[Treatment] 4 Years on CPAP, Still Tired with Morning Headaches

[FancyFrog]

Hi there,

I've been on some kind of PAP therapy for around 4 years now, including CPAP, APAP, and BiPAP, on pressures from 12 to now 20. And while the therapy definitely helps to some degree, I'm still very tired throughout the day, frequently wake up with a headache, nap frequently, etc.

My machines have always reported a high number of central apneas. Originally my doctor said I might have treatment emergent central sleep apnea, but that it would go away within a couple months. Unfortunately, not much seems to have changed. My doctor is rather difficult to get a hold of, but he seems to think we need to keep trying different pressures, some of which I've already tried multiple times.

I'd like to get a better handle on what exactly is going on. I've been reading that CPAPs can make mistakes in measuring events, with sleep/wake junk, sleep/wake transition events, etc. I guess it makes me wonder though, even if somehow all of them are false, they still seem to indicate I'm not having very high quality sleep, and I'm not sure what I can do about it.

---

I set up a camera to record my position throughout the night, and my AHI doesn't seem to be affected much by sleeping on my back.

I've also tried zooming in on some of the central apnea events in OSCAR to look for the big rise and fall in the flow rate graph prior to the event, and most don't seem to have that, though some do.

Here are some of my machine's number's from the last year:

Avg Hrs/Night ------------- 07:03
> 4 hrs/day --------------- 76%
AHI ----------------------- 16.42
OA Index ------------------ 3.91
H Index ------------------- 2.23
UA Index ------------------ 0.12
CA Index ------------------ 10.17
95% Flow Limit. ----------- 0.37
RERA Index ---------------- 1.08
Avg Leak Rate ------------- 1.54
95% Leak Rate ------------- 7.2
% time > Leak Threshold --- 1.45%
Avg Pressure -------------- 16.82

Here are some of the most recent machine settings changes (most to least recent):

AHI      Pressure Relief    Mode       Pressure
--------------------------------------------------------
11.66    EPR: Off           CPAP       Fixed 20
17.45    None               BiPAP-S    EPAP 13, IPAP 17
23.98    None               BiPAP-S    EPAP 11, IPAP 15
15.47    EPR: 3             CPAP       Fixed 17
29.04    EPR: 3             CPAP       Fixed 13
18.49    None               BiPAP-S    EPAP 13, IPAP 17
14.57    EPR: 3             CPAP       Fixed 17
12.37    EPR: Off           CPAP       Fixed 15
12.46    EPR: Off           CPAP       Fixed 17
11.32    EPR: Off           CPAP       Fixed 15

I'll also attach an OSCAR daily view and overview of the last year.

Any help would be greatly appreciated.

[attachment=44283]
[attachment=44284]

[Gideon]

What is your trigger setting?

Why are you at 20 fixed?

After I see your answers I may start from scratch at a lower pressure as higher pressures can, not do, cause central apneas.

[FancyFrog]

Hi Gideon, thanks for the response.

I don't see trigger setting in the clinical menu under CPAP mode. Is there somewhere else it might be?

My most recent sleep study is what determined my current pressure setting. It just doesn't seem to be doing the trick for me unfortunately, and I didn't have a whole lot of hope for it to be honest. I had been on 19 fixed in the past with similarly poor results.

Thanks.

[OpalRose]

Hi FancyFrog,
The Trigger setting is only available in VAuto, S and ST modes. Set at high or very high (in your case, very high) may help with CA's.

Have you tried VAuto mode?

[FancyFrog]

Hi OpalRose,

No I haven't been on VAuto yet. As soon as I got on a BiPAP machine they put me on S mode, and then not too long after moved me back to CPAP mode. Definitely something to think about trying if I can figure it out!