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[Help Requested] How to improve? - Printable Version

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[Help Requested] How to improve? - bigbiz - 09-20-2020

Hi all,

Thanks in advance for taking the time to review my post. I'm not feeling much better after being on CPAP therapy since May. I'm due for a titration study in late October so hoping that may help clear things up. But in the meanwhile, hoping to gather opinions on my treatment / sleeping patterns.

Background: After a "take home" sleep study (AHI: 5.1), I was diagnosed with 'mild' Sleep Apnea earlier this year (~May timeframe) and was put on a CPAP (Resmed Autosense 10). I've tried a few different configurations (nasal mask -> nasal pillows, 5-6 variable pressure to 5.6 fixed), but I still find myself waking up exhausted in the mornings and feeling tired throughout the day, especially around 4-6PM. Example: it's 430PM PST and after getting at least 8 hours of sleep with a ~3 AHI, I'm tired. Didn't do much today besides go grocery shopping.

I also get wired at night, likely insomnia, and have at times suffered from what I think is restless leg syndrome. These latter symptoms have improved post-CPAP, but still occur at times.

Oscar data: I've noticed a few things. First, my AHI tends to fluctuate up and down, hitting 5 at times. Second, regardless of the AHI level, most of it is being driven by "Clear Airway" events. Is it possible that I have central sleep apnea or UARS?

Thanks again!


RE: [Help Requested] How to improve? - OpalRose - 09-20-2020

I don't see evidence of UARS. With a diagnosis of mild sleep apnea and AHI of 5.1, it's not likely you have central sleep apnea and that what you are seeing on your graphs above may be treatment emergent, and may settle down in time.

Do you have access to reports from your at home sleep study? If you do, post it here for review.


RE: [Help Requested] How to improve? - bigbiz - 09-20-2020

Hi thanks for the response. I don't have access, but can request. Is there anything in particular I should ask them for?


RE: [Help Requested] How to improve? - Cpapian - 09-20-2020

For your restless leg you can try taking iron and vitamin C (250) together.  I took it for a while on doctor's recommendation  and it did help.


RE: [Help Requested] How to improve? - SarcasticDave94 - 09-20-2020

The sleep study report asked for should be a detailed multi-paged type not the summary only. Whatever you get is better than zero info though. The reason is you need these to put in your personal medical file. Here in the US it is yours to obtain legally per HIPAA.

I would suggest turning off Ramp. Your low therapy pressures do not dictate it is needed. It also adds pressure swings that can increase CA events including the treatment emergent variety. Consider bumping pressure to 6 and with EPR at 2. This may need to change with more data to base setting changes.


RE: [Help Requested] How to improve? - bigbiz - 12-31-2021

Bumping this old post - please do let me know if starting a new thread would be preferred. Providing an update as well as seeking feedback.

It's been a little over a year since I first posted. I did a sleep center titration / sleep study and have also had my pressure settings adjusted. Unfortunately, I haven't experienced much improvement in my symptoms. For instance, I find myself still waking up feeling "tired" (i.e. unrefreshed), getting sleepy during the day, and find my concentration to be lacking.

I've done extensive bloodwork and have worked with my Primary Care Physician to rule out other causes - it's been negative on these tests. We do think that I may have Persistent Depressive Disorder as well as Irritable Bowel Syndrome. I've been addressing the former with an antidepressant and for the latter am working with a dietician.

Still, I can't help but think that my sleep just isn't where it needs to be. Despite pressure adjustments, it's extremely rare for me to hit AHI < 1.0. The events that do occur are typically Clear Airway events (Centrals).

I'm currently exploring the following:
(1) Reducing EPR as I hope this will help reduce the Centrals
(2) Trying out a cervical collar - I'm on nasal pillows and have noticed that I wake up with a congested nose and dry mouth
(3) Playing with humidity settings - see above on congested nose

Attaching some reports as well (Sleep Study readout + 2 recent OSCAR reports).


Many thanks in advance for your time and advice.


RE: [Help Requested] How to improve? - Sleeprider - 12-31-2021

Your sleep titration test confirms good results at relatively low pressure. The test notes a high non-respiratory arousal index, and that is likely the source of ongoing fatigue. We can try looking a a close-up of your respiratory flow (3-minutes) where the flow wave is clearly visible. You have always had a variable inspiratory flow rate. I don 't know that we can suggest therapy changes to resolve the problem, but we might as well take a closer look.

Thanks for coming back to your original thread. It helps not to have to search for the old one and it appears this is a continuation of the same issues.


RE: [Help Requested] How to improve? - bigbiz - 12-31-2021

@Sleeprider thank you for the reply!

Where are you getting that I have a high non-respiratory arousal index? Are you deriving this based off of total arousal index minus resp. arousal index? What is a "normal" index number? My sleep doc didn't mention or point this out when we reviewed the test results a year back but now I wish that he had.

Is it possible that these arousals have something to do with my jaw opening at night?

Here's some close-ups of my flow rate - hope these are helpful.


RE: [Help Requested] How to improve? - SarcasticDave94 - 12-31-2021

So you have 2 each of Obstructive Apnea and Hypopnea, and 6 Central, and the diagnosis is Obstructive Apnea.

2+2+6=4?

I guess the tech has BDDDB degree. That's Blind Deaf Dogs Don't Bark, compliments of K9U.


RE: [Help Requested] How to improve? - bigbiz - 02-13-2022

Bumping this thread. Since I last posted, I began utilizing a cervical collar, not too sure if it's having a beneficial effect on me.

I've also reduced EPR to 0 and have been slowly ramping up my min and max pressures. It appears my centrals have gone down, but I'm seeing more flow limits and hypopneas. I've read elsewhere on the board that EPR is typically used to treat flow limits, but for me, I worry it would lead to increased centrals.

Also, I've noticed that as I bump up the pressure ranges, I'm still hitting the max pressure, likely due to flow limitations.

Appreciate any guidance folks can provide.