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Weird breathing patterns? 3 months on CPAP, AHI of 4, still feel awful
#1
Weird breathing patterns? 3 months on CPAP, AHI of 4, still feel awful
Hi all,

This is my first post to the forum after lurking for a few months and I'm hoping someone could take a look at my oscar chart and see if anything doesn't look right.  

I started CPAP therapy roughly 3 months ago, following an at home sleep study that led to a diagnosis of "Mild positional sleep apnea" with an average AHI of 10 increasing to 15 when supine. I was given a Resmed AirSense 10 Elite CPAP with an F20 full face mask set to a pressure of 10 with EPR of 3.

Over the three months my AHI has dropped to an average of just over 4. It's nearly always between 3.5 and 5.5 on any given night, it's very occasionally gone as low as 1.8 and as high as 12. I've been wearing the mask on average a little over 7 hours a night, I think I've only missed 3 nights where I just couldn't get comfortable in the mask and gave up. I've also been making a big effort to sleep on my side and to avoid mask leaks.

Despite all this I still feel tired all the time. I generally sleep through the night fine, but I wake up feeling terrible each day, I'm so tired, spaced out and often have headaches. Getting up requires a ridiculous force of will and find I generally need at least 2 power naps to get through the work day (luckily I work from home) I limit these to 20 minutes but could easily sleep for a couple of hours if I didn't set an alarm.

I've been spending some time reading up on interpreting oscar data, and whilst I understand what the different event types / AHI are etc, I don't fully understand where to go beyond there. I've noticed what looks like some very weird breathing patterns at stages throughout the night on the flow rate chart but I really don't understand what I'm looking at beyond that. I've attached my chart from last night and I'd be really grateful for any feedback anyone can provide! 

Thanks in advance!


Also, a bit of background in case it's useful: I'm 37, male with a BMI of 27 with a few health conditions I take regular medication for: Levothyroxine, Sertraline and Xagitin XL [modified release methylphenidate for ADHD]). My thyroxine levels were checked very recently and were all fine.


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#2
RE: Weird breathing patterns? 3 months on CPAP, AHI of 4, still feel awful
You have flow limits up the wazoo. Do a google scholar search on flow limitation - that’s probably a good start on why you’re not feeling refreshed. I will let more experienced members offer/correct my advice, but my initial instinct is A. You need a new titration. B. You need an auto setting. Or C. Try raising your pressure until you don’t have flow limits or can’t tolerate further pressure because of centrals, aerophagia, etc.
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#3
RE: Weird breathing patterns? 3 months on CPAP, AHI of 4, still feel awful
Hi leftfield!  -  Welcome

Since you are at the limits of EPR, your next best thing is to not sleep on your back.  In this position, gravity is not your friend.  Try side sleeping.
Crimson Nape
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OSCAR Chart Organization
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#4
RE: Weird breathing patterns? 3 months on CPAP, AHI of 4, still feel awful
Up your pressure to eliminate OA events, start with 11, we may go higher.

Some of these events appear to be positional in that you are likely tucking your chin. Try a pillow modification to get your head flatter, thinner 1 vs. 2 pillows, less firm, etc, MAYBE later we will talk about a soft cervical collar, see my signature for a link to a discussion and explanation.
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#5
RE: Weird breathing patterns? 3 months on CPAP, AHI of 4, still feel awful
Thanks everyone for the responses! I've put the pressure up to 11 and I'll see how I get on with that tonight. I'll also take a look into the pillow situation and see how that goes!
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#6
RE: Weird breathing patterns? 3 months on CPAP, AHI of 4, still feel awful
Thanks once again for the suggestions, here is the result of last night's sleep on pressure setting 11 (I also disabled auto ramp). My perception is that I slept through the night without waking up. I definitely swallowed air and woke a little bloated but it wasn't severe. I can't really tell if I feel any different overall, maybe a little better? Although I also slept an extra hour over the night before.

Any thoughts? My instinct is to push up to 12 tonight, or should I stick with the same pressure for a bit longer?


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#7
RE: Weird breathing patterns? 3 months on CPAP, AHI of 4, still feel awful
One other question I wanted to ask. The NHS sleep clinic didn't even discuss different machines with me, they just gave me the AirSense 10 Elite, but having since done some research I'm thinking I'd be better off with an AutoSet? 

I've got a follow up appointment on 19th and I'm going to ask them for an AutoSet, if I get one for free, all well and good! If not I'm more than happy to buy one myself, the cost isn't prohibitive to me, I just wanted to check the machine is a worthwhile upgrade for me (it doesn't just have go faster stripes etc).

Thanks again for all your help.  Smile
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#8
RE: Weird breathing patterns? 3 months on CPAP, AHI of 4, still feel awful
I will leave the pressure recommendation to Gideon. If you can easily afford an Airsense 10 Autoset, I wonder whether you might instead want to invest a little more and get a ResMed Aircurve 10 VAuto. This has all the affordances of the Airsense 10 Autoset, but it can also provide more pressure support. (Your EPR is the equivalent of PS of 3.) Greater PS could help with the flow limitations. No telling whether the FLs play a role in your unrefreshing sleep, but it is quite possible.
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#9
RE: Weird breathing patterns? 3 months on CPAP, AHI of 4, still feel awful
Take your pressure to 12 for now.

Talk with your doc about getting a VAuto BiLevel because your flow limits per your chart are high and you need more PS to treat/minimize them because you feel they maybe disrupting your sleep.

For sure they are making you expend more energy breathing thru the night, that is counterproductive to a good night's sleep.

Yes the autoSet will be marginally better for you but you need a VAuto, a BiLevel without backup.
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#10
RE: Weird breathing patterns? 3 months on CPAP, AHI of 4, still feel awful
Start a daily list of all the bad. These are symptoms that are not going away. These include bad readings including your flow limits.

This is justification for a BiLevel so you have a line that says despite a PS is 3 (EPR) my FL ar 0.47 vs less than 0.10.
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