[CPAP] 2 month in and still tired

[Furchtbar]

Hi,

So after having 4 sleep studies with an AHI of 70 (at home) and 50 (in the lab without mask) and 11 and 2 (in the lab with mask), I got a CPAP machine. I have been using it for 2 months every night. However, I still am tired and sometimes need to sleep all the day. I wake up from time to time and need to burp and fart very badly. I find it very hard to concentrate.

I read my SD card using OSCAR and the result does not look like other posts in the forum. Any advise?

Here are the screenshots:


   
   

Cheers!

[Jay51]

The need to "burp and fart" when you wake up sounds like aerophagia (swallowing air).  Reducing pressure(s) is usually the best way to stop this.  GERD is a contributor to aerophagia.  

Here is some reading on Lowenstein PrismalLne machine's optimization from our wiki:  

Lowenstein PrismaLine optimization

[Furchtbar]

Thank you very much for the hint! I've updated the settings as described in the wiki and taken some detail screenshots of the flow patterns for interesting sections. I am not quite sure what to make out of the flow patterns. I have flow limitations almost the whole night and this seems to be a problem, I guess? Do you need any more details of certain times?

[Jay51]

Since you have so many flow limitations, softpap is probably the best place to start.  You have 3 different levels of softpap on your machine.  

Section 2.1 goes into it in more detail (of the Lowenstein PrismaLine link above).  

You can try all 3 levels of softpap if you desire; and see which one works best for you.  Probably best to start with level 1.  Then try 2.  Then 3.

[Furchtbar]

I am already on SoftPAP 1. I tried SoftPAP 2 a few times and found it hard to get to sleep using it, but maybe it is just a matter of getting used to it. SoftPAP 3 is not available on my machine. Thank you for the advise!

[Jay51]

Thank you for that information.  

Softpap is the best way to help stop flow limitations on your machine.  

If you have tried softpap 1 and 2 already and still are having a lot of flow limitations, I don't know what else to recommend.  If you had clusters of events, positional apnea treatment may help you.  

If anyone has anything to add to help Furchtbar, please post (especially members with Lowenstein Prisma machines).

You can try some positional apnea techniques (lowering pillow height, side sleeping vs. back sleeping with something to keep your chin from tucking, and even trying a soft cervical collar).  You do have clusters of H's.  

• 5.3Positional Apnea
  

[Dormeo]

Furchtbar, do you have nasal congestion? FLs can originate in the nose as well as further down in the pharynx. Increasing the difference between inhalation and exhalation pressures may help with pharyngeal FLs but probably not nasal ones. For those, you'd need to figure out how to un-stuff your nose.

I also want to comment on your long sleep times. I suspect they are counterproductive, and I also suspect you would benefit from restricting yourself to no more than nine hours. I know from experience how hard that is to do when you feel tired during the day, but I hope you can give it a try.

Finally, I am curious whether you feel tired/fatigued during the day or, instead, sleepy. I wish my German were good enough to convey the difference. The big question would be whether, during the day, you want to nap or whether, instead, you just feel low on energy and mental acuity.

[Furchtbar]

I tried SoftPAP 2 again. I don't really like it, because the machine sometimes misfires during inhalation and it feels like falling into a hole, but I found that by enabling ramp up, that effect is somewhat reduced and at least I get to sleep. However, I don't think it had any effect, I've attached some screenshots again.

Positional apnea may indeed be a problem. Most days I have a phase of about 90 minutes where everything is perfectly fine and then the breathing starts to go bonkers and the machine blows me up like a balloon. I found my way into the clinical menu today and I reduced the pressure to 8-11 from 8-13. Maybe that helps with that. I also ordered a soft cervical collar from Amazon which should arrive tomorrow. Is there any device that records my sleeping position or is this even helpful at all? I think of maybe just setting up a night vision camera to get a better idea of my sleeping position. I have the feeling that my airway closes up when my chin goes toward my chest and just recording the position of my chest would probably not help checking that.

@Dormea, yes, I have heavy nasal congestion and I use both decongestant and cortisone nasal spray and after having tried nasal strips, plugs and all kind of things I settled with magnetic nasal strips with a magnetic rail. Most nights I need another spray of decongestant in the middle of the night and I try to not use it during the day to not build up any tolerance.
 
Regarding the tired/sleepy problem: They translate to the same word in German. But I had ChatGPT explain that to me. I am probably sleepy, not tired. I feel like unable to concentrate, my eyes close and I need to lie down and sleep and after 90 minutes of sleep and 30 minutes of waking up, I am able to function again for an hour or so. Some days I push trough and stay awake but then I get nothing done at all. But some days I am perfectly fine, for example after the last day of the sleep study. They woke me up a 5 AM, which is not my time at all but I felt great and without any urge to nap that day. Maybe it was their different mattress or pillow, which would also hint at positional apnea... We'll see.
Thanks for all the help so far! I will do another round of experiments and see what helps. 

[Jay51]

Those are still an incredibly high number of flow limitations.  Lots of H's as well.  

In regards to recording your sleep:  some members have used cameras, etc. to record their sleep. Your choice if you want to or not. 

When the soft cervical collar arrives and you use it, that should give even better clues as to what is causing all of these flow limitations.  

It is wise like Dormeo has stated to look at your nasal set up, congestion, etc. to see if anything is causing a problem there.

[Dormeo]

You might benefit from seeing an ENT doctor (ear, nose, throat), who may also refer you to an allergist.

I'm fascinated to hear that you had a good day after the sleep test. Do consider replacing your pillow and even mattress. And do consider limiting your time in bed at night.

Keep us posted!