obstructive events.


Thanks for sharing your insights.  Let me know if you'd like to see any additional data.    I should be feeling better with the increased Min Pr but I'm feeling worse.  This puzzles me.
Post Reply Post Reply






Donate to Apnea Board  
#38
RE: Brain fog, lack of energy -- why did dropping my EPR make such a difference?
My apologies if my replies aren't linking to the posts in the thread.   I keep forgetting that "reply" doesn't attach my reply to the post that prompted it.

(09-22-2021, 03:28 PM)factor Wrote: I would set the Min pressure to 9 and run a test.  

Also check to see what Mode is set on the machine
Look in the clinical menu for
Mode: For Her or AutoSet

If its in For Her you might try just AutoSet.

This is very sound advice.  It never occurred to me to tinker with Mode; I'm on the "for her" setting.    I'll try that after I've done my full experiment with Min Pressure.    Yes, I've read that many men like the "for her" algorithm and maybe I'd have better luck with the "for him" setting.

I will keep posting results as they come in.
Post Reply Post Reply
#39
RE: Brain fog, lack of energy -- why did dropping my EPR make such a difference?
(09-22-2021, 08:23 AM)SevereApnea Wrote: Fascinating thread with great input by all. (Health warning: another Loooonng post [yawn] Rolleyes)

@Albigensian

Nasal vs Full face Mask:

Certainly worth a go, you will only know if you have tried it for a while, a week maybe.
.......

AHI
Once your AHI is less than 5 and you are feeling OK then there is so much day to day variation between AHI readings it's not worth stressing about.
The goal is not AHI 0, in fact I regard that as overtreated.


Eventually you won't even focus on the AHI, just how you feel. 

Obtructions:
I ignore my OSA score. I only worry about them if the OSA are long, say 30 - 50 seconds and clustered.
Other than that they are normal, and I am quite happy with them. Most of us have them. That is why a normal value for AHI is < 5 and not = 0.

I try (hard!) to ignore the day to day variations: and prefer try and look for trends. Wood for the trees etc.

Flow limits: enough discussion already. Don't try and understand the Proprietary reasons for the difference of appearances of
FL chart and numbers. As Gideon said in #24 if you really want to see FL zoom in on the Flow Chart.

.......
Lastly, and hopefully to put an end to this long post of mine here is some more data, if you like that kind of thing.

Last year I looked at days where I had the same Pressure Settings and Machine Settings and the same mask.
I only changed the EPR and looked at the effect on the Achieved Median EPAP and 95% EPAP.
When I lowered the EPR (red numbers) the EPAPs went up (green numbers) and vice Versa.
For example between 20 and 21 March the increase in EPR from 0 to 3 gave a fall in EPAP values and so on.

I just include this in response to your original post and hope this gives you some idea of how this kind of works for some of us. 
Of course if you change the Min Pressure and Max Pressure and EPR at the same time things will get a bit more messy!
Caveat Emptor etc.

So if you are on a fixed CPAP of say 7 cm H20 with EPR 0 and you then want to increase the EPR to 1 for some reason, you will want to also increase the CPAP value to around 8 cm H20 otherwise your EPAPs will fall to around 7, and may fall below the level you need to stave of (most of) your Obstructions.

Hope this helps a little.

......

SH, thanks!    I will try a full face mask once I am through this round of experiments.   It does sound promising, though, so it is definitely on my "to do" list.   Getting rid of my pop-pop-pop lip flutter would be great; it is muted by my recently-adopted trick of wrapping a cloth headband around my head but over my mouth but it might be even less disruptive to my sleep if it wasnt happening.

I swear that I'm not chasing some perfect score:  I just want to be not-stupefied, not-brain-fogged, not inert.     The problem had become so acute that I was dragging around to an array of specialists (ENT, cardiology, etc.) to try to find out why my quality of life had deteriorated so dramatically.  As it turns out, of course, the problem was my APAP settings!   So, I am intent on settings that make me feel better.  I wouldn't mind lots of OA's if they weren't part of a night of poor-quality thin sleep that left me foggy-brained and headachy.   Right now, there's nothing showing on my OSCAR charts except the OA's -- so, I have to assume that they are (most of) what is leaving me foggy/groggy -- although your idea about changing "mode" does suggest an alternate route.

I will spend some time learning about Flow Limits but only after I've worked my way through EPR and Min Pr settings -- and, perhaps, changing the Mode from "for her" to "for him," to see if that makes a difference.  I agree that it's prudent to change things slowly and change only one thing at a time.

Love the correlational work.  I'd like to add in a set of variables about how well I feel on a number of dimensions, unless I find a magic formula that makes everything perfect and then don't have to think much about this for a long, long time.  (Ideal outcome!)   Did you download the data from Oscar or did you create the spreadsheet by hand?   Let me know because, if its downloadable, I'll feel really dumb if I essentially make a set of punch cards.
Post Reply Post Reply
#40
RE: Brain fog, lack of energy -- why did dropping my EPR make such a difference?
(09-22-2021, 03:08 PM)SarcasticDave94 Wrote: Is it safe to say your chart with lower flow limits is more comfortable and adds more to being well rested? If so, you're definitely headed the right direction.

Yes, last night's (appended earlier in the threat) sleep (EPR 3/Min Pr 8, 95% Flow Limit .05) was more restful than the previous night (EPR 3/Min Pr 7, 95% Flow Limit .15) (also appended earlier in the thread).   

I did not feel as rested as I did during the earlier nights with EPR 1/Min Pr 5, though.    BUT most of those EPR 1/Min Pr 5 nights had 95% Flow Limits of over .10 -- generally not more than about .15, but still over the desirable 1.0.    On the other hand, those EPR 1/Min Pr 5 nights also had tended to have absurdly low AHI's -- often, less than 1.    So, not much was happening (that was being recorded) other than some weird breath stuff related to Flow Limits.

So I will continue experimenting.   Min Pr up by 1 tonight, to 9.    Let's see what happens.

Thanks.
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  New user with central apnea, screen shots included, what changes should I make? mrfast 7 171 10-21-2021, 06:02 PM
Last Post: SarcasticDave94
  AHI difference between DS1 and ResMed S9 jas32 2 130 10-15-2021, 10:02 PM
Last Post: jas32
Sad Oxygen dropping when falling asleep Stephenie.welch 3 215 09-22-2021, 09:37 PM
Last Post: S. Manz
  [CPAP] My Supplier Says There's No Difference Between a "for Her" Airsense10 and others S. Manz 20 1,029 09-22-2021, 01:45 PM
Last Post: CorruptAlligator
  Can I Make My Resmed ASV act like a Bipap? FormerSnoreGremlin 1 165 08-28-2021, 03:54 AM
Last Post: SarcasticDave94
Question ASV Mode vs ASVAuto Mode - What's the Difference? RayBee 26 3,014 08-21-2021, 08:16 PM
Last Post: S. Manz
  Leak rate super low, Low AHI ..waking up with brain fog? tierdal 17 560 08-11-2021, 12:22 PM
Last Post: Sleepster


New Posts   Today's Posts






About Apnea Board

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