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New to CPAP, feeling like a zombie
#1
New to CPAP, feeling like a zombie
Hello, I've only been on a CPAP for about 2 months and using OSCAR for 10 days.  I'm feeling especially tired this morning and wondering if there's something in my graphs that's obviously the culprit.  I'm still trying to make sense of the graphs.  I am a mouth breather and I tried the mouth strips for the first time last night.  Although my AHI is better than the previous night, I feel just as tired (if not worse) than yesterday.  There appears to be some event activity around 3:30 a.m.   Unsure


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#2
RE: New to CPAP, feeling like a zombie
Welcome to the Apnea Board,

I'm seeing 3 areas that need to improve to better your sleep therapy. The first isn't too bad, but it has room to get better. Leak rate. It's certainly not a runaway bad state but the leaks might be a cause of disruption.

Now for the other 2, both of which are ruining your sleep therapy. Obstructive Apnea clusters and the higher Central Apnea.

The Obstructive clusters are likely caused by what we call Positional Apnea. This positioning is based on your chin pointing towards your chest, causing neck airway kinking, imagine the garden hose being kinked and restricting water flow. Causes? A thick or high stack of several pillows that needs to be thinner. If not this, then a soft cervical collar may be necessary to keep your head and neck aligned better to reduce kinking. And this Positional issue isn't the same as positional sleep in the sleep study. There it's a back, side, stomach position. Docs don't know about this other issue typically, but PAP users do.

Part three, the machine purple flags of CA or clear airway referring to Central Apnea. For quite a few newer CPAP users, CA present themselves due to an imbalance in CO2 and its being flushed out faster than the nervous system is accustomed to. This can be possibly your CA issue as this can diminish in 3 months of PAP use. There's a small percentage though that CA were pre-existing, showing on your sleep study diagnostic test.

Here's what I'd suggest as actions, test yourself for Positional Apnea by pointing your chin down towards your chest. Notice any breathing difficulty? If yes, you just recreated the Positional Apnea kinking action. Then review your pillow stack and research soft cervical collars.

Next, contact your doc or the test facility and request your full detailed diagnostic test results, and Titration if done. If they resist, mention HIPAA law permits you to request and receive these. You may need to sign a release form. We're looking to see the data with your CA issue, so for myself I'm fishing for the Apnea events count and type chart. Also if comments regarding CA are present. The goal is, get the reports, redact personal info, add into a post to show us the data.

Last one for now, check your mask for proper fitting and see if it leaks. Never tighten one to be uncomfortable or painful. If that's the only way to control leaks, then the mask cushion size is wrong, the straps aren't adjusted correct, or just the wrong mask for you. This is the least of your concerns at this time. Clusters and CA are higher priority.

PS most of your leaks are mouth leaks, signified by the flatter, round pattern shown on the leak trace.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#3
RE: New to CPAP, feeling like a zombie
Welcome to the board you will get some help here. 

You have 2 issues first centrals- I will let dave or others give advice on those. 

Teheran other are OA and H events. Take a look at both graphs (OA - H events l). No they are clustered together. That shows positional apnea. Positional apnea can’t be adhere with Cpap pressure inc. it happens when you sleep in a position that is cutting off your own airway. You have to stop getting into that position. 

Many times it is from sleeping on your back or sleeping on to high of a pillow. Those can be corrected by obvious changes. However if it is not that easy many people have found a collar helps a great deal 

Please look at the link below in my signature link on collars. It shows people without and the same people with collars. Huge difference.
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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#4
RE: New to CPAP, feeling like a zombie
Agree with Dave. My priority would be positional, then centrals, then if still needed the leaks.
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#5
RE: New to CPAP, feeling like a zombie
PS I've forgotten to mention, to act against your CA, consider lowering EPR by 1 and take note how your CA change after a night. Post a chart tomorrow, it'll be evident if EPR made a difference in lowering CA.

The negative of this is that Obstructive, Hypopnea, Flow Limits will probably increase with a lower level EPR. Obstructive vs Central, actions to counteract them oppose one another, 2 sides of a teeter-totter with CA on one side, Obstructive on the other. Acting on either side makes the other go up, at least in the majority.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#6
RE: New to CPAP, feeling like a zombie
Thanks for the welcome!  

I appreciate you taking the time and giving me advice.  I normally prefer to sleep on my back and pre-CPAP I have slept propped up on several pillows because of allergies, initially at least.  I recently purchased a Contour CPAPMax Pillow 2.0 to help me with my position.  I've been trying to sleep on my right side more and this pillow allows for that as well as back sleeping.  I try to use pillow by itself, but it's lower than what I'm used to (even though it's a wedge pillow).  However, a few times I've used it stacked on top of another pillow.  Guess I better stop doing that.  The pillow alone is supposed to help with alignment.  If I continue to have positional apnea, I'll definitely look into a cervical collar.

