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[Treatment] I've been using my CPAP for a few weeks, and I'm still exhausted. Looking for help.
#1
I've been using my CPAP for a few weeks, and I'm still exhausted. Looking for help.
It was suggested that I post here after posting on Reddit, and not really sure why I didn't do it from the get go, lol.

So I finally got a machine after a few miserable years, and I'm trying to figure out how to zero in on my best settings. I feel terrible each day. Still waking up feeling tired, body pain (kind of like fibromyalgia but I know it's sleep related) dark circles under my eyes, and brain fog. Already spent two years thinking it was my thyroid, but all my levels are now in order, along with other hormones, vitamins, and minerals.

Currently using the Resmed Airsense 10 - Autoset, and a F20 mask with chinstrap as I'm a mouth breather at night. I'll include the data that I have from OSCAR, but I only have about a weeks worth of data there. Part of my issue is that I'm not sure if I have just OSA, or UARS, so it's taken more time to zero in on what's going on. I had a bad in lab study, and my at home study showed a higher showed a higher RDI than AHI. 

As of now, I've raised my pressure slightly, from 5 to 7, as I noticed my median pressure was closer to 7, although looking at this past week, I think I need to raise it again. Also, I was noticing that I was having some problems exhaling, so I turned EPR on 3. Might have been too high, as I've been feeling worse the few days I turned it on. Maybe also I just need to be patient, as I think I've had this for a long time, and my body needs time to adjust and heal. I also do have an appointment with an ENT specialist in 6 weeks to address my deviated septum. It's not as if I can't breat out of my nose, but I can usually only breathe out 100% from one nostril, and then either not at all, or partially from the other. 

Regardless, here's what I'm working with, still new to this, so please let me know if there's anything else I can add. Also, I can only add a few pictures I believe ATM, so here are a few from last week, and I'll add more when I can. 


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#2
RE: I've been using my CPAP for a few weeks, and I'm still exhausted. Looking for help.
Welcome to the board, there are many very knowledgeable people here that can help.  I have a couple suggestions that I think will help.

To start with I see that you increased your min from 5 to 7 - I would go up to 8 to help stop the events you have had.

I can't tell if you are using EPR (exhale pressure relief) or not but I would set it at 3 and see if that does not help you with the flow limits.  flow limits are apnea just like all other obstruction apnea.  EPR helps to control them.

And it looks like you may have some positional apnea.  That can NOT be treated with the machine - you have to find out the position you are getting into and avoid that position.   It is also called chin tucking - any time your chin drops down to your sternum you are cutting off your own airway.  It happens when you are using to high of a pillow and many times it happens when you sleep on your back.  You do not have a large amount of apnea caused by this but enough that you need to look into it.

again the setting I would use for a couple of day is -

min 8
EPR 3
max 12

let's see your oscar tomorrow, I think it will be a better night for you.
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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#3
RE: I've been using my CPAP for a few weeks, and I'm still exhausted. Looking for help.
(10-04-2021, 03:45 PM)staceyburke Wrote: Welcome to the board, there are many very knowledgeable people here that can help.  I have a couple suggestions that I think will help.

To start with I see that you increased your min from 5 to 7 - I would go up to 8 to help stop the events you have had.

I can't tell if you are using EPR (exhale pressure relief) or not but I would set it at 3 and see if that does not help you with the flow limits.  flow limits are apnea just like all other obstruction apnea.  EPR helps to control them.

And it looks like you may have some positional apnea.  That can NOT be treated with the machine - you have to find out the position you are getting into and avoid that position.   It is also called chin tucking - any time your chin drops down to your sternum you are cutting off your own airway.  It happens when you are using to high of a pillow and many times it happens when you sleep on your back.  You do not have a large amount of apnea caused by this but enough that you need to look into it.

again the setting I would use for a couple of day is -

min 8
EPR 3
max 12

let's see your oscar tomorrow, I think it will be a better night for you.


Thanks for your insight, it's actually nuts you're able to notice that from just my sleep report. I do sleep lately on my back, and that was just because I found myself ending up on my back for whatever reason. I thought I might as well do it from the get go. Also, it was the only way prior to getting my CPAP, that I could sometimes, and that wasn't very often, get ok sleep. That being said, I wasn't using EPR at that point, I added this recently, and my sleep seemed to get worse. Perhaps I shouldn't have just jumped to a 3, instead doing 1 or 2, or maybe I just need to get used to it. I'm including the couple of days I did use it for reference. 


