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How can I make my treatment more effective?
How can I make my treatment more effective?
Hello all - I've been using a BIPAP for about 15 years, with varying results.  For the past couple of years, I feel like I've been tired all the time, seemingly as bad as before I was originally diagnosed with sleep apnea.  I nap whenever I get the chance, and I feel like I sleep entire days away on weekends etc.  To be fair, I don't think that is all due to apnea, it's partially mental health related.  I have some depression (who doesn't, these days?) and ADHD, and some of the sleeping a day away is as much due to a lack of motivation as to being tired, but if I can get past the tired issue it would certainly help. 

It has been several years since my last sleep study, so I don't have those results or prescription info available currently. I thought I remembered my top pressure from the sleep study recommendations being very high, something over 30, but looking at the OSCAR data it appears to peak at 20. I know my settings have been changed a time or two in the interim by the respiratory therapist at the DME, but I don't remember specifics.

I just installed OSCAR and downloaded the data from my AirCurve v10 Auto.  I'm no expert, but from what I know the data looks less than idea.  Hopefully some of the more knowledgeable people here can help me to understand what I'm looking at and what I can do to improve it.  I will include screenshots of the daily and overview tabs below.  I got a new mask yesterday, the Dreamwear Full Face, so I'll include the prior day's daily data as well since it may be a more accurate picture of where I have been.  My old mask was a Resmed Swift FX, with a chin strap.  I decided to give a full face mask a try again because I felt like the chin strap was not doing a great job of keeping my mouth closed.   

The screenshots are below, and if I can answer any other questions or provide more info to help please let me know. 


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RE: How can I make my treatment more effective?
Welcome to the forum.
A simple question, why is your PS at 7?
Do you have any breathing issues other than apnea?
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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RE: How can I make my treatment more effective?
No other breathing issues.  I do remember that being a part of the recommendations from the last sleep study though.
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RE: How can I make my treatment more effective?
I have had apnea & adhd diagnoses during the course of my adult life. in retrospect I am certain they were both present in my childhood. there's also no question in my mind that adhd is caused by or at least exacerbated by sleep deprivation. same with depression symptoms. there's simply no way to maintain vigor, vitality & motivation from a state of exhaustion.

I don't think my adhd is gone exactly, but you may find, as I have, that symptoms of adhd & depression are significantly reduced by better sleep. apnea isn't the only wrecker of sleep but if we're lucky, properly optimized cpap is all it takes. otoh, sometimes we have to look beyond apnea for more restorative sleep. whatever it takes, I think there's a better than even chance that better sleep will help you with those other things.
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RE: How can I make my treatment more effective?
The apnea definitely aggravates the ADHD.  Now that you mention it though, I've also felt for a couple of years that my ADHD meds weren't as effective as they used to be.  I never associated those before, but it has been roughly the same time period.  Not that I can do without my ADHD meds, because if I don't take those for a day, those are the worst of the days where I lay in bed all day and do nothing.  It would be nice though to get more out of them than just forcing me to wake up stay awake through the workday.
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RE: How can I make my treatment more effective?
I see two problems.
1. positional obstructive sleep apnea
2. incorrect settings with ridiculous pressure support.

Read the positional apnea wiki that describes how your airway becomes blocked by "chin-tucking" http://www.apneaboard.com/wiki/index.php...onal_Apnea
Read the Soft Cervical Collar wiki that describes the solution. http://www.apneaboard.com/wiki/index.php...cal_Collar

Change your settings:
Mode Vauto
EPAP min: 10.0
PS: 4.6
Max Pressure: 18.0

You must implement the whole routine to get this to resolve. The soft cervical collar will make lower pressures and pressure support effective, and you will be much more comfortable. Your AHI may be reduced below 2.0.
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RE: How can I make my treatment more effective?
before I finally found partial relief from sleep deprivation with cpap & by reducing my periodic limb movements, I had built up to taking between 60 & 100 mg generic adderall & 200 mg modafinil and I still napped 1 to 3 times a day. now just 200 mg modafinil & I can't nap through it. attitude, focus, motivation, perseverance, etc., are much improved. hopefully you will have a similar experience.
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RE: How can I make my treatment more effective?
Thanks for the suggestions.  I ordered a couple of collars, but one didn't fit at all, and the other was too tight (I tried sleeping with it for a couple of hours, and had an AHI of 12 for that period.  Ouch!).  

While waiting for those to come, I picked up a couple of different pillows that were available locally and which I've heard can help - a neck roll pillow and a wedge pillow.  I tried each for a couple of nights, but after lying awake for hours, I gave up and went back to my regular pillow.  I think the issue with both is that I feel like I have to lay flat on my back, and I generally roll around several times before getting to sleep, both sides, back, stomach, all over.  My wife says that once I get to sleep, I settle onto my back, but if I can't get there, these pillows aren't going to help.  I actually do kind of like the neck roll pillow, if I allow myself to move around, but then by the time I get to sleep I'm unlikely to end up with it positioned properly to keep my head back. 

So, I've ordered a 3rd collar (3rd time is the charm, right?) that should be a better fit, and a buckwheat pillow which seems more like my style.  We'll see if either of those work out any better. Meanwhile, I haven't changed any settings for my machine yet.  Since Sleeprider said that I need to implement the whole routine, I thought I'd wait until the collar arrived, but given that I'll be waiting a couple more days, maybe I'll try adjusting the pressure settings tonight.    I'm hopeful that a little lower pressure setting would eliminate some leaks, and maybe allow me to loosen the straps a little.  Right now, I have to have the mask uncomfortably tight around my head to keep it sealed to my face. 

I'll share another update as soon as I have something to share.
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RE: How can I make my treatment more effective?
You should start the new pressures tonight - don’t wait.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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RE: How can I make my treatment more effective?
I vaguely remember being told in the past that there are a couple of settings which can't be used together. I don't recall whether this was for my current or previous machine, but I want to say that it was the Auto mode and either smartstart or ramp. Does that sound right?

When adjusting settings in the machine tonight, I was able to adjust all of those settings, so I assume that there is no conflict between them, at least with my current machine?
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