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OSCAR data review - Low AHI Still tired
#31
RE: OSCAR data review - Low AHI Still tired
Glad to hear results are improved with the higher pressure. Results are pretty good, however there are a couple periods of flow limitation. Your machine can be adjusted in increments of 0.2 cm and since you are looking for improved comfort, the logical next step is actually to try an increase of 1-cm. If that turns out to be too much, then it is likely your ideal pressure falls somewhere between 12 and 13 cm. Anyway, the idea is to continue to trial higher pressure, decide if it's better or worse, then once you have passed your optimum pressure, back off and start using the smaller increments of pressure to fine-tune.
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#32
RE: OSCAR data review - Low AHI Still tired
I have a couple of questions for the OP.
How long have you been using the CPAP?
How long before you got the CPAP did you have untreated sleep apena?

From my experience, and no guarantee of medical information correctness, CPAP was not a magic quick cure.
It is a valid treatment and it can limit sleep apena, but sadly, it is NOT a cure.
After my first night on CPAP, the next morning the nurse came in and asked how did I feel?
I felt the same as the previous day or month or year.
With the CPAP, I felt no different INITIALLY. Over time, with constant CPAP usage, I started feeling more refreshed.
However it took me a few years (with low AHI every night over that time frame) to get over the sleep debt.
I do not know if medically, they believe in sleep debt, but for me, I do now.
Once I had "paid off" the debt, most mornings now, I feel refreshed and alert.
No more drowsiness in meetings (although they still are boring)
No more drowsiness while driving (this was getting serious)
No more drowsiness while watching TV or listening to the radio.
It takes times, but pay off your debt and you should start feeling MUCH, MUCH better.
I had incurred 10+ years of sleep debt due to the apena and my reluctance to do anything about it.
I dislike having to use the CPAP every night, but I do use it every night.
I disliked the issues caused by the apena far worse.
It is a choice that I make to use it every night and it is the right one for me.
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#33
RE: OSCAR data review - Low AHI Still tired
(09-01-2019, 11:23 AM)HoseHead58 Wrote: However it took me a few years (with low AHI every night over that time frame) to get over the sleep debt.  
I do not know if medically, they believe in sleep debt, but for me, I do now.
Once I had "paid off" the debt, most mornings now, I feel refreshed and alert.

I had a similar experience. I have reason to believe that I had sleep apnea for almost 30 years before I was diagnosed and began CPAP therapy. In all those years my body had to adapt to having sleep apnea, which meant sleep disturbances multiple times per hour. My body learned, I believe, to be wary of falling into the deeper levels of sleep because it "knew" it would lead to an apnea and a subsequent sleep disturbance.

It took my body a couple of years to fully realize that it's okay to fall into deeper levels of sleep. For some people that adaptation takes only a few minutes. We are all different. I tend to be an anxious person, so I think that made it harder for me to adapt.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#34
RE: OSCAR data review - Low AHI Still tired
(09-01-2019, 11:23 AM)HoseHead58 Wrote: I have a couple of questions for the OP.
How long have you been using the CPAP?
How long before you got the CPAP did you have untreated sleep apena?

From my experience, and no guarantee of medical information correctness, CPAP was not a magic quick cure.
It is a valid treatment and it can limit sleep apena, but sadly, it is NOT a cure.
After my first night on CPAP, the next morning the nurse came in and asked how did I feel?
I felt the same as the previous day or month or year.
With the CPAP, I felt no different INITIALLY.  Over time, with constant CPAP usage, I started feeling more refreshed.  
However it took me a few years (with low AHI every night over that time frame) to get over the sleep debt.  
I do not know if medically, they believe in sleep debt, but for me, I do now.
Once I had "paid off" the debt, most mornings now, I feel refreshed and alert.
No more drowsiness in meetings (although they still are boring)
No more drowsiness while driving (this was getting serious)
No more drowsiness while watching TV or listening to the radio.
It takes times, but pay off your debt and you should start feeling MUCH, MUCH better.
I had incurred 10+ years of sleep debt due to the apena and my reluctance to do anything about it.  
I dislike having to use the CPAP every night, but I do use it every night.
I disliked the issues caused by the apena far worse.
It is a choice that I make to use it every night and it is the right one for me.

