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[Treatment] I am more confused than ever....
#1
I am more confused than ever....
Hi Everyone, 

I'm hoping someone may have some new insights or lines of thinking for me to run down. I have been suffering from fatigue for almost three years. Here is my timeline:

January 2016 - I first began experienced feeling fatigued. I had slept well my entire life up until this point. Oddly, my fatigue had an irregular pattern: I would wake up feeling exhausted one day, and feel fine the next. This pattern, in some irregular form, has persisted. 

July 2017 - After lots of bloodwork and a night in the sleep lab, my first sleep doctor (Dr. Cooper) told me that she did not think I had apnea. She informed me she suspected I had anxiety and should work with my PCP or a psychiatrist. Despite not feeling particularly anxious and not knowing what else to do, I followed her advice. 

August 2017 - I went to the Rheumatologist because my bloodwork revealed a very high rheumatoid factor. We ran down this avenue and found no other factors for inflammatory disease. 

September 2017 - I asked my PCP if I could try an SSRI. I ended up taking Celexa. For about two months, I felt mostly better, despite slight brain fog. By late November, my symptoms of fatigue had returned. 

December 2017 - I started going to a psychiatrist to understand if maybe I needed a different SSRI. My psychiatrist did not think I had any anxiety that would be causing the level of fatigue I was experiencing. 

February 2018 - I stopped taking Celexa because its efficacy ceased. 

March 2018 - I returned to Dr. Cooper to see if she had any other ideas. I got a CPAP that I used briefly with minimal instruction and even less success. 

May 2018 - I have a turbinate reduction and septoplasty. 

December 2018 - I visit another sleep doctor. Sleep Doctor #2 tells me I have 18/RERAs per hour. I am diagnosed with Upper Airway Resistance (UARS) and receive a CPAP. I feel better for about three months. My doctor doesn't understand my regression, and I ask for a referral to Oregon Health and Sciences University (OHSU)

May 2019 - ENTs at OHSU tell me I have a collapsed nasal valve and should have surgery.

August 2019 - I have a four-hour surgery on my nose and sinuses. I come home from surgery and sleep on a foam wedge pillow. For about a week following the surgery, I feel good. 

October 2019 - I meet with a PA at OHSU sleep medicine and have a titration study booked for January 2020

Currently - I am trying to refine my settings, so I nullify all events. From what I see on sleepyhead: I should be feeling great, but I'm not. Has anyone seen such madness before? Any insights? Leads?

THANK YOU!
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#2
RE: I am more confused than ever....
(11-27-2019, 01:49 PM)JL3000 Wrote: December 2018 - I visit another sleep doctor. Sleep Doctor #2 tells me I have 18/RERAs per hour. I am diagnosed with Upper Airway Resistance (UARS) and receive a CPAP.

To me, this is the most important piece of information.

You might read some of the recent UARS threads here (tarah's might be particularly relevant to you), as it may give you some ideas (and further questions).

In particular, as you read through that material, compare your "flow limitation" numbers and graph to what you see there. You want to reduce those a fair bit, as they seem to correlate with RERAs. And sometimes/often CPAP isn't adequate to do this, and you need to move to a bilevel.

PS - when you post the screenshots, make sure to remove the pie chart on the left.
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#3
RE: I am more confused than ever....
Welcome to the forum.

Your EPR is set to 2. Set EPR=3 and repost. Please see the Organization link in my signature. You are missing what is for you the most important chart, Flow Li9mitations.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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#4
RE: I am more confused than ever....
What is the basis for the 9 cm min?  Not challenging it, just curious as to what the thinking is behind that particular number.

What I can see is pretty darned decent, something I have gotten used to and where I seem to be well served. I wish we were privy to any formal diagnosis of sleep quality and arousals.
Serial Tapist
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#5
RE: I am more confused than ever....
Hi @Bonjour, 

Please see the updated and correctly formatted charts. I will set my EPR to 3 for tonight. 

Cheers!
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#6
RE: I am more confused than ever....
(11-27-2019, 03:07 PM)JL3000 Wrote: Hi @Bonjour, 

Please see the updated and correctly formatted charts. I will set my EPR to 3 for tonight. 

Cheers!

You still need the left sidebar; you just need to remove the pie chart from it ;-)

Make sure you review the wiki page that bonjour suggested, and the point about the missing FL graph.
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#7
RE: I am more confused than ever....
Hi @Mesenteria,

Thinking for the base pressure setting of 9 is based on previous data. I was seeing a trend that my pressure would ramp up to 8-8.5 shortly after falling asleep (from an initial setting of 6). I figure, narrower and more accurate of a range I can delineate, the less the machine will need to work in order to catch and resolve events. 

Cheers!
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#8
RE: I am more confused than ever....
Thanks! Sorry for the confusion.
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#9
RE: I am more confused than ever....
Getting closer, but still missing the FL graph.
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#10
RE: I am more confused than ever....
I am not doing well at this  Laugh-a-lot
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