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CPAP for a year. Still feel poorly.
#1
CPAP for a year. Still feel poorly.
Hey all. I've been on here a while, but it's been about 9 months since my last thread. I've been on CPAP for just over a year, and though my numbers are 'pretty good', I still feel like walking death. 

I was diagnosed as mild, with 5.9 AHI (at home test). Based on feedback from my machine early on, I suspect my true AHI is a bit higher - probably in the low teens. 

I'm tired ALL DAY EVERY DAY. I never feel well rested. Waking up in the morning is never not absolutely miserable. I dread going to work every day because I know that work means 8 hours of straining to force my addled brain to accomplish about an hour's worth of actual production. 

I'm still fairly confident that the main culprit is some form of sleep disordered breathing. Prior to being diagnosed, I would not have described my sleep as 'fragmented' or 'disrupted'. But since being on CPAP (especially early on), I've had the occasional 'good night', and have re-learned what actual sleep can feel like. Unfortunately, these nights are few and far between - and they don't seem to have an obvious correlation to my score (good nights are generally low score nights, but a low score does not always equal a good night). 

I'm 26. Male. I'm thin. At least for the last year or so, I've been eating fairly healthfully. I wear a soft cervical collar, and a full face mask. I purchased a latex mattress topper in an effort to get off of my back (only somewhat successful). Lately, I've been keeping the pressure at a static 12.5 cm. 

My scores hover around 2.5 - 4. 

I guess I'm just hoping for some chart gurus to share some wisdom. I struggle with pressures above ~13 (aerophagia), and have not noticed any returns when I've bumped it up beyond that. I have an ENT appointment coming up to look at other options (surgery, oral appliance).

[attachment=13292][attachment=13293][attachment=13294][attachment=13295][attachment=13296]
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#2
RE: CPAP for a year. Still feel poorly.
I would look elsewhere to why you feel poorly. Your chart looks good. did it do a limb movement on the home study?
You could move the pressure up 1cm and see if it clears some more stuff.
you could raise the start pressure up from 4cm to 6 and then 1cm at a time till you can turn ramp off.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#3
RE: CPAP for a year. Still feel poorly.
More charts. 

[attachment=13301][attachment=13300][attachment=13299][attachment=13298][attachment=13297]
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#4
RE: CPAP for a year. Still feel poorly.
(06-28-2019, 10:08 PM)ajack Wrote: I would look elsewhere to why you feel poorly. Your chart looks good. did it do a limb movement on the home study?
You could move the pressure up 1cm and see if it clears some more stuff.
you could raise the start pressure up from 4cm to 6 and then 1cm at a time till you can turn ramp off.

Thanks for your feedback. 

Could be something else, though it's tough for me to rule out disordered sleep, at the very least. 

I've never been able to successfully fall asleep without the ramp function. It definitely drives the AHI up, but I don't really see it as a problem, as it's only undertreating for the relatively short duration. 

I've tried 13-13.5 cm, and a little higher to a much lesser extent. I can give it a go again, now that I'm more adjusted to the cervical collar. 

I wonder if I could be having more RERAs than the chart indicates, and if my problem could be primarily anatomical/positional. Are there circumstances where CPAP cannot alleviate obstruction, regardless of compliance/tolerance?
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#5
RE: CPAP for a year. Still feel poorly.
I've had the minimum bumped up to 14 for the last two nights. 

Unlike in the past, I've had no trouble tolerating it. Might have to do with the cervical collar (which I was not consistently wearing before) doing something to prevent aerophagia? Who knows. 

The first night was a little bit of a step back. Ignoring the ramp period, it looks pretty good - but it's as if the machine stopped responding to my events later in the night. 

The second night (last night) is pretty spectacular. I woke up at around 6 hours in, and my machine reported 0.9 AHI, which has to be the best score I've ever had for that long of a period of sleep. Anecdotally, I woke up having had the most intense, vivid dream that I've had in I don't know how long. Ignoring the ramp period, the second segment of sleep is pretty solid too. I still didn't feel great when I woke up this morning, but I felt that I had slept DEEP, if that makes sense.  



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#6
RE: CPAP for a year. Still feel poorly.
Have you tried zooming in on the flow rate chart to see whether you can spot arousals? Try capturing about 4 minutes and then scrolling horizontally.

Arousals often show up with more irregularity than sleep breathing, and if you are turning over or moving around a lot, you may also see greater amplitude in the flow rate.
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#7
RE: CPAP for a year. Still feel poorly.
(06-30-2019, 09:57 AM)Dormeo Wrote: Have you tried zooming in on the flow rate chart to see whether you can spot arousals?  Try capturing about 4 minutes and then scrolling horizontally.

Arousals often show up with more irregularity than sleep breathing, and if you are turning over or moving around a lot, you may also see greater amplitude in the flow rate.

Thanks. 

At what amplitude should I consider it an arousal? What would that indicated? RLS? 

I definitely see some 'events' of some kind, scrolling around zoomed in, but I'm not sure what qualifies as an 'arousal'.
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#8
RE: CPAP for a year. Still feel poorly.
I'm attaching two charts showing what I take to be arousals, one with a CA and one without.  I think they both reflect partial or full wake-ups, and I think the one with the CA flagged represents me holding my breath while I turn over.  Hope this helps!


Attached Files Thumbnail(s)
       
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#9
RE: CPAP for a year. Still feel poorly.
(06-28-2019, 10:02 PM)Rcol Wrote: Hey all. I've been on here a while, but it's been about 9 months since my last thread. I've been on CPAP for just over a year, and though my numbers are 'pretty good', I still feel like walking death. 

I was diagnosed as mild, with 5.9 AHI (at home test). Based on feedback from my machine early on, I suspect my true AHI is a bit higher - probably in the low teens. 

I'm tired ALL DAY EVERY DAY. I never feel well rested. Waking up in the morning is never not absolutely miserable. I dread going to work every day because I know that work means 8 hours of straining to force my addled brain to accomplish about an hour's worth of actual production. 

Have you considered the possibility that you might have Hypersomnia? A lot of people think CPAP will cure this but its neurological (I think). I h ave similar issues with tiredness and CPAP has taken me 50% of the way there but I get a lot of fatigue due to hypersomnia.

The at home study won't show hypersomnia you have to go into a lab to get that detected.
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#10
RE: CPAP for a year. Still feel poorly.
Quote:Diotima245

Have you considered the possibility that you might have Hypersomnia? A lot of people think CPAP will cure this but its neurological (I think). I h ave similar issues with tiredness and CPAP has taken me 50% of the way there but I get a lot of fatigue due to hypersomnia.

The at home study won't show hypersomnia you have to go into a lab to get that detected.

I have all sorts of theories (Gut issues? Thyroid?), but not much evidence pointing anywhere. Hypersomnia doesn't seem likely to me - though I'm mostly ignorant about it. I don't have much trouble staying awake throughout the day, and I generally take a bit of time to fall asleep. I'm mostly just fatigued, and have poor concentration, and feel sort of inflamed most of the time. But then - the sleepiness is tough to judge, because I self medicate with coffee (not to any extreme degree, 2-4 cups a day). I guess I often have a 'sleepy feeling' in my eyes, but I'm not nodding off.

I've tried (lightly) pushing my sleep tech for an in-lab study, but she tells me she doesn't think it would "give us any new information", and wants me to wait and see what the ENT says about my airway.
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