Unfortunately, an in-lab CPAP/BIPAP titration was denied by insurance.  Instead, I had a home sleep test done (Knox T3 machine) in June that included:  airflow by nasal pressure transducer, chest movement by chest belt and oxygen saturation and pulse oximeter.  Respiratory monitoring showed a moderate number of obstructive apneas and hypopneas with a respiratory distress index of 19.1 per hour. My baseline oxygen saturation was 88%, lowest saturation was 83%.  My garmin watch also monitors my SpO2 and many times the lowest is 75%, pretty scary.  As a side note, I did quit smoking 6 weeks ago, after smoking for over 40 years.  I had a CT lung cancer scan and there were no concerning nodules and some mild coronary calcification.

So I was diagnosed with significant hypoxemia and moderate obstructive sleep apnea- hypopnea syndrome.  I'm surprised there was no mention of central apnea but then maybe the home study isn't as thorough as an in-lab study.  I have a follow-up with my Apnea NP on Monday to discuss CPAP results and possible overnight oximetry testing. She is looking to explore the underlying cause of my sleep apnea, it's not weight related (BMI is 24).  I will request a copy of the sleep study test and post it here.

You may be right about the size of my mask.  I find myself tightening it a lot throughout the night.  I have the AirFit F30 and I just can't get comfortable with it on.  I would prefer not having a full mask but being a mouth breather, I'm not sure if that's possible.  I'm hoping that the mouth strips will help train my brain to breathe through my nose exclusively.  Something else I will be discussing with the NP.

Thanks again!

Thanks
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#7
RE: New to CPAP, feeling like a zombie
Thank you!  I'll take a look at the Cervical Collar link.
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#8
RE: New to CPAP, feeling like a zombie
The report from the sleep test might be useful, but a lower level of info than a lab test. It can't hurt to request the report for your personal health file if nothing else.

Do you recall if there was a wide Velcro belt you had to wear for the test? This is in reference to an effort belt that helps determine whether or not an Apnea had no effort, an indication of Central Apnea. If it had one, the results might be more accurate than you think regarding CA vs OA.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#9
RE: New to CPAP, feeling like a zombie
[attachment=36705 Wrote:SarcasticDave94 pid='419391' dateline='1635451278']The report from the sleep test might be useful, but a lower level of info than a lab test. It can't hurt to request the report for your personal health file if nothing else.

Do you recall if there was a wide Velcro belt you had to wear for the test? This is in reference to an effort belt that helps determine whether or not an Apnea had no effort, an indication of Central Apnea. If it had one, the results might be more accurate than you think regarding CA vs OA.

Yes, I did have to wear a wide belt. This is the set-up that I had.     

 I'm not sure if it's capable of detecting Central Sleep Apnea even though it measures respiratory effort.  It doesn't measure eye movement activity or electrical activity of the brain like a sleep study done in a clinic.  So you think my CA events are not true CA?   Maybe it followed an arousal?  Looking back at my data in the last week, I notice that I have more CA events than OA, also some CSR ones.  Hopefully that one is a fluke.  On Sunday I had 2 CSR events.  The first was for 21 minutes and the 2nd was 15 min long.  That day I also had 71 CA events and 141 OA events.  Is it possible that I have complex sleep apnea?
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#10
RE: New to CPAP, feeling like a zombie
That effort belt setup is similar to a lab belt setup in the image. Effort measures literally are you trying to breathe or not. It would be good enough to differentiate between Obstructive with effort but blocked airway and Central with no effort.

OK so it recorded 71 CA to 141 OA. There's a tendency to have CA, so it's worth noting. With 71 CA there, treatment emergent CA would not be conclusive in your OSCAR chart. That 71 CA states you are predisposed to have some. Best clear cut case would have been 50% CA on the test, but again that's quite a few more than most I'm thinking.

I think we'll need to work at trying to get therapy to "avoid" CA as best as possible, note that it may not be successful. Avoidance is no Ramp or EPR, maybe modified pressures, lessening the range, etc. If avoidance fails, it's on to building a case for ASV.

Begin taking detailed notes on the therapy, how you feel, fatigue, unrest, discomfort, etc. and the CA info from OSCAR, and the adjustments being done to avoid CA. You're building evidence of needing ASV if it gets there.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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