Continuous problem. Please advise.

[Visitor]

I'm using cpap consistently (as in every night for at least 7-8 hours and often more)

Settings

Start pressure 4.0

Minimum setting 8.5

Maximum 12

This gives me a (near constant) Pmean value for the last three weeks of 8.5 nearly every day (software readings)

AHI is 0 on most days

The problem

For the last month, I have been exhausted again (pretty much every day), as I was before using CPAP. This has gotten worse and now I am dragging myself through the days.

I can't figure out what is wrong. Leakeage is within range of the manual specifications for the Breas. Some days I wake up out of breath, and some days (though not often) with a dry mouth. Most obvious symptom is drooping eyelids (very bad case of it).

When I have the occasional bad night, leaving me tired during the day, I write it off as normal. When it is consistent, like last month, it wears me out. I get depressed. This is a concern, as I experienced it before using the cpap solution (which changed my life). I know it is apnea related so I'm keen to avoid medication (which I've not taken before either).

I will schedule a meeting with the specialist asap.

Some things I've tried

I refrained from asking advice on intermittent problems, have dealt with leaks as best as I could, made sure to clear passages by adjusting the nasal mask before I go to sleep, have tried every trick I could think of night after night to optimise matters, and I can't think of anything else at this stage. I also ordered a new mask (the Philips Nuance Pro Nasal Pillows) to see if a change could help. I'm using the P10, clean it regularly, make sure that the vents are cleared etc.

Advice?

This is just to check if anyone might have any suggestions on what else could be wrong. Are there things I should keep in mind when I meet with him?

Could I need Bipap? I know there are ways to check this, but I can't interpret the graphs for this issue (and really consider that the specialist's job). Paula mentioned I might look into lowering exhale pressure on the Breas, but it does not have this option.

Hope the apneaboard hive mind can suggest some possibilities I might broach with the specialist or some tips I could still try out.

[brianwood619]

If your waking up out of breath is there a possibility you have copd. If copd is a possibility then typically BiPap helps out better with that disorder as well as central apneas.

[AshSF]

Your RERAs might still be high. I have a machine that reports RERAs as well. For me, the AHI was under 1 pretty soon but I used to feel not so fresh some mornings. I saw that RERAs were higher on those days. So, I raised my minimum pressure from 4 to 7 slowly in 1 cm increments. And I feel fresh every morning consistently now.

Now the only variable that can make me feel less fresh is the hours of duration of sleep. I need to sleep 7+ hrs to feel good.

[Sleeprider]

Without data and graphs, we are left to pure speculation. Since your machine is not compatible with Sleepyhead and other software most use here to evaluate issues like this, you should probably get input from you doctor or DME who can review your data. You mention that you're managing leaks as best you can, but don't offer a leak rate. If you are in large leak much of the night, the AHI events cannot be detected by the machine, and of course leaks are detrimental to a good night sleep. If this is something you want to focus on as an issue, it would help to know if you are experiencing leaks around the mask interface, from tubing or connections, or if you might be mouth-breathing.

[herbm]

and with a P10, you should be able to get your leaks down to new nothing.

P10's are so quiet that any significant air noise is a leak -- get your pillow seated better, change sizes, or ensure you're keepng your mouth closed.

Also, don't sleep AT ALL without the mask -- you seem to be saying you sleep most of the night with it -- use it 100% of the time.

If you get good treatment then do pursue other causes with your doc.

[Mr. Van Winkle]

[
Advice?

This is just to check if anyone might have any suggestions on what else could be wrong. Are there things I should keep in mind when I meet with him?

Could I need Bipap? I know there are ways to check this, but I can't interpret the graphs for this issue (and really consider that the specialist's job). Paula mentioned I might look into lowering exhale pressure on the Breas, but it does not have this option.

Hope the apneaboard hive mind can suggest some possibilities I might broach with the specialist or some tips I could still try out.
[/quote]

Have your Testosterone level checked, you sound like it could be off.
just a thought.
Good Luck hope you get better soon.

Mr. Van Winkle

[Visitor]

Thanks for the replies. I can post stats, but people tend to respond that they can't figure them out as they are too differently displayed from sleepyhead etc. (I posted some in the past).

I checked leaks on the stats given by the software and they are in normal range.

I do wear the mask all the time.

I breathe at times with my mouth as the chin strap slips and head gear slip at times to different positions, leaving too much leeway (the P10 is great, but the headgear sucks). But even during nights where the gear does stay on, I have problems.

Why do you bring up testosterone Mr. V. W.? There could be other causes than a CPAP issue of course, but I've had blood tests before and everything was in normal range (including testosterone).

[Mr. Van Winkle]

Why do you bring up testosterone Mr. V. W.? There could be other causes than a CPAP issue of course, but I've had blood tests before and everything was in normal range (including testosterone).
[/quote]

Sorry I didn't mean to offend you in any way, I know low t can make you tired and run down (no energy) and depressed.
I'm not a doctor, but I do treat myself for low t.
Best wishes!

Winkle

[archangle]

This is yet another example of why you need a fully data capable CPAP machine with airflow waveforms.

How did you end up with a Breas machine? Do you live outside the US? I thought those were mostly used outside the US.

I don't think the Breas does airflow waveforms, but I could be wrong. Do you have software to read your data, or do you get it off the display somehow.

You might try raising your minimum pressure. It could be that even though you're not having apnea, you're having airflow limitations. Does the Breas machine distinguish central apneas from obstructives?

You might see if there's some way to get a fully data capable CPAP among the models listed as good in my signature line. Sometimes you can find a good machine through Craigslist fairly cheaply.

[Visitor]

No offense taken Winkle. Problem is, those symptoms can stem from a number of issues. I'll get a blood test as well as consulting the specialist, just in case.