Feeling daytime sleepiness again after 2 weeks of use

[MikeBa]

Hi all. This is a long one so please bear with me. I have been using the CPAP machine for two weeks. The first week I was feeling great as detailed below, even with not great AHI numbers hovering around 3 to 5.

The first week experience :

• Generally feeling rested since the first night of using it. I still do feel tired during the days but it's nothing like before where I had to literally fight to stay awake. The yawns that I experienced after one night have reduced gradually and they are fewer and more spread throughout the day
  
• My throat and mouth are not dry in the mornings when I wake up. I sleep in an air-conditioned room, and I'm not sure if was due to mouth breathing/snoring or because the air was dry, but I always used to wake up with a dry and sore throat. Now, whether due to the humidifier or because I'm able to breathe through my nose better, I don't experience that anymore.
  
  
• I also seem to have less phlegm/mucus in the mornings and throughout the day. My nose and throat feel so clear and I don't have the feeling of blockage in the throat that I had constantly
  
  
• I used to wake up with aches in the chest and diaphragm area, and they were there throughout the day and I always felt like I wasn't able to take a deep breath. Those aches are gone now! The feeling of being able to breathe normally without aches and pains is really amazing.
  
  
• Related to the above, I always felt like I had to consciously take a breath. I had to think about breathing and it wasn't automatic or spontaneous. It has gotten better, but I find myself sometimes doing it again.
  

I looked at my Oscar data and tried to make some changes to the min/max (started with 4-15) and also EPR. From 4-15, I made it 9-15 with auto-ramp, 9-15 with auto-ramp EPR 3 and then 11-15 auto-ramp with EPR 3. 

However, the past week after trying to change the settings has not been great, and the last 2 days I have been feeling the old daytime sleepiness kicking in and I couldn't control taking a nap. The feeling reminded me of how I felt before I started the CPAP therapy. I'm not sure if it's due to the changes I made with regards to the pressure and EPR settings. Hope some of you experts can help. I have attached some screenshots, and would be happy to provide more if needed. Some days the flow-rate seems to be good and smooth. and others not so.

Thank you and I appreciate any feedback you might give!

           

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These are screenshots of the last 3 days.

           

[Jay51]

Your last 3 days OSCAR charts 11-15 epap with EPR 3 look better statistically (0.03 95th percentile flow limitations), but you say you feel worse with this set u p than the 4-15 epep with no EPR.  

You have 2 acceptable set up combinations.  How you feel in the morning is very important as well.  It is your choice which set up you choose to go with here.  With the 1st 3 charts you posted, you said you felt good.  With the last 3 days, not so good.  

Other members may have some insights and suggestions for you as well.

[MikeBa]

Thank you Jay51. I feel the same in the morning, well rested and feeling the same as when I started CPAP. It is later in the day that the sleepiness kicks in and I'm unable to control dozing off. Do you think I need higher pressure?

[Jay51]

Yes.  You can raise your maximum to 16 (since you hit the 15 at times).  You can go slowly by 0.2 increments if you like, or simply go up to 16.0  

Watch out for possible aerophagia and/or an increase in CA's.   Hopefully this will not be a problem for you.

[MikeBa]

Do you think I should raise the minimum as well? I noticed before I made any changes that my median pressure was around 9 to 10. Now with EPR 3, I should be setting the minimum pressure 12 to 13?

I did get slightly more aerophagia on 28th Jun, the first day I made the change from 4-15 to 9-15, and then for the past week as well I can see and feel the stomach bloating and distension but no other symptoms like pain or excessive gas. Does aerophagia typically go away over time as the body gets used to it or will it always occur at higher pressures?

[MikeBa]

I just realised I have this pattern of waveform going on. This is an example from 28th June. Is this periodic breathing and is it something to worry about? 

   

[Jay51]

Thank you for the information and the OSCAR charts.  

Yes, you can raise your min epap pressure as well like you are thinking.  

Balance it against the aerophagia.  

Aerophagia seems to be an individual thing in regards to exact pressure.  One person may get aerophagia at exactly 8.0   While another person may get it at 25.0  

Experimenting will tell for you.  You may get used to (adapt) successfully to these higher pressures in time as well.  There is a chance that you may not either.  

People diagnosed with GERD may have a more difficult time with aerophagia as well, due to the functionality of the esophageal sphincter.

[MikeBa]

       

The graphs from last 2 nights. Last night I made the change to EPR 2. It doesn't seem to have made much difference. However, I've noticed the leak rate going up compared to the first 3 screenshots I shared in the first post, where the leak rate was virtually 0. Could the mask be losing its effectiveness due to washing? Snoring also seems to be going up compared to before.

Also, what do you guys think of the breathing pattern I posted above?

[Jay51]

The new leaks could be from adding EPR 2. 

The mask leaks could be from simple wear on the silicone (making it less effective).  

Or it could be other things as well.  

On these charts you have a few OA clusters at times.  This could be indicative of positional apnea.  Things like lowering pillow height, side sleeping instead of back sleeping (with a collar or pillow or something wedged between your chin and chest to prevent chin tucking.  Also a soft cervical collar could help.  

Here is some more reading on positional apnea from our ApneaBoard Wiki: 

• 5.3Positional Apnea
  

[Deborah K.]

Your flow limits were better when you used EPR 3.  Maybe you could also shorten your ramp time to 10 minutes and see if that helps.

If you are suffering from aerophagia, maybe you should lower your upper pressure limit a few points for a while to see if that helps.

Best wishes for achieving great therapy and comfort!