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Still tired with CPAP
Still tired with CPAP
Hello AB !

I am 33, I have been diagnosed sleep apnea 1 year ago (30 events per hour). I have been with my insurance CPAP machine (Dreamstation APAP pressure 5-12 since July this year). AHI was oscillating between 5-7 events per hour.

As I was still tired and it was complicated to change the prescription's pressures I decided to buy Airsense 10 Autoset and used both the dreamstation and the airsense (I used mostly dreamstation to be 4 hour compliant).

I just decided to give back the insurance's machine, and I will now only use my own machine to treat my sleep apnea.

Is it normal I still feel tired ? I am quite anxious about it (Even though it's better than before I used the machine)

Any help is welcome
Thank you

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RE: Still tired with CPAP
The main type  of event you have is a central.  Centrals are very common with people starting pap therapy and many times clear up on their own.  A central is when you stop breathing for no physical reason (blocked air way).  We all do that while we are awake, like stopping breathing when you bend down to pick up something or stopping when you hear something strange and you want it real quiet...  But you are asleep when a central happens.  and really it will occur off and on for quite awhile as your body adjusts.

Central can NOT be controlled by a normal pap machine and a special machine is needed.  BUT don't worry yours is not bad enough and I'm sure they will diminish as you get use to the machine.  We can't stop them but we can try to avoid them for now. My suggestion is to move the min=7 and change the EPR to off or 0.  That usually helps with centrals.  After you get use to the therapy we would increase the EPR to help get rid of the flow limits.

It also looks like you are using the ramp.  IF you can turn it off or decrease the time on the ramp.  While you are on the ramp you are not getting any therapy.  Most of the people here have turned it off completely.

Your number are good and I hope these changes will help you sleep.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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RE: Still tired with CPAP
Thank you for taking some time, I will try these settings tonight. I really appreciate it ! Smile
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RE: Still tired with CPAP
Yep, this is likely plan of attack for treatment emergent CA. As suggested remove EPR and bump to 7. If you have a Ramp active, turn it off as well.

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RE: Still tired with CPAP
I tried these settings last night.Thank you all for your help, you had a good guess, globally my events decreased Smile I-love-Apnea-Board

Not sure how I should interpret these graphs however,

Maybe my mask (Dreamwear nasal pillow) leaks too much under high pressure, can this trigger micro wake up ?

I will try to tighten the mask stronger next time.
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RE: Still tired with CPAP
I would like you to do 2 things to make your charts show everything better.
1. Put in a dotted line on the Leak chart -  Take your mouse and point it to the area at the left of the leak chart (near the name "leak rate".  Then click the right button and go down to dotted line at the bottom of the menu. Then choose "leak rate upper theshold".  Now you have a dotted line that shows when your leaks become a real problem. 

2. Go to view at the very top left of OSCAR. click on view and choose from the menu reset graphs and then standard.  That will take away the pie graph and show your machine settings that we need to see.

Now for your nights chart.  You cut in half the centrals, great.  I think what woke you last night was the flow limits.  If you look at the bottom of this post I listed the obstruction events, their % of obstruction and length of time they occur.  They are the mildest of the Events but if you have a lot of them together it disrupts sleep.  If you look at the chart, when they occurred was when you woke up.

The problem is to help with the flow limits we need to raise the EPR.  BUT if we do you will have more centrals.(we took it away to help limit centrals.)  So we need you first to get use to the therapy and when your body has less central events we can start to raise the EPR.

I think you need to stay on the settings tonight and we will see how you are doing.

As far as the mask do now over tighten it.  I don't know if you have that bad of a leak but usually people wear their masks to tight.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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RE: Still tired with CPAP
I will continue with this settings tonight.
Thank you for your explanations concerning flow limitations it makes things clearer to me Smile

I updated the screenshots here (Could not find how to edit my previous post)


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RE: Still tired with CPAP
I give you a quick update concerning this night.

I am quite surprised to see how different these graphs looks between the first and second part of the night.

Looking OSCAR :
 - 1st part (6h27) AHI is 1.71 (only centrals) 
 - 2nd part (1h26) AHI is 11 (mostly centrals) Huh

Maybe second part is not relevant  Thinking-about

Should I stay at this settings until my centrals gets lower ? How many central apnea/hour should I expect ?

Thanks all for your help, I will keep you updated Wink

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RE: Still tired with CPAP
See how the higher pressures are producing more centrals?
See how your flow limits are increasing your pressure?

Set your max pressure=10

To clip the top of your pressure to reduce centrals. You may need to reduce pressure further but let's see what happens first.

I'm moving toward a fixed pressure.
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RE: Still tired with CPAP
Great, I will try this tonight
Indeed, most centrals in second part happen when pressure is > 10.

Do you mean that fixed pressure might be a good idea as the difference between min and max might be narrow ? Or because pressure change might have unwanted side effect ?

Thank you Smile
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