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Should I change my pressure settings?
#1
Should I change my pressure settings?
Here's a little backstory before I address my concerns. Thanks!


Male, White, 23, 5'10, 165 lbs


My health has felt like it’s been in the crapper for way too long. When I was 12-13 I was diagnosed with GERD (acid reflux). It affected my sleep a little bit from what I remember, but not hugely. Right around this time I also started developing a bit of general anxiety, but again wasn't debilitating. And then, starting at age 16, I woke up one day and noticed I was a little tired for some odd reason. I have been tired ever since that day. Not even a day or a minute of feeling well again. I've gradually gotten tireder and tireder over the course of the past 7 years, to the point where I'm at now where I can hardly function because the exhaustion has become so debilitating. From the moment I wake up to the moment I fall asleep I feel so unbelievably drained, and as the days goes on I get tireder and tireder.


I have had practically every sort of blood/urinary test done, have had heart scans, cortisol levels checked, vitamin/mineral checks, thyroid, etc. Vitamin B12, magnesium, iron, calcium, h. pylori, candida, etc. Everything comes back fine and just about everything has been ruled out it seems. I have tried for the hell of it multiple anti-anxiety/anti-depression medications, none of which helped me in the slightest. My diet is healthy, I still try to exercise most days of the week (although it's gotten harder to due to my shear exhaustion). Exercise does not make me feel better or worse. I do not suffer from insomnia. I do not have ADD/ADHD. I do not suffer from any joint pain or any real pain for that matter. I average 7-9 hours of sleep a night and usually fall asleep very easily, although I do usually wake up 1-2 times a night to pee. I stay very hydrated throughout the day. I have slightly elevated CO2 levels in my blood (but nothing dangerous), slightly elevated bilirubin levels, and slightly elevated ferritin levels. I do not get sick that often, maybe two colds a year, never had mono. On a side note, about 2 years ago, for a span of 2-3 months, I would get this painful abdominal/stomach pain on and off. It has since dissipated.
Symptoms include:

  • Chronic fatigue that has gradually gotten worse and worse over 7 years span

  • Overall cognitive decline (concentration, alertness, memory, focus, brain fog, processing words, etc.)

  • Coordination/motor skills decline

  • Feel like I move extremely slow now both mentally and physically

  • Urge to urinate more (especially at night)

  • No energy

  • Extremities/body parts feel so utterly exhausted and numb-like to the touch. It’s been a gradual decline as well.

  • Head often feels very tired and heavy

  • Occasional headache (not super often though)

  • Consistent yawning throughout the day

  • Wake up many mornings with a dry mouth/throat. Also sometimes throat feels sore/irritated like I'm coming down with an illness, but then goes away the next day.

  • I notice I tilt my head to the side often

  • Minor facial acne (not acne prone) Also these weird things I get once or so a month on my face. They initially look like a zit, but then stay raised with no sensitivity to them, then they flatten out and stay there as a mark for what seems like forever.

  • The worse I get, I feel more anxious/stressed easily where everything feels like a chore

  • Overall hearing quality seems slightly weakened

  • Seem slightly more bloated in face (but could be due to a bit of weight gain) but also look heavier than I really am.

  • Feel intoxicated much more easily/quickly

  • Have a perpetual drunk-like feeling like I'm not quite in real life. Never fully feel "there"

  • Hand-eye coordination and spatial awareness has declined sharply

  • Feel more awkward all the time

  • Lower libido (but can still get and maintain an erection and ejaculate)

  • Night sweats often

  • Sometimes lump type feeling in throat (mostly at night)

  • Acid reflux history

  • Just the past 6 months or so, slight nauseous feeling every once in while, but no vomit.

  • Sensitive to sunlight/bright light. Also get eye floaters
Overall, it just feels like everything is suppressed by this fog that has gradually gotten worse and worse over time. For example, humor, caffeine’s effect, sex drive, post-workout adrenaline and endorphins, getting plenty of sleep, etc. I can sort of FEEL all these things for the most part, but it feels hidden and pushed down from this utter exhaustion and intense fog. It’s like nothing can surpass the fatigue and fog.

