APAP Newbie - Not feeling better yet

[Jake B]

Hi folks,
I've been reading through the forum lately and learned a lot so far. I decided to start a thread of my on to get some advice.

I've been on AutoPAP for about 10 days now (still very early I know). After multiple negative home studies, I finally had an in-lab sleep study and was diagnosed with mild sleep apnea. The study showed an AHI of 12.1 consisting of 5 obstructive apneas, 1 central apnea, and 87 hypopneas, and oxygen levels never dropped below 90%. A CPAP titration study was recommended, but I opted to take the machine and begin APAP instead.

As mentioned before I began therapy about 10 days ago but I haven't felt any results yet. I would venture to say I might even feel a tad worse than before. My main symptoms seem to be excessive sleepiness, fatigue, mood issues (depression/anxiety), foggy-headedness, and just overall waking up never feeling rested no matter how much I sleep. I have tolerated the machine and mask very well with no issues so far, but I figured I might be seeing SOME progress at least. My sleep doctor said this is normal and to give it more time, but it is difficult to stay positive when nothing has changed yet. Don't worry - I'm not giving up yet!

I'm using the ResMed Airsense 10 APAP with nasal pillows which I tolerate very well after getting used to everything. I believe I might have been breathing through my mouth a couple of nights, so I have an appointment next week to test a few more masks and see if I might be able to tolerate a full face mask and see if that helps anymore. I've noticed sometimes it feels like a can't breathe as well, even though my pressure has been mainly around 7-10 with EPR set to 3. A lot of times I will wake up with a slight headache and 'tight chest' as if I haven't been breathing properly and getting enough air when I'm asleep (which I find odd considering I have a machine blowing into my lungs). Something doesn't seem right even though my doctor thinks everything is fine. I will attach the OSCAR data from one of my recent nights, formatted as close as I could get it to the Wiki page.

Some other info...I have been receiving allergy shots for over a year and I am on Cymbalta for depression and anxiety (I'm assuming caused by the lack of good sleep). 

Sorry for the long post. I am looking for some opinions about others' experiences and any advice on how to get to feeling better. Let me know if I can provide any additional information. Thanks!

Jake

[Jake B]

Wanted to add something else. It still seems like I'm having typical sleep apnea symptoms. Tiredness/fatigue, waking up with the urge to use the bathroom, night sweats, etc.

[OpalRose]

Welcome to Apnea Board, Jake B!
Thanks for posting a chart.  Your results are near perfect and suggests you are being well treated.

Your leak rate is well within limits and does not affect your machines ability to do it's job.

With that said, some folk can adapt rather quickly and for others, it just takes more time.  Talk to your doctor about your anxiety, possibly an adjustment in your meds is in order to help you relax more. Also, check on the side affect of any medications you take, as that can affect your sleep.

I wouldn't give up on your mask just yet as it is the most minimalistic mask for comfort.  I would suggest that you try a larger nasal pillow.  Many of us have discovered we need a larger size than what the DME suggests.

Here are some sleep hygiene tips that may help.

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

[Dormeo]

Welcome, Jake! I notice a discrepancy between the event flags and your AHI. Could you check to make sure you have CA flags turned on? Look in the bottom left corner of the daily chart and make sure all the options are showing green (and black).

You did a great job with Oscar formatting. One final tweak would be to squeeze in your flow limitations graph. To make room, you can grab the horizontal gray bars that separate the graphs and move them around.

Let's take another look once you've had a chance to address those two issues. You are off to a great start in many ways, and possibly you just need to be patient, but it'd be good to have the experts take a look at your chart to see whether they can give you some advice about adjustments to your settings.

[Jake B]

Welcome, Jake!  I notice a discrepancy between the event flags and your AHI.  Could you check to make sure you have CA flags turned on?  Look in the bottom left corner of the daily chart and make sure all the options are showing green (and black).

You did a great job with Oscar formatting.  One final tweak would be to squeeze in your flow limitations graph.  To make room, you can grab the horizontal gray bars that separate the graphs and move them around.  

