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[Symptoms] Still Tired on CPAP - Suggestions Based on OSCAR Data?
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Still Tired on CPAP - Suggestions Based on OSCAR Data?
Hi, first-time poster. 

I had a home sleep study and then (many months later) received the results and was given a diagnosis of moderate OSA. Sleep study results showed an AHI/REI of 14, RDI: 19.5, ODI: 11.2. I was given the Airsense 10 auto cpap.

Background that may not be necessary: 

After getting the apap, it took me some time to get acclimated and experiment with a few masks and to keep it on all night. I found a mask that I was reasonably happy with (Dreamwear) in terms of comfort and low leakage. For awhile I was using it rather consistently for a full night's sleep (7-9 hours) and the nurse was happy with my numbers, but I do not recall my (very long-time) symptom of excessive daytime sleepiness ever noticeably lessening. (I do not believe this usage is all shown in my overview because it was over a year ago (April 2021).)

I then started experiencing painful bloating that seemed to be associated with cpap use (presumed to be aerophagia). Sometimes it would be upon waking in the morning, sometimes waking me up in the middle of the night. My nurse practitioner lowered my pressure settings (the maximum, I guess?) a few different times trying to help with the bloating, each time saying that my apneas during usage were satisfactory enough that it would be fine. It seemed to help some of the time, but then, other times, the bloating would still be pretty bad. I also tried a chinstrap, gas X, and occasional mouth-taping (despite the fact that I had no evidence that I was even having mouth leaks; I'm not a mouth breather and have never snored (even before treatment); i never wake with dry mouth; I never woke up in the middle of the night from air escaping my mouth). I unfortunately became increasingly noncompliant due to the association of the cpap with painful bloating and no relief of drowsiness. The nurse then said I'm pretty much at the lowest pressure setting and recommended an oral appliance. 

I tried to get in contact with dentists and my insurance but everyone gave me differing information about whether or not I could get insurance coverage and how I would actually get it or find a provider. A few months passed where I was in limbo, using no treatment. I gave up on trying to track down an in-network provider and get approval, especially given everyone's warnings about it possibly causing jaw issues long-term.

Current Struggles / Asking for suggestions, given the OSCAR Data 

I have recently tried to start using my apap again because I am so very hypersomnolent and drowsy all the time, plus y'know I don't want to die early. I'm in an adjustment period where some nights I only end up wearing it half the night, waking, taking it off, and then nodding off without putting it back on. 

However, last night, I used it for ~7 hours, had a low AHI, woke up naturally, and I had enough energy to get out of bed and go for a walk, but then I became very drowsy again only ~2 hours after being up, so I used the cpap for a long nap, and I am still tired. 

Also, the other day I was very drowsy and tried to take a nap with the cpap but ended up not being able to fall asleep; still, laying there trying to sleep for like an hour and having the cpap on left me painfully abdominally bloated for a few hours. So I am still concerned about raising the pressure too much above where it is, when this issue still seems to happen some of the time? 

I am discouraged that I may not feel much more wakeful even with fully compliant therapy from this machine, and I wonder that perhaps there are changes I need to make with the machine settings that might make me /feel/ more rested, or if there may be other breathing/sleep issues happening at night that aren't necessarily registered in AHI (RERA? UARS? I don't know). Any suggestions, given the data? 

Attached are my original sleep study, an overview of past year, and my daily data from last night's sleep. 
   
   
   
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RE: Still Tired on CPAP - Suggestions Based on OSCAR Data?
Most have trouble getting enough air at a min pressure of 4. Also your pressure increases are being driven by flow limitations and may be disrupting your sleep.  For your EPR setting of 3 to work you need a pressure of at least 7 because the machine can't go lower than 4. I suggest a min pressure of 7 and max of 9. Give that a try and let us know if it helps.
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