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Over 2 years in and still tired w/Oscar charts
#1
Over 2 years in and still tired w/Oscar charts
Good evening.

I'm a 47 yo male, 6'-0", 175lbs, non-smoker, exercise regularly and take two medications, Valsartan in PM for hypertension and Levothyroxine in the AM for hypothyroid.  I took an in lab PSG 2 years ago looking for answers to my fatigue, brain fog and sleep maintenance insomnia.  I had an AHI of 8, largely made up of centrals and hypopneas.  The centrals were deemed to be sleep stage shifts or the like.  After a few months on the autoset, the centrals largely went away.  However, since then I've found very little relief for insomnia, fatigue, brain fog, memory issues, etc..  At times I have chased my own UARS diagnosis, even though the PSG didn't show RERAs, but have found no solution.  I do notice that often if my AHI is below 1, I am more tired than if it is between 1 and 2.  I'll note that I can't recall the last time I saw an AHI of >2 on this machine, though my suspicion is that my AHI is so low because I'm not getting much deep sleep.  I'll add some screenshots for your perusal.  

In the nights shown below, I have slept relatively well, or so it seemed.  Waking maybe 3-4 times that I recall.  Last night I actually got out of bed to use the restroom, but that is not typical of my routine.  In the past I have tried melatonin at varying dosages and more recently, Doxepin, but have not taken anything for the past 2 weeks, so these charts are drug free, so to speak.  

Thanks!
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#2
RE: Over 2 years in and still tired w/Oscar charts
This is not what you asked, but I noticed you have a high and steady leak rate. I recommend checking the hose, connections, and humidifier tank seal to see if any of them need replacement. Or are you using a mask that normally has a high leak rate? Or could try replacing the hose, etc. if you have spares. The steadiness of the leak rate suggests you have a good mask fit. The CPAP machine should easily provide proper therapy with that leak rate. It is possible that the leak (presuming there is one) is adding some background noise or other disturbance to your sleeping.
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#3
RE: Over 2 years in and still tired w/Oscar charts
Your chart doesn't show obvious issues but the flow rate chart is ragged in appearance. I would like to see a few 4 minute duration views (zoom in until flow rate chart indicates duration of 4 minutes) from periods that you believe are representative of your normal breathing. You can also include extra views if you see anything that appears odd to you and that occurs on a regular basis.

Edit: Missed the leaks, I too would guess hose, humidifier or one of their connections to be that constant in nature.
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#4
RE: Over 2 years in and still tired w/Oscar charts
Thanks for the suggestions about leak rate.  I'll take a look and see what's going on.  

Here are some screenshots.  I wasn't sure if I should be looking for my best breathing or just what seems to be happening most often.
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#5
RE: Over 2 years in and still tired w/Oscar charts
Here's another that looks really erratic.  Could any of this erratic flow be due to nasal congestion?  I do often wake with partially clogged nasal passages, and sometimes, only one side of my nose functional.
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#6
RE: Over 2 years in and still tired w/Oscar charts
Interesting flow rate patterns. I would like to see an example with mask pressure instead of pressure (can drag it up below flow rate and move pressure down).

First test is to try and fix leaks. After a night without the regular leak will try a change in pressure.
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#7
RE: Over 2 years in and still tired w/Oscar charts
Do you have any flow rate that looks normal?
I can see why you are having so much trouble. That is very rough breathing.

By any chance do you have access to a VAuto or other BiLevel? I'd like you to try some higher levels of pressure support.
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#8
RE: Over 2 years in and still tired w/Oscar charts
I recently (less than a month ago) replaced my mask and hose. I did have a new water chamber so I put that on.  Looking back over the past 12+ months, my steady state median leak rate ranges from 9-14 on any given night.  I just plugged my hose with the machine on at 9cm and I can hear a slight hiss in the water chamber if I listen really carefully and closely, though I'm not sure if that is normal or not.  

Here's another screenshot with the mask pressure included.
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#9
RE: Over 2 years in and still tired w/Oscar charts
Gideon,

   I'll attach one that looks normal to me.  I don't have access to any other machines, short of buying one.  My insurance is a super high deductible type, so any machine I buy is likely fully out of pocket.
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#10
RE: Over 2 years in and still tired w/Oscar charts
Compared to your recent days this looks pretty good. Any idea what's different?
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