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AHI is mild but I feel like a zombie - OSCAR review request
#1
Ohmy 
AHI is mild but I feel like a zombie - OSCAR review request
Hi all,

I have been using an APAP for a little less than a month and only recently have I been able to tolerate it for a full night.  Unfortunately, I still feel horrible even after 8 hours of "sleep".  I'm hoping that its just a matter of finding the right settings.

Without going into too much detail, my doctor is not very helpful in this regard and I am on my own in finding the right settings (which is fine by me).  For example, I received the device with factory default settings (5-20 pressure, flex, etc..).  For the sake of context, based on my symptoms I suspect I have UARS but my doctor is not willing to give that diagnosis (to anybody) and because of the way my insurance works I can not afford see another doctor. Anyway, that is not the point of my post, I just wanted to give a clearer picture.

My strategy has been to start low (5-8) and move up from there while evaluating my data with OSCAR.  Last night i moved up to 6-9 and while my AHI is slightly lower, I feel absolutely horrible.  Like I didn't sleep at all.

Potentially useful information:
  • Flex - OFF.  I cannot tolerate flex.  It feels like the timing is off when i use it.  As if it is starting the exhale when i am still breathing in which makes me feel like I am suffocating.
  • I started the journey to PAP therapy about two years ago when i started waking up with debilitating tension headaches caused by severe jaw clenching at night.  I have gotten them to a manageable state through supplement's (see below) and physical therapy.  My hope is that they are caused by OSA and I can see some relief after getting this APAP figured out.
  • Male, thin, mid-30's
Supplements before bed - what I have settled on to help prevent clenching headaches
  • Magnesium
  • GABA
  • theanine
  • Tumeric
  • potasium

Thank you for reading and for any advice.


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#2
RE: AHI is mild but I feel like a zombie - OSCAR review request
Your charts are well-presented and I think you can improve on this. I agree with you on the Flex feeling out of sync and far prefer the Resmed which offers EPR that is identical to bilevel pressure and follows your breathing rather than changing pressure before you initiate inhale or exhale. The overview of the night shows a very clean respiratory flow rate, punctuated by large random spikes in flow, often with hypopnea or OA that occur in small clusters of two to four obstructive events and variable breathing flow. The close-ups confirm these are obstructive in nature and tend to show inspiratory flattening (flow limitation) before or after the event.

Current pressure is 6.0 to 9.0 with a brief 5-minute ramp at 4.0. I suggest turning the ramp off as it seems unneeded and increasing minimum pressure by 0.5. Something about your sleep position is encouraging "chin-tucking" which intermittently obstructs your airway. If you are using more than one pillow or one that is firm, tall or sleeping on an incline, you need to re-think your sleep position. I don't think the problem needs a soft cervical collar, but the mechanism of this pattern of apnea and hypopnea is discussed in this wiki article http://www.apneaboard.com/wiki/index.php...onal_Apnea We have a lot of members that do use a soft cervical collar, but with mild cases, it is often sufficient to just be aware of the issue and deal with sleeping position. Flow limitation does not look to be persistent in your results, but most of those spikes in the flow rate that you see are probably arousals related to flow limits or events that might be improved with the Resmed EPR or by improving your sleep position. These small arousals add up to the fatigue or zombie feeling you have, and the objective is to minimize this as much as possible.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: AHI is mild but I feel like a zombie - OSCAR review request
Thank you for the reply.  

I use the ramp pressure of 4 to help me fall asleep.  I'm not sure how well i can tolerate a setting of 6.5 right from the start but I can try.

I do use a taller "cervical pillow".  I started using it after a neck injury required me to sleep on my back while healing and just never stopped.  I'll try a flatter pillow.  Does it matter if its soft or firm?

I am going to the dentist today to get a mandibular advancement device fitted.  I have noticed, especially when laying on my back, that when my jaw relaxes towards my throat it is very uncomfortable to breath.  I think because of this I find it nearly impossible to sleep on my back and I have always been a side sleeper.

When I adjust the minimum pressure to 6.5 should i also adjust the maximum to 9.5 or leave it at 9?
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#4
RE: AHI is mild but I feel like a zombie - OSCAR review request
Your ramp is so brief, just go with what works best for you. After years of starting with a pressure of 13/9 I guess the idea of a 6.5 start pressure seems easy. In truth, as long as there are no leaks, I'll be surprised if you do notice it. You don not seem to need a higher maximum pressure, so minimum 6.5, maximum 9.0.

The contoured memory foam pillows are a big problem. I know they advertise them as helping in exactly the way we use a soft cervical collar, but I have seen a LOT of positional issues due to this type of pillow that goes away when a flatter pillow is used. A rolled towel or neck roll is better if you actually need the support. The problem with the contour pill is they are not friendly to side-sleeping or if your head is not positioned in the "well". Give us some time to work with you before investing $$$$ getting a MAD. They don't work well for most people and we may be able to help you find a much better solution. A properly fit soft cervical collar supports the jaw from behind is is a lot less uncomfortable than a MAD.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: AHI is mild but I feel like a zombie - OSCAR review request
I changed the ramp to 5, pressure to 6.5-9, and used a flatter pillow.  Unfortunately, I don't feel much better and my AHI went up (although it normally fluctuates between 5-10 each night anyway).

It is too late for the MAD, its on its way. Even if it doesn't work I'll be glad I tried it just to know for sure.  My dentist is trying a new supplier and it really wasn't that expensive.


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#6
RE: AHI is mild but I feel like a zombie - OSCAR review request
I'm still seeing the positional issues with groups of apnea and hypopnea. Keep trying this for a bit and we may need to look at ways to stabilize your airway. This is only a 0.5 cm change in minimum pressure, so it is not a very aggressive response at this point.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: AHI is mild but I feel like a zombie - OSCAR review request
I wonder if you're getting enough oxygen with a minimum pressure below 7. Could you try raising the minimum to 8 just to see what happens? Your ahi is really high. and you're maxing out on the high pressure. Try raising the upper limit on your pressure too. Raising both should help to bring down the number of events and/or give a better response, so you can lower your ahi.
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#8
RE: AHI is mild but I feel like a zombie - OSCAR review request
(03-10-2022, 11:37 AM)hegel Wrote: I wonder if you're getting enough oxygen with a minimum pressure below 7. Could you try raising the minimum to 8 just to see what happens? Your ahi is really high. and you're maxing out on the high pressure. Try raising the upper limit on your pressure too. Raising both should help to bring down the number of events and/or give a better response, so you can lower your ahi.

Sure. I'll try anything.  I'll set it to 8-12(?) and see what happens tonight.
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#9
RE: AHI is mild but I feel like a zombie - OSCAR review request
aa87 you're on the right path.

I've done this for a long time--about 35 years. Yet I felt like a zombie too until I got help here.

This is an amazing forum with so many people that help so much!
DaveL
compliant for 35 years /// Still trying!

I'm just a cpap user like you. I don't give medical advice. Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

http://www.apneaboard.com/wiki/index.php..._The_Guide

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#10
RE: AHI is mild but I feel like a zombie - OSCAR review request
yep, I'm curious how things went for aa87. I'm guessing s/he might have to raise the upper limit past 12.
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