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Suddenly feeling worse after 10 months of therapy? (w screenshots)
#1
Suddenly feeling worse after 10 months of therapy? (w screenshots)
Hello my new sleep disordered friends, I've been doing APAP therapy for almost 10 months but I recently started to feel extremely tired again and I cannot pinpoint why.

I'm waking up during the night and way before my alarm, falling asleep on the couch, having a real hard time with focus and memory, and just generally feeling like garbage. I don't know what to make of this and would appreciate any insights from more experienced PAP pals :)

I'm sharing as much information as I can in the hopes that something will make sense to someone! Please see timeline with sleep study results below and attached OSCAR screenshots (sidebar and daily view for last night, then an overview of the whole year).

December 2020 - I was diagnosed with OSA after my sleep study (referral was for chronic fatigue combined with longstanding mental health issues) and immediately began a trial of APAP treatment. My Respiratory Disturbance Index was 33.3 and consisted entirely of RERAs and hypopneas. More detailed study results are below.

March 2021 - After three months of consistent therapy use (with a couple pressure adjustments) I was still not feeling any better, but I was told to just keep going and wait longer for results. I got very conflicting messages about how long it would take for me to feel better.

May 2021 - At this point my psychiatrist (different from the physician overseeing my PAP trial) prescribed me two new medications for various reasons related to my mental health. One of these meds is a wakefulness promoting agent. This new combo seemed to work well for me and I gradually began to feel a bit better. At some point in May I took a break from the machine for a couple weeks to see if it made a difference in how I felt during the day, and it didn't seem to. Overall the primary differences I noticed were that with the machine, I was slightly less likely to wake up in the middle of the night, and I had fewer panicky nightmares where I couldn't breathe. There was another short break in May when I had to swap out my trial machine for another due to technical issues.

August 2021 - I was a bit less compliant with machine use over the summer, but still using it most of the time. I had been hoping for a clearer sign that the machine was helping me but not in a place where I could safely stop my medications to compare. I was under some pressure to end my trial, so I just went ahead and committed to purchasing my machine because an RDI of 33.3 scares me and I was anxious about what might happen to me if I didn't use PAP treatment long-term. Thankfully my health insurance covers most of it.

September 2021 - I start feeling worse, as described at the beginning of my post. I have been gradually waking up earlier and earlier and not being able to fall back asleep. I feel much sleepier during the day (compared to over the summer) and my cognitive function is much worse. I'm still using the machine and I have not changed my meds again. I have noticed more leaks but my AHI hasn't really changed much. For what it's worth, I have also had a couple significant external stressors over the past two months, but would not have expected this level of exhaustion just from going through them. 

So here I am! Apologies for the massive wall of text; I wanted to be as thorough as possible. If there is anything I've missed that would be helpful, please let me know. Thank you in advance!

SLEEP STUDY RESULTS

I summarized most of my December 2020 report below and I think that's the most relevant information... If any more detail like the charts would be helpful for additional context, let me know. 

Sleep onset latency: 31m
Total sleep time: 5h21m
Time awake after sleep onset: 71m
Sleep efficiency: 75.8%

Time in sleep stages:
27% N1
56% N2
17% N3
0% REM

Respiratory events:
AHI of 7.1 and RERA index of 26.2, for total Respiratory Disturbance Index (RDI) of 33.3
No apneas recorded
38 hypopneas (lasting as long as 94s)
140 respiratory event related arousals

Other notes:
Sleep disordered breathing was worse in supine sleep (time in supine sleep vs. non-supine sleep was about 50/50)
Mean oxygen saturation 96.5% and minimum of 93%
ECG normal throughout the night

Assessment: 
Poorly consolidated sleep is fragmented with multiple stage shifts (254) and awakenings (36). Abnormal sleep architecture with no REM sleep recorded. Diagnosed with obstructive sleep apnea-hypopnea syndrome.

OSCAR SCREENSHOTS

   

   

   
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#2
RE: Suddenly feeling worse after 10 months of therapy? (w screenshots)
Quote:December 2020: My Respiratory Disturbance Index was 33.3 and consisted entirely of RERAs and hypopneas.
This screams of UARS with a (un)healthy sprinkling of RERAS.

I think you are using the wrong machine, I suspect that you would be better with a ResMed AirCurve VAuto BiLevel running with more PS.

Your charts are missing the important chart Flow Limits as Flow Limits are one of the rivers of pressure.
Do note that your 95% Flow Limits is 0.13, like to see that no higher than 0.10.  Your RERAs are .95 index.  For most treated users this is zero.

The best fix is increased PS (EPR on your machine)
A small fix, it will not help you much overall is to set your min pressure to give your EPR (Which is 3) room to work.  With this change you also should increase your Max pressure to 12 to provide a little more room to work.

I'd start with a PS = 4 on a VAuto given a choice.
With your machine we will have all the PS that can be applied so then the need is to increase Min and Max pressures 
Try What I have suggested above, and see if you can trial a VAuto for a while.

Mode: AutoSet (not for her)
Pressure = 7-12
EPR = 3, Fulltime.

To evaluate further please post several random 3-minute ScreenPrints.  These will be used to evaluate for Flow Limitations so include both good and bad portions.
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#3
RE: Suddenly feeling worse after 10 months of therapy? (w screenshots)
(09-24-2021, 10:19 PM)Gideon Wrote: To evaluate further please post several random 3-minute ScreenPrints.  These will be used to evaluate for Flow Limitations so include both good and bad portions.

Hi Gideon, thanks for your response. Below I've attached a screenshot of Flow Limitations for the whole night and then two 3-minute selections. There were times during the night obviously when nothing was showing so I picked two spots that actually had bars. Hope I got this right!

   
Entire night

   
3 mins

   
Another 3 mins
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