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

[Help Requested] How to improve?
#1
[Help Requested] How to improve?
Hi all,

Thanks in advance for taking the time to review my post. I'm not feeling much better after being on CPAP therapy since May. I'm due for a titration study in late October so hoping that may help clear things up. But in the meanwhile, hoping to gather opinions on my treatment / sleeping patterns.

Background: After a "take home" sleep study (AHI: 5.1), I was diagnosed with 'mild' Sleep Apnea earlier this year (~May timeframe) and was put on a CPAP (Resmed Autosense 10). I've tried a few different configurations (nasal mask -> nasal pillows, 5-6 variable pressure to 5.6 fixed), but I still find myself waking up exhausted in the mornings and feeling tired throughout the day, especially around 4-6PM. Example: it's 430PM PST and after getting at least 8 hours of sleep with a ~3 AHI, I'm tired. Didn't do much today besides go grocery shopping.

I also get wired at night, likely insomnia, and have at times suffered from what I think is restless leg syndrome. These latter symptoms have improved post-CPAP, but still occur at times.

Oscar data: I've noticed a few things. First, my AHI tends to fluctuate up and down, hitting 5 at times. Second, regardless of the AHI level, most of it is being driven by "Clear Airway" events. Is it possible that I have central sleep apnea or UARS?

Thanks again!


Attached Files Thumbnail(s)
           
Post Reply Post Reply
#2
RE: [Help Requested] How to improve?
I don't see evidence of UARS. With a diagnosis of mild sleep apnea and AHI of 5.1, it's not likely you have central sleep apnea and that what you are seeing on your graphs above may be treatment emergent, and may settle down in time.

Do you have access to reports from your at home sleep study? If you do, post it here for review.
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#3
RE: [Help Requested] How to improve?
Hi thanks for the response. I don't have access, but can request. Is there anything in particular I should ask them for?
Post Reply Post Reply
#4
RE: [Help Requested] How to improve?
For your restless leg you can try taking iron and vitamin C (250) together.  I took it for a while on doctor's recommendation  and it did help.
Sleep-well
Post Reply Post Reply
#5
RE: [Help Requested] How to improve?
The sleep study report asked for should be a detailed multi-paged type not the summary only. Whatever you get is better than zero info though. The reason is you need these to put in your personal medical file. Here in the US it is yours to obtain legally per HIPAA.

I would suggest turning off Ramp. Your low therapy pressures do not dictate it is needed. It also adds pressure swings that can increase CA events including the treatment emergent variety. Consider bumping pressure to 6 and with EPR at 2. This may need to change with more data to base setting changes.
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
#6
RE: [Help Requested] How to improve?
Bumping this old post - please do let me know if starting a new thread would be preferred. Providing an update as well as seeking feedback.

It's been a little over a year since I first posted. I did a sleep center titration / sleep study and have also had my pressure settings adjusted. Unfortunately, I haven't experienced much improvement in my symptoms. For instance, I find myself still waking up feeling "tired" (i.e. unrefreshed), getting sleepy during the day, and find my concentration to be lacking.

I've done extensive bloodwork and have worked with my Primary Care Physician to rule out other causes - it's been negative on these tests. We do think that I may have Persistent Depressive Disorder as well as Irritable Bowel Syndrome. I've been addressing the former with an antidepressant and for the latter am working with a dietician.

Still, I can't help but think that my sleep just isn't where it needs to be. Despite pressure adjustments, it's extremely rare for me to hit AHI < 1.0. The events that do occur are typically Clear Airway events (Centrals).

I'm currently exploring the following:
(1) Reducing EPR as I hope this will help reduce the Centrals
(2) Trying out a cervical collar - I'm on nasal pillows and have noticed that I wake up with a congested nose and dry mouth
(3) Playing with humidity settings - see above on congested nose

Attaching some reports as well (Sleep Study readout + 2 recent OSCAR reports).


Many thanks in advance for your time and advice.


Attached Files Thumbnail(s)
           
Post Reply Post Reply
#7
RE: [Help Requested] How to improve?
Your sleep titration test confirms good results at relatively low pressure. The test notes a high non-respiratory arousal index, and that is likely the source of ongoing fatigue. We can try looking a a close-up of your respiratory flow (3-minutes) where the flow wave is clearly visible. You have always had a variable inspiratory flow rate. I don 't know that we can suggest therapy changes to resolve the problem, but we might as well take a closer look.

Thanks for coming back to your original thread. It helps not to have to search for the old one and it appears this is a continuation of the same issues.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#8
RE: [Help Requested] How to improve?
@Sleeprider thank you for the reply!

Where are you getting that I have a high non-respiratory arousal index? Are you deriving this based off of total arousal index minus resp. arousal index? What is a "normal" index number? My sleep doc didn't mention or point this out when we reviewed the test results a year back but now I wish that he had.

Is it possible that these arousals have something to do with my jaw opening at night?

Here's some close-ups of my flow rate - hope these are helpful.


Attached Files Thumbnail(s)
           
Post Reply Post Reply
#9
RE: [Help Requested] How to improve?
So you have 2 each of Obstructive Apnea and Hypopnea, and 6 Central, and the diagnosis is Obstructive Apnea.

2+2+6=4?

I guess the tech has BDDDB degree. That's Blind Deaf Dogs Don't Bark, compliments of K9U.
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
#10
RE: [Help Requested] How to improve?
Bumping this thread. Since I last posted, I began utilizing a cervical collar, not too sure if it's having a beneficial effect on me.

I've also reduced EPR to 0 and have been slowly ramping up my min and max pressures. It appears my centrals have gone down, but I'm seeing more flow limits and hypopneas. I've read elsewhere on the board that EPR is typically used to treat flow limits, but for me, I worry it would lead to increased centrals.

Also, I've noticed that as I bump up the pressure ranges, I'm still hitting the max pressure, likely due to flow limitations.

Appreciate any guidance folks can provide.


Attached Files Thumbnail(s)
       
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  Central apneas and tips to improve CPAP therapy jcp519 20 1,287 02-21-2024, 12:37 PM
Last Post: jcp519
  [split] Doctor won't help improve Vauto settings JohnCondor 7 527 02-19-2024, 04:20 PM
Last Post: SarcasticDave94
  Improve Respiratory Rate? MrIvanDrago 4 348 02-16-2024, 01:23 PM
Last Post: MrIvanDrago
  Improve my CPAP Performance dpoelker 4 261 02-06-2024, 03:27 PM
Last Post: Sleeprider
  Advise requested: Should I LOWER my pressure? Aknakon 21 1,135 12-22-2023, 08:25 AM
Last Post: Sleeprider
  New CPAP user here. Ready to learn. Please advise how I can improve! Sleepyman12 4 502 12-13-2023, 05:51 PM
Last Post: PeaceLoveAndPizza
Question Help interpreting OSCAR results to improve my sleep Provolone 5 541 11-08-2023, 11:13 AM
Last Post: Provolone


New Posts   Today's Posts


About Apnea Board

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