Let's take another look once you've had a chance to address those two issues.  You are off to a great start in many ways, and possibly you just need to be patient, but it'd be good to have the experts take a look at your chart to see whether they can give you some advice about adjustments to your settings.

Thanks for noticing that. I enabled the CA flags and squeezed the flow limitations graph in with the others.

Since the screenshot doesn't show my machine settings, I copied and pasted them below:
 
Mode    APAP
Pressure Min    8.00 cmH2O
Pressure Max    15.00 cmH2O
Antibacterial Filter    No
Climate Control    Auto
EPR    Full Time
EPR Level    3cmH2O
Mask    Pillows
Patient Access    Yes
Ramp    On
Ramp Pressure    7.00 cmH2O
Ramp Time    20.00 Minutes
Smart Start    Off


Humidity and temp are on AUTO settings.

[OpalRose]

Jake B,
If you want to clean up the Clear Airways a bit, change your EPR setting from 3 to 2 and watch. You can also turn down to EPR 1 as long as your comfortable.

Dormeo, good catch! I didn't see that.

[jaswilliams]

Jake there are not enough CA’s to worry about for now they are likely due to rolling over or disturbed sleeping they will reduce over tine I see no benefit in reducing the EPR as your overall numbers are less than 2

[Dormeo]

Jake, you get to take your pick between the advice of two wonderful experts! As you will gather, it can be hard to know what is causing what when it comes to CAs. Your CAs might all be events that happen while you are awake, or partly awake, or they might be reflections of some adjustments in the neuro-chemical signalling that tells you to take a breath. Either way, they are also, as some people put it, consistently inconsistent.

With numbers as low as yours, the biggest question is how you feel. So far, you're not experiencing improvement, but that may just call for patience. So it would be perfectly reasonable to leave things as they are.

In your place -- and this is just me -- I think I'd try reducing EPR to 2 to see how it goes. If it feels lousy, put it back to 3. If it feels OK, then leave it there for a week and see what the results are. And the main results you'd be looking at would be how you feel, rather than what the numbers are. -- But this is because I have a personal disposition to experiment. The downside can be getting a little too obsessed with minor adjustments, I have to confess.

[Jake B]

Jake, you get to take your pick between the advice of two wonderful experts!  As you will gather, it can be hard to know what is causing what when it comes to CAs.  Your CAs might all be events that happen while you are awake, or partly awake, or they might be reflections of some adjustments in the neuro-chemical signalling that tells you to take a breath.  Either way, they are also, as some people put it, consistently inconsistent.  

With numbers as low as yours, the biggest question is how you feel.  So far, you're not experiencing improvement, but that may just call for patience.  So it would be perfectly reasonable to leave things as they are.

In your place -- and this is just me -- I think I'd try reducing EPR to 2 to see how it goes.  If it feels lousy, put it back to 3.  If it feels OK, then leave it there for a week and see what the results are.  And the main results you'd be looking at would be how you feel, rather than what the numbers are.  --  But this is because I have a personal disposition to experiment.  The downside can be getting a little too obsessed with minor adjustments, I have to confess.

So far, no relief in symptoms and as I mentioned in my original post, I might even feel a touch worse. Not sure if that can be attributed to the machine being new and my body adjusting, or if something just isn't right. I'm assuming the APAP is working if my AHI reduced to around 1, I just hoped to feel some results immediately. I know it might take a while, but since I'm not feeling relief it's hard to stay positive that this will work. I'm going to stick with it as long as it takes though! I've read where mild cases of apnea can take longer to treat (and my doctor agrees).

I'm very impatient 

[Jake B]

Another relevant question:

Is there a way to identify mouth breathing through OSCAR data? Last night I woke up multiple times with dry mouth, and my wife verified that the air was leaking from my mouth a few times. I'm just curious if there's a way to pinpoint these moments by looking at the data.

As I mentioned in my OP, I'm scheduled to try a few more masks this week so I'm hoping I find one I can tolerate and that will help me more.