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[Symptoms] New To Therapy Feeling Tiredness Returning
#1
New To Therapy Feeling Tiredness Returning
I recently started CPAP therapy about a month ago. I’ve taken to it very well and sleep an average of 7 hours a night without removing the mask except upon awaking or when disconnecting from the machine to use the restroom which has become a once per night event (compared to a minimum of three bathroom tips per night before PAP therapy) and I have not slept one night without it since starting.
The first week of treatment I felt noticeably better as far as feeling rested and having more energy. I was not experiencing any daytime sleepiness which was great.
This past week I am feeling more tired and I notice more RERA events flagged than previously and looking over the details of the past month I see an uptick in RERAs this past week specifically. This seemed to happen about the time I started to use a chinstrap as I am a nasal pillow user and started noticing symptoms of mouth leaking by way of developing a dry mouth that I hadn’t noticed being a problem the first couple of weeks of therapy.
I also have a full-face mask which I finally slept in last night because I was experiencing some moderate nasal congestion that I could not resolve before sleeping. Looking at the details in OSCAR for last night this is the most events I have seen since beginning therapy. The full face-mask I used is a DreamWear Full Face Mask.
The mask I use daily is a DreamWear Gel Nasal Pillow Mask that inserts into the nose and sometimes switch to the DreamWear Nasal Mask that the nose just rests against due to the other nasal mask sometimes causing irritation to the nostrils. I clean the nasal pillows daily with a mild detergent and hot water and air dry them.
I have also started shaving my face to try to make sure I am getting the best seal with the masks I can, but I am accustomed to have a full beard and prefer not being clean shaven. Now that I have shaved even the slightest stubble on my upper lip makes using the Nasal Pillow Mask makes the skin painful from pressure against my lip.
I would like if someone could task a look at some screenshots of OSCAR to maybe give advice on what I can do to improve the tiredness that seems to be creeping back into my life the last two weeks.
I am going to have a follow up with the APN that works with the neurologist that diagnosed my sleep apnea at the end of this month to discuss how things are going but honestly I don’t know what to expect they will say considering that looking at the details in OSCAR my AHI stays mostly below 5. I do not expect them to review any data or make any suggestions to improve my therapy with numbers this low. During the sleep study it was determined that my AHI was 120.4 events per hour and I was having 79.1 events per hour during REM sleep. I've attached three different screenshots from OSCAR over the past week that I feel like were my worst days.


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#2
RE: New To Therapy Feeling Tiredness Returning
Welcome to the forum.

you are most likely tucking your chin. The clusters of obstructive events are the indicator. Read the Wiki article on Soft Cervical Collars (see my signature, and the positional apnea wiiki article pointed to in the SCC wiki article.
You also have high Flow Limits and RERAs. For that you need to enable EPR =3 (the max), Fulltime. If indicated we will suggest lowering this on review.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
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#3
RE: New To Therapy Feeling Tiredness Returning
Bonjour is one of the most knowledgeable on this site. Good he stopped by
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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#4
RE: New To Therapy Feeling Tiredness Returning
The clustering is VERY pronounced, and I'm betting you will see a lot of improvement when you find a comfortable collar. Ironically, it may be that you're tucking your chin now because you have gotten more comfortable with the new experience and are resuming a former sleep posture.

It's worth seeing whether the pressure can help you power through the congestion. Some people find that if they stick with it, the congestion eases after about 20 minutes with a nasal interface. You might also try using some over-the-counter Flonase, squirting it in about an hour before bed time. It takes a few weeks of daily use to kick in, so give it that long to see whether it helps.
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#5
RE: New To Therapy Feeling Tiredness Returning
@bonjour thank you for your suggestions. I have not been able to purchase a cervical collar due to finances but will look into it. I have a 'sloppy' way of sleeping and tend to move around and displace the pillows (usually two) I lay on causing them to get bunched up under my neck which is probably the culprit causing me to tuck my chin. I have had nights in the past waking up that way.


I attached a screenshot of the night of the 11th where I had changed the EPR settings to level 3 and on full time. My overall AHI was 16.98 and I am pretty sure this was a positional/chin tucking issue. The next night my AHI went down to 2.11. I removed one pillow that night and adjusted the remaining pillow so that it would keep my neck as straight as possible. I have been using a chin strap to keep my mouth closed and noticed that it is slipping and causing my mask to also become dislodged sometimes falling off of my face completely. Hopefully knowing what I do now I can improve my sleep and start feeling more rested. I still feel tired today even with the low score last night. 

Sad


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#6
RE: New To Therapy Feeling Tiredness Returning
@Dormeo thanks for your input as well! I haven't noticed much benefits using Flonase or any other of the over the counter corticosteroids, but may consider giving that a try again. Generally, wearing the nasal pillow definitely powers through any sinus congestion I have. It wasn't working that night so I took a decongestant as well but did not notice any relief until I woke later for a bathroom break. At that point I decided to just stick with the full facemask and ended up having one of he worst recorded nights of sleep using the CPAP!  
Oh-jeez

I am going to look into trying a different full facemask to have on hand but I am not sure what to try. I like masks where the hose connects on top and Resmed has one like that but it seems a lot like the Respironics Dreamware mask that I didn't have good results with.
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#7
RE: New To Therapy Feeling Tiredness Returning
Wow, what a dramatic difference between those charts! You clearly made a good move getting rid of one of the pillows. Cervical collars are available for under $20 if you can stretch the budget that far.

What is really interesting to me is that the change brought down your flow limitations and RERAs as well as your AHI. When you get the positional thing completely licked, you're going to be the person whose thread we send other people to: look at what he did!
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