I was recently diagnosed with mild sleep apnea and have been using a CPAP machine for a bit now (haven't noticed much difference yet due to mask changes and inconsistent usage). I also had an extensive food intolerance test done and am mostly sensitive to kidney beans (rarely eat them though). Every other sensitivity is very mild (barley, cherries, halibut, mushrooms) or nonexistent.
Others have mentioned things like CFS/ME, POTS, fibromyalgia, depression, etc. I just don’t think that is the issue.

After a few consecutive nights of CPAP use, I do notice a few areas of improvement that may or may not be directly related to CPAP. Notably the decrease in night sweats, reduction in stomach acid problems, I have not been waking up with a dry mouth/throat, and I haven't been waking up with an intense need to drink water or use the restroom. BUT, energy wise and fatigue wise, I still feel awful. Maybe it hasn't been long enough or consistent enough? 

Now, to my main questions. My diagnosed AHI is about 6.5. When I use the CPAP consistently, my AHI is still 3-5 every night. My pressure is set to 5-15. I am wondering if maybe this could be too low to notice any benefits? I have included a couple of graphs from SleepyHead for you to take a look at if you'd like. Any feedback is greatly appreciated!

I use a Resmed Airsense 10 and a nasal mask.


https://imgur.com/a/bLl3HS1
https://imgur.com/a/xz6JvAu
https://imgur.com/a/BrT9dwO
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#2
RE: Should I change my pressure settings?
I would try reducing your EPR to 1cm or even to off. Most of what your getting is Clear airway events. Sometimes the body takes time to adjust to CPAP and the O2/CO2 exchange gets thrown off balance. Using a lot of EPR can make it worse. It usually takes a month or two for your body to adjust.
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#3
RE: Should I change my pressure settings?
Welcome to the forum.  We will help you out.

First a couple of chart issues.

Please attach your screen prints because that makes it easier for us to view them.  See the sea green bar below the edit box when you are composing?  It says Attachments.  Enter them there.

You said "I have slightly elevated CO2 levels in my blood (but nothing dangerous)" and I immediately thought Central Apnea.  Clear Airway and Central Apnea are synonymous and compose the largest chunk of your Apnea.  Your Central Apnea is not over 5 AHI so it will likely be ignored by your medical team.  I would like to see a full copy of your Sleep Studies, not just the summaries.  The CO2 concentration in the blood is one of the most important signals that we get to breathe.  I am not a doctor but I suspect that this is having an impact on your Central Apnea.

You have virtually no obstructive Apnea when under pressure (one reason why I want to see your Sleep Studies) and that means that your CPAP machine is set up completely wrong for you.  I'm going to suggest that you change your settings to basically CPAP mode at a pressure of 5.  We can also set both your Min and Max pressures to 5.  Please download the "CPAP Setup Manual" for the "ResMed Airsense 10 Autoset" By clicking on the "CPAP Setup Manual" button in the top banner of this page.  You will have to send an email to receive it so you can skip the 1st 2 sections if you choose.

The ROT is to lower pressure and prevent pressure variance to treat Central Apnea on a CPAP machine.  

How are your Oxygen levels?  Your nighttime oxygen levels?  Many of your symptoms could be explained by Oxygen Desats.

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 

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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: Should I change my pressure settings?
Your charts need to be reorganized as show in the organize your Sleepyhead charts in my signature. Turn OFF your EPR. You have treatment emergent central apnea and exhale pressure relief is making it a lot worse.
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#5
RE: Should I change my pressure settings?
Bonjour Thanks for the reply.

My oxygen levels are good.

I think my main concern now is whether or not a CPAP/APAP machine like the ResMed Airsense 10 can be used to effectively treat Central Sleep Apnea? Because that is really my only issue. The machine has eliminated virtually all of my Obstrctive apneas, but my centrals have remained the same. Not sure if it is something in the settings I can change or if I need a different machine entirely?

I will post sleep report.
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#6
RE: Should I change my pressure settings?
Per what you say your readings are you do not qualify for getting an ASV, t6he CPAP machine that will treat Centrals.  On an AutoSet we try to avoid getting Centrals at the cost of having more Obstructive events.  In general we increase pressure to resolve Obstructive events.  Increasing pressure tends to increase Central Apnea.  Thus the balancing act.