I've been using the CPAP for a couple of months now, im not looking for a magic cure and i dont particularly think my post came across like that? Anyway im sorry if i did, im just trying to increase the quality of my sleep like other members are here, but i do not necessarily buy into the "you need to use it for a year and then you might feel better because of sleep debt" mentality. Only i know how i feel and i know that its to do with my machine as the adjustments i've made have shown noticeable improvements in my energy levels despite my AHI being consistent, if it truly was sleep debt then none of this would make a difference. I have absolutely no issues with compliance and i actually find sleeping with the machine pretty damn comfortable so none of that is an issue either.
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#35
RE: OSCAR data review - Low AHI Still tired
(09-01-2019, 10:15 AM)Sleeprider Wrote: Glad to hear results are improved with the higher pressure.  Results are pretty good, however there are a couple periods of flow limitation.  Your machine can be adjusted in increments of 0.2 cm and since you are looking for improved comfort, the logical next step is actually to try an increase of 1-cm.  If that turns out to be too much, then it is likely your ideal pressure falls somewhere between 12 and 13 cm.  Anyway, the idea is to continue to trial higher pressure, decide if it's better or worse, then once you have passed your optimum pressure, back off and start using the smaller increments of pressure to fine-tune.

I decided to go up to 13 as that was what my old machine was set to before i got one through the NHS, i do feel better overall but i still dont consider my energy levels to be "normal" I am going back to see my doctor soon to see if there could be anything else but one thing to note is that my flow limitations have remained largely the same despite a 2.0cm pressure increase, i was under the impression that these would improve under the increased pressure, can anyone hazard a guess as to why im still getting flow limitations? One thing to note is i do have a pretty bad deviated septum to the point where one nostril is completely blocked and the other is very heavily blocked, breathing through my nose is not an option for me, could this have an effect?


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#36
RE: OSCAR data review - Low AHI Still tired
(09-11-2019, 05:29 AM)cwbolton Wrote:
(09-01-2019, 10:15 AM)Sleeprider Wrote: Glad to hear results are improved with the higher pressure.  Results are pretty good, however there are a couple periods of flow limitation.  Your machine can be adjusted in increments of 0.2 cm and since you are looking for improved comfort, the logical next step is actually to try an increase of 1-cm.  If that turns out to be too much, then it is likely your ideal pressure falls somewhere between 12 and 13 cm.  Anyway, the idea is to continue to trial higher pressure, decide if it's better or worse, then once you have passed your optimum pressure, back off and start using the smaller increments of pressure to fine-tune.

I decided to go up to 13 as that was what my old machine was set to before i got one through the NHS, i do feel better overall but i still dont consider my energy levels to be "normal" I am going back to see my doctor soon to see if there could be anything else but one thing to note is that my flow limitations have remained largely the same despite a 2.0cm pressure increase, i was under the impression that these would improve under the increased pressure, can anyone hazard a guess as to why im still getting flow limitations? One thing to note is i do have a pretty bad deviated septum to the point where one nostril is completely blocked and the other is very heavily blocked, breathing through my nose is not an option for me, could this have an effect?

Some flow limitations require a lot of air pressure to be normalized. That's why people like me who primarily deal with persistent flow limitations usually switch to a bilevel. You have to understand that the flow rate represents the speed at which the air move through your airways and that there are two ways to improve it. 

The first and most basic way to speed up the air exchange is to lower your airways resistance. This is how a fixed pressure CPAP works.  The pressurized air push the soft tissues out the way resulting in a decreased airways resistance and with the decreased resistance the flow rate increases. But sometime lowering the resistance requires too much pressure and it's not practical to go this way. That's when a bilevel might be the solution.

A bilevel  open your airways by pressuring the air just like a fixed CPAP does. But it also works as a ventilator by switching as you inspire and expire from an high pressure (IPAP) to a low one (EPAP). A ventilator is something that can breath a bit for you, it's like having a third lung. If you want an electrical analogy, it's just like adding a second battery to your circuit. Now having this third lung helping you, as you might guess, increase the speed at which the air moves through your body. This results in a normalized flow rate without having to lower your airways resistance and dealing with higher pressures.

The downsides of a bilevel are that it's more expensive than a regular CPAP (about twice the cost) and some people don't tolerate it that well and start experiencing central apneas when they use it (not that frequent though).

