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Mild Sleep Apnea (but still tired) - Printable Version

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Mild Sleep Apnea (but still tired) - brainf0g - 08-06-2019

Hello Apnea Board:

For years, I’ve been sleeping for seemingly 7-8 hours every night with infrequent wakening in the middle of the night. Most days, I wake up exhausted and the brain fog keeps me from operating as well as I know I can. My S.O. observed unusual breathing/gasping while I slept and suggested I go get a sleep study done.

My insurance would not cover a lab study due to a lack of major symptoms but instead covered a home sleep study (Philips Respironics Alice PDx) which resulted in 6 obstructive apneic events, 72 hypopneic events, 0 central apneas, and 0 mixed with an AHI of 10.7 (which I know is not much compared to a lot of you). I’m sure the results weren’t super accurate, but the doctor prescribed a trial with a CPAP (details of the “rig” in my profile). I’m about 2 weeks into the 1 month trial.

The first night (Screenshot #1), I struggled figuring out how to breathe with the nose mask on (included documentation and resources weren’t very helpful) and only managed to sleep about 5 hours total once I figured out I needed to close my mouth lol… but still woke up the next day feeling amazingly refreshed as if I slept 8+ hours without the CPAP.

The following night (Screenshot #2), I still struggled with breathing a bit, but managed to sleep closer to 7 hours and once again felt refreshed and clear-minded the next day. Great, right?

After that 2nd night, each following night, the mouth-breathing reduced. I tried the included chin strap, but it was pretty much useless. Wound up picking up the Caldera Releaf Neck Rest as recommended by this site and pretty much eliminated the mouth breathing… nice! The only modification I’ve made to the settings was to increase the EPR level from 2 to 3 and disabled the 15min ramp up.

Now here’s the problem… while my OSCAR graphs (at least to me… Screenshot #3 and 4) look like they are continuously improving and looking very clean, I have not been able to experience that same level of feeling refreshed and clear-minded since the first two days. Was my body just shocked (in a positive way) the first couple nights? Is there something in the most recent graphs I’m not seeing? Do I just need to keep being patient and wait to see if things get better? I do have a follow up appointment with the doctor in a couple weeks, but I’ve found the contents of this site and forum to be WAY MORE informative than he and his staff have ever been. Any feedback is welcomed and appreciated!

RE: Mild Sleep Apnea (but still tired) - DeepBreathing - 08-06-2019

G'day brainf0g. Welcome to Apnea Board. Your numbers look excellent, so you should achieve refreshing sleep. A couple of things to think about:

A lot of people do have a brief honeymoon period of a few nights when everything seems wonderful. It is (as you put it) your body being shocked in a good way. You've probably had apnea for years and it will take some time to undo the damage done.

Although the leaks are well within limits, they are pretty consistent all night long. They can disturb your sleep, especially if the air is blowing into your eyes or making "face farts". Controlling the leaks may improve sleep quality.

Finally, this is Apnea Board so we tend to think of all health issues from the apnea viewpoint. However there are myriad other causes of fatigue including
  • Uncomfortable bed or other environmental factors (noise, light, children waking you).
  • Other medical conditions (heart, lungs, vitamin deficiency, thyroid etc etc) which your GP can test for.
  • Psychological or emotional stresses (anxiety, worried about work, loss of a loved one).
My best guess is that you're going to do fine with your Resmed and will again feel that refreshing sleep you had the first few nights.

RE: Mild Sleep Apnea (but still tired) - alexp - 08-07-2019

You seem to have leak issues that may be a bit more pronounced in the last two nights. Try to fix it and see if it helps.

You gave us your AHI, but what was your RDI during your sleep study? I had a home study as well and they were still able to give me a number (on the hypothesis that an increase of my heart rate by more than 5 bpm = arousal). I'm asking just to make sure you are not suffering from UARS.

RE: Mild Sleep Apnea (but still tired) - alexp - 08-07-2019

And you should put back your EPR to 2. I don't think this is the problem but it's lowering your effective pressure by 1 and you said you were feeling fine before increasing it. It might worth a shot.

RE: Mild Sleep Apnea (but still tired) - Melman - 08-07-2019

Since the machine pressure will not drop below 2 and your median pressures are barely over 6 the increase in EPR only changes pressure support from 2 to 3 when your machine pressure increase to 7. So in you case, there is not much difference between EPR 2 and 3. I doubt the change had much effect if any.

Generally increased pressure support  is helpful in reducing flow limitations and obstructive events. I'm not sure what alexp means by stating it reduces effective pressure by 1 but perhaps I have something to learn.

I think DB and alexp were right in suggesting the consistent leaks may be the problem. If you haven't already, I suggest you read the mask primer (link below) It addresses control of leaks.

RE: Mild Sleep Apnea (but still tired) - alexp - 08-07-2019

From what I understand the ERP value lower the pressure on exhalation (epap) in order to help you breath just like a bipap does. Since most apneas events happen during exhalation, it does increase the pressure you need to prevent apneas.

I may totally wrong though as I'm not an expert on the subject.

RE: Mild Sleep Apnea (but still tired) - brainf0g - 08-07-2019

Thank you DeepBreathing, alexp, and Melman!

- I will move the EPR back to 2 tonight
- Thank you for the Mask Primer article. I do not have most of the symptoms listed, but I will check into hose management. My best guess at this point is the seal doesn’t seem to be as good when I turn my head to the side (vs. sleeping on my back which is how I am most of the night). I can hear a little air escaping from the sides of the mask
- Unfortunately the RDI was not included in the report they sent me home with
- and lastly, I’m hoping DeepBreathing is right and it will get better over time

RE: Mild Sleep Apnea (but still tired) - brainf0g - 08-08-2019

Just a quick q... is the Leak Rate looking any better? Looks like it peaked out at 10.8 (after I stopped talking before falling asleep). Is this considered "Good" or "Great"?

Also still groggy fwiw.

RE: Mild Sleep Apnea (but still tired) - alexp - 08-08-2019

Yes it seems alright now. Also, can you zoom in on a couple series of breaths? Just to see if UARS
could be a possibility. Hard to know since you don't have your RDI.

If you are not feeling better in a couple of weeks, it might be worth checking it out to rule out the possibility. 

You should read this article as well 

RE: Mild Sleep Apnea (but still tired) - Melman - 08-08-2019

You have reduced your 95% leak rare from over 10 L/min to a little over 3. That is a very good improvement. I would say very good but but maybe not great. Probably not enough to worry about but it's hard for me to speak from experience ax my 95% leak rate is usually 0. I wouldn't worry about an occasional spike unless it bothers you. I suapect we all have them. Overall your chart looks very good.