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Hi Everyone,
Been having a tough time with sleep and could really use some advice and help. I have recently re-started using an APAP and have tried several settings based upon research and recommendations in several posts. I have been doing a ton of research on this forum and a few others and have learned so much. What a great resource.
Some Background: In 2015 I had a home sleep test after complaining to my primary care Doc about waking up gasping for air and experiencing several symptoms associated with sleep apnea. The test revealed that I had mild OSA and an APAP was provided. I wasn’t given a sleep study report or even told what my AHI was. The APAP provided was a Phillips System One. I was started out at a pressure rate of 4 min/20 max, but my remote DME changed settings over several months to 6.5 min/20 max. I never really had any issues adapting to treatment and for the most part it seemed to help.
After about 12 to 15 months (2015-2016) I had developed severe back issues that required 2 surgeries and subsequently lost 50 lbs. With the weight loss my previous symptoms of waking up gasping for air subsided to the point that I didn’t think I required the assistance of an APAP. I took myself off and all seemed fine. This continued until the past few years (2018–2020) when I experienced really poor sleep, waking up frequently (fragmented sleep) and short duration, perhaps 5 to 6 hours duration regularly. I have been able to keep my weight off however and still don’t have any sensation of not breathing or gasping for air.
I am a disabled Veteran and use the local VA for my Primary care now. I requested a sleep study from the VA back in early May, and it was conducted overnight in a Lab on 6/30. It took me two months to get the results after complaining regularly. Even though I hadn’t received the report from the VA yet, I knew that the study indicated I had sleep apnea since the Lab tech told me so. Given this, I pulled out my old System One and started using it again while waiting for the VA to provide my report and recommended course of treatment. The sleep report indicated moderate OSA, 1 obstructive, 1 central and 35 hypopneas for an AHI count of 7.2. It also indicated 56 arousals total, 9 respiratory and 11 leg movement (PLM) arousals.
I have tried various settings on my system one by pouring through the data and doing extensive research on this forum. I have increased the pressure from 6.5 slowly up to 10, played with AFLEX settings, 1 2 & 3, and while my AHI numbers were decent <3, I still had fragmented restless sleep and short duration.
While waiting for the VA to complete my study for two months, I came upon a great deal on a new ResMed AirSense 10 Autoset. The results were startling, AHI numbers consistently <1, however I am still experiencing restless and fragmented sleep, awakening several times a night. Over the past 6 weeks I experimented with the Autoset changing the minimum pressure and EPR settings and although in general I am sleeping deeper and better overall; my sleep is still fragmented with several awakenings. Given the lack of adequate sleep, I am constantly fatigued, frequently in a fog, tired, horrible mood and everything else that goes along with it.
Looking painstakingly at my data over the past several weeks, my flow rate seems to indicate several flow limitations at times (flat tops) which lead to arousal. I could be wrong given my limited experience, but that’s what it looks like to me. Given this, and the fact that I can’t seem to get past the fragmented sleep no matter how I change my APAP settings I think I need pressure support due to the flow limitations and am thinking I may do better on an Aircurve VAuto. The VA is sending me a Phillips Dreamstation APAP and I know from personal experience with my System One, and this Forum that this is the wrong equipment for me. They also Titrated me at 5-10 which is way too low. I need 9-10 min with 20 max on a Phillips to keep my airway open.
Other info:
Meds: Synthroid & taking some supplements for the PLMS
Mask: Spent a small fortune over the past few months buying and trying several types of masks. Best set up for me with minimizing leaks has been the P10, taping mouth and using a chin strap (Bad mouth breather)
Sleep Position: Back and Sides
I have attached a copy of my recent sleep study and some Oscar charts from my System One and new Autoset.
I am sorry this is so long. I attempted to provide enough background and information to be useful. I am at my wits end trying to find a way to get better sleep, improve my quality of life and am turning to the experts on this forum for help. thank you in advance for any advice you can provide! I really appreciate it!