Hope it might sense :-) Note that I didn't have time to check your charts so I don't know if flow limitations are really a problem in your case.
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#37
RE: OSCAR data review - Low AHI Still tired
(09-11-2019, 08:02 AM)alexp Wrote:
(09-11-2019, 05:29 AM)cwbolton Wrote:
(09-01-2019, 10:15 AM)Sleeprider Wrote: Glad to hear results are improved with the higher pressure.  Results are pretty good, however there are a couple periods of flow limitation.  Your machine can be adjusted in increments of 0.2 cm and since you are looking for improved comfort, the logical next step is actually to try an increase of 1-cm.  If that turns out to be too much, then it is likely your ideal pressure falls somewhere between 12 and 13 cm.  Anyway, the idea is to continue to trial higher pressure, decide if it's better or worse, then once you have passed your optimum pressure, back off and start using the smaller increments of pressure to fine-tune.

I decided to go up to 13 as that was what my old machine was set to before i got one through the NHS, i do feel better overall but i still dont consider my energy levels to be "normal" I am going back to see my doctor soon to see if there could be anything else but one thing to note is that my flow limitations have remained largely the same despite a 2.0cm pressure increase, i was under the impression that these would improve under the increased pressure, can anyone hazard a guess as to why im still getting flow limitations? One thing to note is i do have a pretty bad deviated septum to the point where one nostril is completely blocked and the other is very heavily blocked, breathing through my nose is not an option for me, could this have an effect?

Some flow limitations require a lot of air pressure to be normalized. That's why people like me who primarily deal with persistent flow limitations usually switch to a bilevel. You have to understand that the flow rate represents the speed at which the air move through your airways and that there are two ways to improve it. 

The first and most basic way to speed up the air exchange is to lower your airways resistance. This is how a fixed pressure CPAP works.  The pressurized air push the soft tissues out the way resulting in a decreased airways resistance and with the decreased resistance the flow rate increases. But sometime lowering the resistance requires too much pressure and it's not practical to go this way. That's when a bilevel might be the solution.

A bilevel  open your airways by pressuring the air just like a fixed CPAP does. But it also works as a ventilator by switching as you inspire and expire from an high pressure (IPAP) to a low one (EPAP). A ventilator is something that can breath a bit for you, it's like having a third lung. If you want an electrical analogy, it's just like adding a second battery to your circuit. Now having this third lung helping you, as you might guess, increase the speed at which the air moves through your body. This results in a normalized flow rate without having to lower your airways resistance and dealing with higher pressures.

The downsides of a bilevel are that it's more expensive than a regular CPAP (about twice the cost) and some people don't tolerate it that well and start experiencing central apneas when they use it (not that frequent though).

Hope it might sense :-) Note that I didn't have time to check your charts so I don't know if flow limitations are really a problem in your case.

I appreciate the reply, am i right in thinking based off your comments here that my options are to either procure a BiLevel machine OR increase my pressure? I have no issue doing the latter if its required as a short term solution until i get a bilevel
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#38
RE: OSCAR data review - Low AHI Still tired
(09-11-2019, 08:18 AM)cwbolton Wrote:
(09-11-2019, 08:02 AM)alexp Wrote:
(09-11-2019, 05:29 AM)cwbolton Wrote: I decided to go up to 13 as that was what my old machine was set to before i got one through the NHS, i do feel better overall but i still dont consider my energy levels to be "normal" I am going back to see my doctor soon to see if there could be anything else but one thing to note is that my flow limitations have remained largely the same despite a 2.0cm pressure increase, i was under the impression that these would improve under the increased pressure, can anyone hazard a guess as to why im still getting flow limitations? One thing to note is i do have a pretty bad deviated septum to the point where one nostril is completely blocked and the other is very heavily blocked, breathing through my nose is not an option for me, could this have an effect?

Some flow limitations require a lot of air pressure to be normalized. That's why people like me who primarily deal with persistent flow limitations usually switch to a bilevel. You have to understand that the flow rate represents the speed at which the air move through your airways and that there are two ways to improve it. 

The first and most basic way to speed up the air exchange is to lower your airways resistance. This is how a fixed pressure CPAP works.  The pressurized air push the soft tissues out the way resulting in a decreased airways resistance and with the decreased resistance the flow rate increases. But sometime lowering the resistance requires too much pressure and it's not practical to go this way. That's when a bilevel might be the solution.

A bilevel  open your airways by pressuring the air just like a fixed CPAP does. But it also works as a ventilator by switching as you inspire and expire from an high pressure (IPAP) to a low one (EPAP). A ventilator is something that can breath a bit for you, it's like having a third lung. If you want an electrical analogy, it's just like adding a second battery to your circuit. Now having this third lung helping you, as you might guess, increase the speed at which the air moves through your body. This results in a normalized flow rate without having to lower your airways resistance and dealing with higher pressures.

