[CPAP] Too Sleepy's Therapy Thread

[Too Sleepy]

Hello,

Thank you to whoever replies to this. I was diagnosed with an AHI of 11, purely hypopneas- no apneas or RERAs were noted during my in-lab sleep study. I have severe symptoms: drowsiness, sleepiness and general body fatigue. This all started about three years ago and has been progressively getting worse and worse. I started using APAP full-time from the 1st of January, before that I was getting acclimated and couldn't use the mask a full night. However, I progressed to now being able to fall asleep and wake up with the mask secure without any issues. I use P10 nasal pillows which I find comfortable.

Regarding APAP settings, my doctor hasn't helped me at all. I had no titration study done. When I was given my diagnosis near the end of last year the doctor simply said "try out a fixed pressure of 4" without any evidence as to why that would help- it didn't. I haven't been able to get an appointment with the sleep department since then (NHS). 

I'm still very tired, and although it could be that my body is recovering from sleep debt, I have a feeling that something isn't quite right with my CPAP therapy. And I don't have the knowledge to be able to tell what's wrong. Could any of you please help me? OSCAR screenshots below.

Notes:
- Fall asleep and wake up fine with the P10 Nasal pillows
- I have woken up with a dry mouth for the last three days. All the other times I haven't noticed a dry mouth at all.
- I seem to still be waking up during or after dreams, as I have a vivid recall to my dreams.

Thanks!

[Too Sleepy]

More zoomed in screenshots here.

[staceyburke]

Welcome, the only thing I see is that your min 4.6 and your EPR 3 can not work together.  The absolute lowest the machine can go is 4.  EPR (exhale pressure relief) is used to make breathing easier and help with flow limits (which are apnea also but not recorded in the AHI.

Simple fix is to raise the min to 7

That would make the inhale 7 the exhale 4.

Give it a try tonight and I think you will do better.

[Too Sleepy]

Thank you for your response. Could you expand on this to help me understand?

I use a minimum of 4.6 because any higher and I can't fall asleep with it. Do you see flow limits in my charts due to the minimum pressure being too low?

[OpalRose]

Welcome to ApneaBoard!  

Your doctors recommendation of starting with a pressure of 4cm isn't doing you much good.  The use of EPR 3 should be helping, except you are not receiving any benefit with a low minimum pressure.  The machine can't go any lower than 4.  

Let's raise the minimum pressure to 7cm with a maximum pressure set to 12cm.  Keep EPR set at 3.   Note that EPR can raise clear airway events, but I'm not too worried right now since they didn't show on your sleep study and will probably lessen in time.

Edit: I know you seem hesitant about raising your pressure, so take it slow. Try using your machine for an hour before bed, sitting up reading or watching TV. Turn the pressure up to 5, then 6 until you work up to 7. You won't notice this increase in pressure when you are distracted doing something else. In a couple days, you should be able to use the recommended setting of 7cm. You need to trust your machine and let it work.

[Too Sleepy]

Hello, 

Sorry just to clarify. His idea was to do a fixed pressure of 4. My AHI with that setting was too high. So I changed it to APAP mode, 4.6 min to 8 max. My average pressure is 5.3.

[Too Sleepy]

Are the leaks anything to worry about? As I said, recently I've had dry mouth. I wondered if the flow rate indicates that the therapy isn't working.

[OpalRose]

Your main complaint is:
"I have severe symptoms: drowsiness, sleepiness and general body fatigue."

There is more to sleep Therapy than just AHI numbers.  Your numbers are low, but you're still struggling.  Unless there are other reasons for the drowsiness like poor hygiene habits or other medical issues, then we look at Flow Limitation.  The flat tops and areas where there is a dip in the top of the flow wave usually point to FL.

FL and Hypopnea cause sleep arousals that you may not be aware of.

As stated prior, you are not receiving the full benefit of EPR with a pressure set lower than 7cm. Your therapy isn't optimal if your tired all the time.

Also, dry mouth usually points to your mouth/jaw dropping open and allowing air to escape. Your leak rate isn't high, but even small leaks throughout the night can be disruptive.

[Too Sleepy]

Hmm okay. I will try mouth-taping and also adjusting the pressure. The thing is, I can't seem to tolerate anything higher than 4.6 while I'm awake otherwise I feel like I'm working too hard to inhale. Any tips on adjusting to higher pressures?

[OpalRose]

Any tips on adjusting to higher pressures?

Did you read this suggestion that I posted above?

"I know you seem hesitant about raising your pressure, so take it slow. Try using your machine for an hour before bed, sitting up reading or watching TV. Turn the pressure up to 5, then 6 until you work up to 7. You won't notice this increase in pressure when you are distracted doing something else. In a couple days, you should be able to use the recommended setting of 7cm. You need to trust your machine and let it work."