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New APAP user. Still. so. tired.
#1
New APAP user. Still. so. tired.
I was diagnosed 2 weeks ago with severe sleep apnea (37 AHI/hour).  I am now using a Resmed Airsense 10 Autoset for Her.  My prescribed pressures were 5 - 9 cm, but I was topping out in pressure at those levels, so I've been trying to tweak.  I am currently at an 8.6 minimum with an 11 max (I tried a 12 max, but this caused me to swallow a lot of air, so I've turned it back down).  Can someone please take a look at my charts and offer some advice?  I'm not waking feeling rested.  It's still very much a large effort to get out of bed, I wake with a headache, and I feel the need for a nap in the middle of the day.

Also, I wanted to note that the central apneas occur when I'm sleeping on my side.  I tend to sleep mostly on my back and then switch to my side in the early morning.


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#2
RE: New APAP user. Still. so. tired.
The leak rate is very good, I wish I could get mine that low. 
Your upper rate set at 12 was to much but at 11 you are not getting enough pressure - you are bouncing to  the top and your chart shows you need it higher.  I would try 11.6 and see if that is comfortable and does not this the top need for pressure.

I would set the EPR to 1.  That might give you more centrals (on your back you had 0) but it should help with flow limits.  And that should help you sleep better.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
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#3
RE: New APAP user. Still. so. tired.
To add to stacey's info: A good plan of attack in regards to aerophagia/air swallowing is to slowly raise pressure upward over a series of days. Right now you're using a Max of 11, so you may have to keep it there a day or so and then bump it up a bit and repeat several times to get the Max where it's needed. Air swallowing seems to gradually disappear as we adjust to PAP therapy.

Welcome to Apnea Board. And best wishes to successful therapy.
Dave

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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.
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#4
RE: New APAP user. Still. so. tired.
Your flow limitations are very high and the use of EPR will reduce them. To understand flow limitation and how EPR can help, read the wiki http://www.apneaboard.com/wiki/index.php...imitations Your sleep is not satisfying because flow limitation means you are expending a lot of respiratory effort which causes arousals through the night. This is the most common problem with flow limitation, and resolving that problem should make you feel better.

Normally when we turn on EPR, pressure becomes less variable and can even become lower overall. EPR can reduce both hypopnea and RERA. In some individuals an increase in CA events may occur as the increased ventilation reduces CO2. The only way to know if you're sensitive to this bilevel pressure is to try it. EPR settings correspond to a difference in pressure between inhale (IPAP) and exhale (EPAP) pressure and ranges from 1 to 3 depending on the setting used. Dave suggested setting EPR at 1, and while that will help, you probably need a setting of 2 or 3 to reduce the flow limits we see in your results.
Sleeprider
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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.
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#5
RE: New APAP user. Still. so. tired.
I'm in agreement with SleepRider. Look at the second chart. You were using ramp with EPR 2 for a short time. Now line that up with the Flow Limit graph and you should notice that for the short ramp period with EPR 2, there was no Flow Limitation.

I'm not sure, it could be that FL don't record during ramp....does someone know?

I'm not a fan of ramp, so I would suggest turning it off. If you can't do without using ramp, then be sure that your EPR setting is for all night, not just ramp time. This should help with Flow Limitation, Reras.
OpalRose
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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.
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#6
RE: New APAP user. Still. so. tired.
Aerophagia is a challenge I've had to overcome, but I have done so successfully thanks to the advice on this board. I'd encourage you to search the board for that word, and try some of the solutions. Things that have helped me are keeping my head *& shoulders* elevated higher than my lungs, and sleeping on one side rather than the other. I'm sorry I've forgotten which side that is; but I found that tip here, and it really does help.

As I'm falling asleep, sometimes I can feel the air going into my abdomen area (stomach?), and it's a reminder to me to elevate my head/shoulder a little more or to turn onto my other side.
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#7
RE: New APAP user. Still. so. tired.
Thanks everyone. I'm going to turn off ramp, turn my max up a bit, and turn EPR on to 2. Will re-evaluate tomorrow. Fingers crossed!!
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#8
RE: New APAP user. Still. so. tired.
Ok, I made the changes suggested.  Here are my results from last night.  Any additional feedback?  I definitely feel a bit less tired today, and I didn't have any trouble with aerophagia!


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#9
RE: New APAP user. Still. so. tired.
You were able to use EPR at 2 with fewer overall events, and especially your CA events did not rise. Feeling less tired is a great result. Flow limitation is still high so I think you will benefit with the following changes:
Minimum pressure 9.0
Maximum pressure 12.0
EPR 3

This will increase the exhale pressure relief and will hopefully reduce RERA and hypopnea.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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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.
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#10
RE: New APAP user. Still. so. tired.
Ah, so I actually used an EPR of 3 last night instead of 2.  Do you still think increasing both max and min pressure is the way to go?
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