The downsides of a bilevel are that it's more expensive than a regular CPAP (about twice the cost) and some people don't tolerate it that well and start experiencing central apneas when they use it (not that frequent though).

Hope it might sense :-) Note that I didn't have time to check your charts so I don't know if flow limitations are really a problem in your case.

I appreciate the reply, am i right in thinking based off your comments here that my options are to either procure a BiLevel machine OR increase my pressure? I have no issue doing the latter if its required as a short term solution until i get a bilevel

Yes you can try to raise your pressure. Just do it progressively because as you increase the pressure you can have several problems (discomfort, leakage, aerophagia, temporary central apneas, ... ).  By the way, EPR on the Resmed acts like a bilevel but I see you already maxed out the setting so yes a bilevel might be your next option if high pressures don't cut it.
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#39
RE: OSCAR data review - Low AHI Still tired
Hi, cwbolton
UARS (and PLM's) are essentially my single focuses in this blog; those were (almost used to be) my two 50-year sleep drawbacks. After suffering ALL that long with "inmsonia"; when retired, surprisingly with rather good healph (luckly, whithout knowing, blindly, my PLM's was partially treated with clonazepam and like),  two years ago a damn Doctor asked me a PSG; life started changing!
Two-year therapy now; 6 months with Oscar. Good and great experience acquired. CPAP and BPAP are magic. However, for UARS, don't believe in CPAP or APAP; It  would be traps in the middle of the road; don't not work in the absolute majority of times, ending up either in aerophagia or resilient untreated flow restrictions. I think you are trapped in persistent only slightly treated UARS. Repeatitively scrutinizing this blog; I have  seen the very same thing so many times!
You went right on the Mark, above: remaining disturbed sleep often would mean either wrong machine and/ir wrong parameters!
UARS, in particular, is a very serious sleep disturbing issue, even more serious than apneas themselves; used to being harder to treat! Why? UARS always leads to very sensitized brains (more than in apneas), therefore easily arising/awakening/wakening you up, leading to very low sleep efficiency.
Good luck
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#40
RE: OSCAR data review - Low AHI Still tired
Thank you, the bit i dont understand is, the flow limitations are occurring because my EPAP level is too low or high? and a BiLevel would alter EPAP pressures whilst maintaining IPAP pressure, and my resmed device EPR does this but on a smaller scale and its not enough to prevent flow limitations? is that correct? so increasing overall pressure we do on a CPAP as that is the only way we can alter the EPAP levels? im just a little confused because in my head EPR is a bad thing because having negative 3 on the exhale means that its more likely to cause my airway to close than having an IPAP/EPAP of 13 instead of 10/13 Because of EPR

(09-11-2019, 08:28 AM)mper6794 Wrote: Hi, cwbolton
UARS (and PLM's) are essentially my single focuses in this blog; those were (almost used to be) my two 50-year sleep drawbacks. After suffering ALL that long with "inmsonia"; when retired, surprisingly with rather good healph (luckly, whithout knowing, blindly, my PLM's was partially treated with clonazepam and like),  two years ago a damn Doctor asked me a PSG; life started changing!
Two-year therapy now; 6 months with Oscar. Good and great experience acquired. CPAP and BPAP are magic. However, for UARS, don't believe in CPAP or APAP; It  would be traps in the middle of the road; don't not work in the absolute majority of times, ending up either in aerophagia or resilient untreated flow restrictions. I think you are trapped in persistent only slightly treated UARS. Repeatitively scrutinizing this blog; I have  seen the very same thing so many times!
You went right on the Mark, above: remaining disturbed sleep often would mean either wrong machine and/ir wrong parameters!
UARS, in particular, is a very serious sleep disturbing issue, even more serious than apneas themselves; used to being harder to treat! Why? UARS always leads to very sensitized brains (more than in apneas), therefore easily arising/awakening/wakening you up, leading to very low sleep efficiency.
Good luck

I have been doing some reading into flow limitations and UARS does come up, do you think it could be that i have UARS? Or can i have OSA and UARS at the same time? Or does UARS cause apneas as i have an AHI of 34 when untreated as demonstrated by a sleep study. I am seeing the hospital on friday, so i will voice my concerns about flow limitations and UARS.
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