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[Treatment] Still Tired, Trying to treat Symptoms
#1
Still Tired, Trying to treat Symptoms
Hello,

So I posted a while back about still having symptoms despite being on therapy for a year. Well didn't quite follow through on the advice that was posted because I had an appointment the following day. They just bumped my max pressure to 9 and my min pressure to 6, which I a few days later bumped back up to 7 because 6 made me feel like I was suffocating. Since then I've still been struggling with feeling very tired despite sleeping an average of 8-9 hours a night. My AHI varies significantly day to day and recently I've been having big large leaks despite having a  full face mask, I am considering switching back to a nasal mask in March and trying mouth taping, as I find the minimal contact of the mask appealing.

I'd appreciate any help I can get since going to my doctor did nothing really to help. I attached some charts from OSCAR for the past two nights. I'm not quite sure why I keep having such massive leaks, so any suggestions to fix those are welcome too.


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#2
RE: Still Tired, Trying to treat Symptoms
since no one has responded yet I'll add my 2 cents. as I understand it, pr machines report total leak which includes intended or designed venting. that would be the upper graph line. look at the stats in the left panel of the oscar daily page and you'll see both leak rate and total leak. your leak rates are mostly fine except about an hour of what looks like a mouth leak on the 12th. that followed a cluster of hypopnea. you can try a soft cervical collar for both the mouth leaks and the clusters of events, assuming the h is obstructive. however, you have more ca than oa so your h may be central as well, in which case the collar may not help those. post a screenshot of about 3 minutes leading up to and a bit beyond an h or two; we might be able to tell. ca tends to vary from night to night (consistent with your complaint) but if you often have more ca than oa and/or you had ca in your pre-treatment sleep study, there may be a tweak or two you can try to avoid them with your current machine but it isn't designed to treat ca. if tweaks fail to help, you may need to push to get a different modality called asv, but that's not certain at this point. I've never used a pr machine so wait to hear from other members for pressure setting suggestions. the idea with cpap and apap is to reduce pressure and pressure variation to reduce ca without increasing oa too much. it's a balancing act.
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#3
RE: Still Tired, Trying to treat Symptoms
Do try going back to the nasal mask, if it was comfortable for you. A good tape to start with is Somnifix, available via Amazon. It is gentle, holds well, and does not irritate your skin. Be sure to purse your lips before you apply the strip.

I agree with sheepless that there may be a balancing act here, with the OAs and Hs suggesting a higher minimum and the CAs warning you off. And as sheepless says, it is possible that some of the Hs are central.

But a big question is whether your central events are occurring when you are asleep or not. When we're awake, we breathe with less regularity and often pause between breaths for 10 seconds or more. Any CAs that happen while you are awake are irrelevant to your machine settings and apnea treatment.

On the whole, I lean toward suggesting you raise your minimum by .5, to 7.5, to see what happens. No need to change your maximum since it looks like you don't reach it. Alternatively, you could stick with your current settings for a few more nights to see how things shake out.

I also agree with sheepless that you might want to experiment with a soft cervical collar. If part of your leak issue is caused by your jaw dropping, the collar could help, and if you are tucking your chin down toward your chest, it could also help to reduce obstructive events.

Finally, what medications are you taking? And how are you doing on the basic guidelines for good sleep? Here they are:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.
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#4
RE: Still Tired, Trying to treat Symptoms
(02-14-2021, 01:21 AM)novanoe Wrote: Hello,

So I posted a while back about still having symptoms despite being on therapy for a year. Well didn't quite follow through on the advice that was posted because I had an appointment the following day. They just bumped my max pressure to 9 and my min pressure to 6, which I a few days later bumped back up to 7 because 6 made me feel like I was suffocating. Since then I've still been struggling with feeling very tired despite sleeping an average of 8-9 hours a night. My AHI varies significantly day to day and recently I've been having big large leaks despite having a  full face mask, I am considering switching back to a nasal mask in March and trying mouth taping, as I find the minimal contact of the mask appealing.

I'd appreciate any help I can get since going to my doctor did nothing really to help. I attached some charts from OSCAR for the past two nights. I'm not quite sure why I keep having such massive leaks, so any suggestions to fix those are welcome too.

Welcome to the forum!

There are wonderful people here that will help you out.

I've used cpap for over 30 years.  My treatment improved so much when I started taking the suggestions that were offered here.  My old sleep doc was a tyrant.  He only wanted to be sure that my machine was turned on, and I had my mask on.  My story isn't important but I offer it so that you know that you're not alone.

I hope this helps.

Dave
DaveL
Compliant for about 30 Canadian years

I'm just a cpap user like you. I don't give medical advice. I hope to learn from you, and share my experiences with you. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#5
RE: Still Tired, Trying to treat Symptoms
Hello again, trying out 7.5 pressure tonight and will post a 3 min segment as well as general charts for tonight tomorrow morning. Thank you so much sheepless, Dormeo and DaveL
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#6
RE: Still Tired, Trying to treat Symptoms
Hello, I'm back again. So sorry for not posting we had power on and off for the past 3 days because of bad weather. I have a soft cervical collar coming in soon from amazon, and have upped my pressure as suggested to 7.5. Here are some of the charts from last night along with some 3 minute segments for some H's as requested. Any thoughts on what I should do next? 

Thank you for the help!


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#7
RE: Still Tired, Trying to treat Symptoms
CAs ticked up a little, and actually so did OAs. Hard to spot a trend with just a couple of days to go on. The smartest thing would probably be to stay with your current settings a little longer, to let them settle in. I'm also curious to find out how you do with the collar. It'd be great if it turned out to be comfortable for you and to be effective in busting up those little clusters of events.

If you long to make a change, however, I'd suggest raising both min and max by .5.
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#8
RE: Still Tired, Trying to treat Symptoms
(02-17-2021, 06:47 PM)novanoe Wrote: Hello, I'm back again. So sorry for not posting we had power on and off for the past 3 days because of bad weather. I have a soft cervical collar coming in soon from amazon, and have upped my pressure as suggested to 7.5. Here are some of the charts from last night along with some 3 minute segments for some H's as requested. Any thoughts on what I should do next? 

Thank you for the help!

Welcome back.

An insight....

First the other people here have so much skill! They truly helped me out.

I was impatient.  I wanted results right now.



I asked for help.  Changes were recommended.  I set up my new machine as they asked.  (I expected good numbers, right away! Didn't happen right away.)

But it has happened! And the results are beautiful.

And finally, none of the 3 doctors I've had in 30 years have made meaningful changes.  

They simply wanted me to fill out a questionnaire and then prove to them that my machine was on enough hours. That was sufficient in their eyes to judge I was compliant.

It's the fine people here who have provided suggestions that really helped me.
DaveL
Compliant for about 30 Canadian years

I'm just a cpap user like you. I don't give medical advice. I hope to learn from you, and share my experiences with you. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#9
RE: Still Tired, Trying to treat Symptoms
I mostly solved my problem of large leaks by (1) taping my mouth, and (2) cleaning my cushion and face and shaving before bed every night.
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#10
RE: Still Tired, Trying to treat Symptoms
(02-18-2021, 06:13 PM)Karlin Wrote: I mostly solved my problem of large leaks by (1) taping my mouth, and (2) cleaning my cushion and face and shaving before bed every night.

Good suggestions....

I find that OSCAR really helps me.  I reach a point where the mask is just plain done.  Worn out.

So when my numbers aren't good I take a look at performance through OSCAR.

Dave
DaveL
Compliant for about 30 Canadian years

I'm just a cpap user like you. I don't give medical advice. I hope to learn from you, and share my experiences with you. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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