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[Treatment] Compliance good after 1 week, but sleep is now worse than at beginning
#1
Question 
Compliance good after 1 week, but sleep is now worse than at beginning
Hello everyone !

I am new to all of this so excuse the lack of knowledge :').
I ordered my cpap, a RESMED Airsense Autoset for a mild sleep apnea (AHI 6 on a good night) and possibly UARS.
I still do not have access to a bipap for now, so I am dealing with what I have currently.

I felt the "change" the morning after the first night, feeling finally like myself, and for this week, even with a poor CPAP compliance, I felt absolutely changed.
Though it all came crashing down recently, and now, even sleep 9 hours with the machine, and at AHI 1.18, I feel absolutely dead tired.
I have a good sleep hygiene and nothing changed from last week. I even have less trouble falling asleep.

Last night OSCAR data still shows flow limitations, I am currently at Autoset pressure 8.6 / 11.6 (tried to play with the numbers here), with EPR of 2 (I tried 2 last night but before that was at 3). I did have an increased leak yesterday, but I don't have any leaks most of the time, while being on the same pressure. My first night pressure was 7 / 9 with no EPR, and felt much better than last night sleep.

I wonder if something on my data is showing where my symptoms could come from ? I really am not feeling changed anymore, it just feels back to square 1.

Thanks a lot for your help, I hope I did not forget any informations that could help.


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#2
RE: Compliance good after 1 week, but sleep is now worse than at beginning
It would be helpful if you use the menu to select standard graphs.  View>Reset Graphs>Standard.  Once you have done so, please resize the graphs so they all fit on one screen without scrolling.  It helps to see everything all at once.  You can resize the graphs by placing your cursor on the horizontal line between the graphs then clicking and dragging the graph.

As a fellow UARS sufferer, I feel your pain.  Low AHI does not always make us feel good.  I have been helped here on AB by very talented and caring people.  They will be along shortly to help.  Personally, I did not get better until I got a bi-level machine.  My old machine was an APAP, and it never effectively controlled my UARS.  Now, with the bi-level, I feel good.  Help for you is on it's way.
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#3
RE: Compliance good after 1 week, but sleep is now worse than at beginning
The ramp isn't doing you any favors.  I recommend that you turn it off.  Your flow limits look positional. This is probably caused by sleeping on your back.  If you are not sleeping on your back, then it is from chin tucking.  The options for this are, sleep on your side and/or increase your pressure range to 10-14 with an EPR of 3 -Full time.  If you still experience the OA's and hypopneas, consider purchasing a soft cervical collar.  

Here is a Wiki article to help understand the soft cervical collar (SCC):  http://www.apneaboard.com/wiki/index.php...cal_Collar

Good luck!
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Beginner's Guide to Sleepyhead and OSCAR
Apnea Helpful Tips

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: Compliance good after 1 week, but sleep is now worse than at beginning
I will do ! Thanks for the tip Smile.

I am waiting for bi-level to arrive sooner or later, it gives me hope while waiting for a formal diagnostic. How did the bi-level helped compared to APAP ? Curious on what the issue could be for me.

Thanks a lot for the recommendation. 


Do you have any explanation on why the ramp isn't helping ? (do you mean ramp or autoset ?).

I'll look into the positional issue. Maybe I can't breathe by my nose so my body goes on my back to mouth breathe ? In that case you are right, I will try to increase pressure range tonight. 

Hope that bi-level will be an improvement though, and thanks a lot for your clear explanation ! I have been recommended this forum by people on r/uars and I can see why Wink
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#5
RE: Compliance good after 1 week, but sleep is now worse than at beginning
The bi-level offers more pressure support than a standard APAP.  PS is similar to EPR.  With my bilevel I can get up to PS=10 cm-H20 pressure differential between inhale and exhale.  Also, my bi-level allows fine tuning of various timing parameters when it switches between inhale and exhale.  For me, adjusting these parameters were critical to getting a good night's sleep with very low AHI.  As far as I know, no APAP has these timing adjustments.

It took me a while to find the correct settings.  I received a lot of excellent guidance from AB.  You will get the same.
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#6
RE: Compliance good after 1 week, but sleep is now worse than at beginning
For me, my Autoset was just providing enough therapy to feel OK. The AirCurve VAuto is a whole different story. It provided enough PS to eliminate all flow limitations and snores. I'm very sensitive to pressure changes, therefore I use the S mode. This mode has an "Easy-Breathe" option. This automatically adjusts the ramping up, in time, to the IPAP pressure from the EPAP based on your breathing patterns. It is so natural feeling, that I forget the CPAP is operating.

Good luck on the upgrade!
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Beginner's Guide to Sleepyhead and OSCAR
Apnea Helpful Tips

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: Compliance good after 1 week, but sleep is now worse than at beginning
While using the ramp you are really NOT on therapy. In your case you started then stopped in 45 minutes then started again so over an hour of our therapy. I agree turn off the ramp
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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#8
RE: Compliance good after 1 week, but sleep is now worse than at beginning
I understand.
I am a bit surprised though that my pressure levels are still not getting rid of UARS limitations.

Thanks a lot for the support !

Thanks A LOT then, I am a bit ashamed to not have catch up on that myself...


I appreciate the help
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#9
RE: Compliance good after 1 week, but sleep is now worse than at beginning
Cannot help with the technical stuff but I can say, there are a lot of variables in adjusting to therapy. Many of them work against each other. Some problems got better as others got worse but still, overall, progress gets better and better.
CPAP is a journey like “The Wizard of Oz”. It’s a long slow journey. You will face many problems and pick up many friends along the way. Just because you reach the poppies, it doesn’t mean you are in Kansas. 
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#10
RE: Compliance good after 1 week, but sleep is now worse than at beginning
Welcome to the Apnea Board. Nothing to add from the others, so just a greeting. As for BPAP like a VAuto versus CPAP/APAP, the BPAP has more PS than the 3 EPR and it goes up a bit higher in total IPAP. And yes as mentioned, there's a few breath time controls that may be beneficial. As you seem to be one that needs higher PAP pressures, that could be why you're getting a BPAP/VAuto. It's an excellent machine so it will serve you well.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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