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#4
RE: I've been using my CPAP for a few weeks, and I'm still exhausted. Looking for help.
I would keep it at 3 the reason is the flow limits. As I wrote before flow limits are apnea (what you are using Cpap for) and to help with those we rais the EPR. 3 is as high as it goes on an airsense. So I would keep it there. You may have had a bad night but I really don’t believe it has to do with EPR. Unfortunately we all have bad nights. Let’s see how you do tonight.
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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#5
RE: I've been using my CPAP for a few weeks, and I'm still exhausted. Looking for help.
Ah, ok, that makes sense, I'll certainly give it a shot. You guys definitely have more experience with this than I do haha.
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#6
RE: I've been using my CPAP for a few weeks, and I'm still exhausted. Looking for help.
So, I last night made the changes, tried to also change my sleeping position. I feel still fairly tired. Around the same I'd say as it's been. I will say that I ended up waking up somewhat propped up on my back, which I don't remember doing, which might not be helping. With things like positional apnea, is that something that can be adjusted with pressure, or is it really just trying to find ways to not be in those positions? Also, with my little bit of understanding, should I maybe try bumping up the max pressure to 13? I seemed to be hanging around the upper end of my pressure most of the night, and maybe it's just needing to be raised. Not sure if the flow limit helped or hurt, but I think it would be a good idea to keep it for now while trying to raise the pressure?


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#7
RE: I've been using my CPAP for a few weeks, and I'm still exhausted. Looking for help.
Woops, not sure if you can edit, but realized I hadn't put the correct format for the OSCAR data. Here's one that I believe is correct, hopefully that helps.


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#8
RE: I've been using my CPAP for a few weeks, and I'm still exhausted. Looking for help.
Take a minute and compare the flow limits chart to your pressure chart. You can see when you have a
increase in flow limits your pressures increases. I can’t tell how high your EPR is
 Set (can’t see the bottom of the left column) but set it to 3. Is it is already at 3 raise the min up 1 (not the max)

Yes there is still some positional apnea and you cannot help it with pressure changes. Only staying out of the position. I did not mention this before because you do not have a lot of positional apnea, however you may want to look at my link to collars at the bottom of the post. Many people here have found it is the only way they can control positional apnea. AGAIN you do not have a large amount of them like the people in the link.
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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#9
RE: I've been using my CPAP for a few weeks, and I'm still exhausted. Looking for help.
Another method to minimize Positional Apnea is to reduce the amount of pillows used, or if already only using one, to try a different type. The idea is to use as flat a pillow as is comfortable. A high stack of pillows promotes the your chin is pointing towards your chest scenario which is the basis for Positional Apnea. This Positional Apnea is the same as kinking the garden hose, reducing flow. The way to prevent it is a physical removal or prevention of the action that kinks the airway. Just like more water can't overcome the kinked garden hose, your PAP can't overcome a kinked neck.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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#10
RE: I've been using my CPAP for a few weeks, and I'm still exhausted. Looking for help.
Hey guys, been about a week, probably not my best week, but it's all part of the process. First things first. I did want to throw up my original at home study, just to double check what you guys think if I'm correct with UARS. I can throw in my lab study if you want as well, but it went really poorly, like not even 3 hours of sleep. I didn't know you could ask for a sleep aid lol. My S/O also hears me not so much as gasping, but just like it isn't wide enough to breath. Pretty sure I had it since I was a kid, as my mom would tell me she thought I had bad dreams and was just making noises, but in reality I think it was a form of SDB. 

As far as this week, I probably did something stupid, and got impatient. I was still having these flow limit spikes, in addition to just feeling like garbage, I tried upping my pressure. Evidently it was too much, as I just induced a bunch of centrals. EPR was set to 3. Saturday I felt pretty terrible TBH, while Sunday, I felt a little better, then awful, and yesterday was absolutely miserable. Since then I lowered my min pressure to 9. Not sure what my statistics were however, as I was so out of it that I forgot to put my SD card back in my machine  Oh-jeez.

Here was my sleep from yesterday, ran out of space on the last post.


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