Sanity check on next steps (still tired)

[TSomm]

Of course! If ever I find something that really works and I don't feel tired, I'll definitely share! It's been a long, long process, and I'd love to help others in a similar spot.

That's great info! I was wondering about that, so this checks something else off my list.

Thank you again!

[TSomm]

Hello again,

So, I've had these settings (min/max the same) for a bit and I thought I'd report back with some info. When I went up to 10.4 I found I had some issues with my stomach. I may have been setting the mask too tight, but I'm not sure, so if going to a higher pressure is worth trying, let me know and I'll figure out if it's a pressure thing or a mask thing.

October 10th is interesting because I only had CAs. I felt just as tired as I had the few days prior and after (I've been a little more tired than usual the past week/two, which might be because of the weather changing). I know it's only a day, but to me this suggests that it's not necessarily OAs that are causing my tiredness. It could be CAs, or it could be something else.

I posted a couple other days, as well as some of the overview bar charts (I was away for a week, took a portable APAP with me, so no data for the week).

• The period from August 12 through September 17 seems to be quite a bit better than before and after that period.
  
• I want to say there's a loose correlation between lower pressure and lower AHI, but just before my trip I was turning up the pressure and the AHI was going down, so that throws this theory out the window.
  

Based on this, I'm thinking of turning down the pressure, to lower the centrals. Of course, it's going to be a game of obstructive vs central, so we'll see how that goes.

If anyone has any other thoughts or ideas, please let me know. As I mentioned, I'm willing to experiment however I can to help figure this out and I appreciate any ideas and thoughts you fine folks may have.

Thanks again for all your support!

PS. Dormeo - thanks again for this recommendation. It's definitely been interesting and these kinds of experiments really help to keep my morale up.

[Dormeo]

Your flow limitations are certainly reduced! Now I would suggest keeping EPR at 3 and coming down slowly from 10.2, pausing at each new pressure for at least several days, to see what happens to OAs and CAs. If there's a sweet spot, with a reduction in CAs and negligible numbers of OAs, that would be a good way to find it.

I can't remember whether this has already been discussed in your thread, but I wonder whether you need more sleep than you are getting. Some people really need 8 or even 9 hours to feel rested during the day. Any way you can give that a try?

[TSomm]

Your flow limitations are certainly reduced!  Now I would suggest keeping EPR at 3 and coming down slowly from 10.2, pausing at each new pressure for at least several days, to see what happens to OAs and CAs.  If there's a sweet spot, with a reduction in CAs and negligible numbers of OAs, that would be a good way to find it.

I can't remember whether this has already been discussed in your thread, but I wonder whether you need more sleep than you are getting.  Some people really need 8 or even 9 hours to feel rested during the day.  Any way you can give that a try?

Thanks, I'll take this approach to step things down. I'm also going to get a better cervical cushion. I'm fairly tall and the generic one I have feel short.

I've been getting about an hour less sleep than I normally get, so I will definitely increase that for a few days, see what's what. The only problem there is that I naturally wake up after about 7 hours, but I may be able to train myself out of that.

Thanks again! The flow limitations have been much better and I'm happy to see progress there.

[TSomm]

Still struggling along... Tired during the day, etc, etc. I adjusted some settings over the past couple months and found that where I was experiencing better AHI numbers (larger pressure range), my flow limits were much worse. I'm not entirely certain of the correct balance there, but I think that's a problem for another day.

First off, thank you to everyone who has offered advice and support. I've struggled with sleep issues since my teens and it's really uplifting to know that when I get really frustrated and depressed from my sleep issues, there are friendly people willing to do what they can to support random strangers. You're all amazing people, truly.

Could someone please take a look at the attached and let me know if the flow rates are normal? It's a little tough to tell from the Wiki whether these are normal (it'd be great if the final, "good" image was zoomed in similarly to the first two, as the change in zoom makes the details harder to see). The Wiki is awesome and has so much info! If these are abnormal, I understand that changing the pressure is of little value (is that correct?), but would it potentially be helpful to increase pressure settings? My EPR is set to 3, and I believe there's a response setting on my machine that's set to normal (as opposed to gentle, or something like that).

Thanks in advance!

[Dormeo]

The zoomed-in views do show some flow limitation in a majority of the inhalations. Dented and flattened tops indicate some degree of flow limitation even when the FL flags are absent.

There's no telling whether this contributes to your continuing problems of daytime tiredness. For some people, this relatively minor level of FL wouldn't matter at all; for others it would.

I don't think increasing the pressure would help. What can be the most helpful is higher levels of EPR (called pressure support for the machines that can deliver higher levels). But I don't really recommend that you focus on having a different machine.

Just FYI, the little squiggles around the zero line are almost certainly what are called cardioballistic artifacts (or the cardioballistic effect). Your heartbeat very slightly changes the contours of your airway, and that's visible when you pause between breaths. Absolutely nothing to worry about; just wanted to clarify that those squiggles don't have any connection with FL. (I have the same thing and learned what it was through this forum.)

Any progress on sleeping longer?

[TSomm]

Thank you! Yes, there was a period over the holidays where I was able to put in 8+ hours regularly. There was a bit of a difference, especially early in the morning (it was a bit easier to get up and get started), but the evening crash was fairly similar. With work picking up that hasn't been something I've maintained, but I'll get back to averaging 8 hours soon, I think.

I've found that fiddling with the settings and getting to a point where my AHI was relatively low (sub 2), but where the flow limitations were a bit higher led to an increase in my feeling of rest. I'm flip flopping a little now, trying to see where I can find a decent mid-point and how I'll feel then (between flow limitations and AHI).

Sounds like the best advice right now is sleep more and see how that goes. I'll get back on track to 8 hours, see if maintaining that for more than a few weeks makes a difference.