What do you need to qualify to for an ASV, well here is a Wiki for uou.

http://www.apneaboard.com/wiki/index.php...P_Machines
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 

New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Download SleepyHead
Organize Charts
Attaching Charts

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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#7
RE: Should I change my pressure settings?
(01-27-2019, 07:06 PM)bonjour Wrote: Per what you say your readings are you do not qualify for getting an ASV, t6he CPAP machine that will treat Centrals.  On an AutoSet we try to avoid getting Centrals at the cost of having more Obstructive events.  In general we increase pressure to resolve Obstructive events.  Increasing pressure tends to increase Central Apnea.  Thus the balancing act.

What do you need to qualify to for an ASV, well here is a Wiki for uou.

http://www.apneaboard.com/wiki/index.php...P_Machines

Thanks for the link.

What about a BPAP machine? Could that be more beneficial than a CPAP? And is it usually easier to acquire than an ASV?
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#8
RE: Should I change my pressure settings?
I had to and reopen your charts.  There are 2 reasons to have your EPR set to 3.  The first is for comfort, the 2nd is to manage Flow Limitation.  Flow limits are one of the important charts that you did not show us.  They don't show up as events but they can disturb and disrupt sleep.

There 2 reasons to set EPR to zero.  The first is for comfort, hey we are all different.  The second is to eliminate/reduce pressure variance.  Increasing Pressure variance also may cause Central Apneas.  So have you set your EPR to zero?


CPAP choice to treat OSA, CA, obstructive or pulmonary restriction
The Auto CPAP such as the AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea
Just to clarify The VAUTO, ASV and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between the three to treat a single condition.
They should be chosen to treat the specific condition that the user has,

  • To treat obstructive apnea and minor hypopnea and for most initial treatments a standard Auto CPAP such as AirSense AutoSet (or for her) is appropriate.

  • To treat obstructive apnea and hypopnea, and a standard Auto CPAP is insufficient the treatment of choice is the Aircurve 10 Vauto (has higher pressure and greater Pressure Support (PS) (similar to EPR) available

  • To treat central apnea, the only appropriate therapy would be the Aircurve 10 ASV

  • To treat obstructive or pulmonary restriction including hypoventilation, would be the Aircurve 10 ST
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 

New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Download SleepyHead
Organize Charts
Attaching Charts

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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#9
RE: Should I change my pressure settings?
(01-27-2019, 09:00 PM)bonjour Wrote: I had to and reopen your charts.  There are 2 reasons to have your EPR set to 3.  The first is for comfort, the 2nd is to manage Flow Limitation.  Flow limits are one of the important charts that you did not show us.  They don't show up as events but they can disturb and disrupt sleep.

There 2 reasons to set EPR to zero.  The first is for comfort, hey we are all different.  The second is to eliminate/reduce pressure variance.  Increasing Pressure variance also may cause Central Apneas.  So have you set your EPR to zero?


CPAP choice to treat OSA, CA, obstructive or pulmonary restriction
The Auto CPAP such as the AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea
Just to clarify The VAUTO, ASV and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between the three to treat a single condition.
They should be chosen to treat the specific condition that the user has,
  • To treat obstructive apnea and minor hypopnea and for most initial treatments a standard Auto CPAP such as AirSense AutoSet (or for her) is appropriate.

  • To treat obstructive apnea and hypopnea, and a standard Auto CPAP is insufficient the treatment of choice is the Aircurve 10 Vauto (has higher pressure and greater Pressure Support (PS) (similar to EPR) available

  • To treat central apnea, the only appropriate therapy would be the Aircurve 10 ASV

  • To treat obstructive or pulmonary restriction including hypoventilation, would be the Aircurve 10 ST

Okay, this is very useful information. I have set EPR to zero.

My next question is, where would you draw the line between someone with CSA needing to switch from an auto CPAP to a BPAP or ASV? Cause right now my central sleep apneas are only averaging about 3-5 an hour, which many people have said is completely normal and not necessary to get an ASV. Agree?
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#10
RE: Should I change my pressure settings?
The Medicare standard says with treated Obstructive events under 5 (this is your AHI - all central events) and all your central events over 5 you should qualify for ASV..

Otherwise it is based. On hope you feel including how you tolerate CPAP or a basic Bilevel without backup such as My VAuto.

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 

New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Download SleepyHead
Organize Charts
Attaching Charts

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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