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New user of APAP (3 months), mixed but generally good results
#1
Question 
New user of APAP (3 months), mixed but generally good results
Hello everyone, first time posting on this forum. I wanted to post my story and get some input from you guys. Been lurking the forum a bit lately and I think you are a wonderful community.

I am a 25 year old male, BMI 19.5 (borderline underweight). I follow a very healthy diet to gain weight, and used to physically active until sleep apnea made it almost impossible to make any effort, be it physical or mental. I suffer from chronic allergic rhinitis and turbinate hypertrophy, and to make things worse I had an accident that deviated my septum at a very early age. I got a septoplasty and a turbinectomy at age 15 that improved my snoring, but recent visits to my ENT show that I got my big turbinates back, and my nose still is pretty big.

I used to be a very heavy sleeper and found it easy to fall asleep. A few years ago I started working out to gain weight and noticed gym days made me somewhere around 13-16 hours of sleep to feel truly rested. Then a few months ago I started having speech problems, could barely concentrate at work and almost dropped out of university because I just couldn't keep up with the pace of things. I also woke up with headaches and tachycardia that would last the entire day. Deep down I knew I was having some sort of sleep problem but I never really knew what it was until my psychiatrist told me to get a sleep study, and it turned out to be sleep apnea. 11 AHI nREM, 35 AHI REM, not dependent on posture, lots of tossing in the bed.
After I got the sleep study results I fell into a vicious cycle of insomnia, sleep debt, and even suicidal thoughts. The wait for the CPAP felt eternal, but it finally came. I got a Dreamstation APAP.

The first day of APAP is undoubtedly the most energetic day in my entire life. I feel asleep very quickly, slept about 7 hours and felt well rested, was able to work out very hard, had a very productive day at work and I felt like I completely turned my life around. Second day was similar, I felt like I woke up a bit too early but it was relatively good. The rest of the therapy has been okay but not quite as good as that very first day. Way better than the two months before APAP, but I still feel like I need around 12 hours of sleep to feel well rested. I can survive on 10 hours a day but every now and then I get cycles of insomnia and sleep debt that have to be broken with old antihistamines or amitriptyline. 

My AHI is usually under 5, but even the days with AHI 0.2 I still don't feel as good as the first day. For some reason I also started getting aerophagia a few weeks into the therapy, something which didn't happen before. I have been taping my mouth shut with transpore tape because the Philips chin strap I got does absolutely nothing to stop it. It's also worth mentioning that at some point my provider gave me a F&P Simplus (L size) mask because my Resmed Quattro FX (M size) was leaking a bit around my hook shaped nose, but for some reason ended up making my AHI worse even though it's incredibly comfortable.

Needless to say, I have had 100% compliance since day 1 and wearing a full face mask means absolutely nothing to me because I do not ever want to go back to pre PAP days.

Now that I managed to type all that out, I wanted to know if you can spot any patterns in my OSCAR data that could help me understand why my therapy is feeling so-so lately. Any suggestions, even changes in equipment, are welcome. Thanks in advance!

PS: I am also due for a septorhinoplasty + second turbinectomy and have high hopes that they will improve things.


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#2
RE: New user of APAP (3 months), mixed but generally good results
Welcome to the forum and the rest of your life good job on the graph posting. I would not change the settings as they look to be working well for you sometimes it’s not all about sleep apnoea, are you on any medications that could be causing tiredness ?
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#3
RE: New user of APAP (3 months), mixed but generally good results
My take on the charts is that you should turn off any ramp and move minimum pressure to 8.0. There is some flow limitation and hypopnea that a higher minimum will resolve. The Sept 4 results show OA before therapy pressure is reached with ramp, however it looks like you already dealt with that. I often favor a comfort-first approach, so give the higher minimum pressure a try, and if you have any issues, feel free to back off, but I think it will help and is not a particularly high pressure for most of us.
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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#4
RE: New user of APAP (3 months), mixed but generally good results
Thanks a lot for your replies!

The only medication I am on is mometasone furoate spray for my rhinitis. I don't know if that might contribute to my feeling tired, probably not.

I also think 8 is not a particularly high pressure, and it actually feels like it's a bit too easy to breathe, almost as if it wasn't effective enough. I will increase the min pressure to 8 and report back in a few days.

Would decreasing Flex to 2 be a good idea? I'm kinda worried about the CAs I'm seeing in the charts because I didn't have a single one in my sleep studies. They only showed 1 OA and 60 HO.

If it's of any help, I'm posting some zoomed in flow charts.


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#5
RE: New user of APAP (3 months), mixed but generally good results
I think decreasing Flex can't hurt, but a bilevel or Resmed Airsense 10 Autoset would have been much much better for you. Your respiratory flow rate looks like it was scribbled on the chart, and you NEED pressure support or the Resmed EPR.
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.
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