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Foggy, headache, and still tired each morning
#1
Angry 
Foggy, headache, and still tired each morning
I finally had a better at-home test and received an AHI of 33.  I already had an APAP after my first low-end at-home reported 5.9 AHI.  I kept on my ResMed AS10 APAP which initially was 7-20 with EPR ranging between 2 & 3, and a ramp at 5min (I prefer 0 or 5.)  At my follow-up to the 33AHI test, the NP was happy with my AHI being < 1, but the tiredness, fogginess, scatteredness and headache continued.  So, then I got an O2 ring and can see _most_ of the time my O2 is >90% when using my mask.  I mouthtape and use a cervical collar.  I also use my mask the entire time I am sleeping with rare exceptions.

I have not had a full in-lab sleep study.  Based on the satisfaction of the Dr/NP with my follow-up AHI being <1, I'm not inclined to get one.

Since the beginning of 2024, I can only remember one day of not being as tired as I usually am, but all other issues remained.

I found a sweet deal on a VAuto, $387, for only 83hrs used.  I changed it to my settings and have used it since.  But, I still am tired, etc.

I've tried full face (F30/F40), pillows, and nasal (N20).  I've settled on P30i and P10 which does the best for me.  I've had entirely too much leakage with anything else.

I've attached my latest nights' OSCAR graphs (2024-June-08).  You'll see that there's missing data/time, but its the morning when I took off my mask and kept the O2 ring on.  I can certainly see a difference in the data that the CPAP does help.

What guidance can anyone provide?
       
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#2
RE: Foggy, headache, and still tired each morning
First, please format the chart as spelled out in the link in my signature “Formatting OSCAR Charts”. It is easier for us to review things with those initial graphs.

Without knowing what you already tried, I suggest going back to a baseline we can work from. To wit, try the following:

Mode VPAPauto
EPAP min 7
IPAP max 15
PS 3
No ramp

My logic is I wonder if you are using too much pressure and not enough pressure support. Even though your flow limitations and tidal volume are good, you may be creating a rough nights rest with too much pressure. You can get a good AHI given enough pressure, but it may not be what you need.

If you are game, give it a go for a few nights. If it goes totally off the rails, then let us know right away and someone can help tweak from there.

Edit: I forgot to ask where you have the trigger set. I suggest starting with it on medium if you have it on something else.
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#3
RE: Foggy, headache, and still tired each morning
I've changed the settings to your recommended settings.  I'll let you know how it goes.

Trigger was already set at medium.

I've attached an updated screenshot which I think matches the chart organization.

Also wanted to add I do have RLS also, and I'll be honest, I don't know if it's controlled during sleep.  It's controlled prior to sleep with most symptoms now only occurring when meds not taken.  Also, I have been creepy and recorded myself during the night but I can't see any large movements.
   
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#4
RE: Foggy, headache, and still tired each morning
I do not see anything that stands out as being RLS related. 

What I do see is your pressure hovers around 13.2 or so. There are a few arousals (look for the spikes both above and below the flow rate lines) that are contributing to feeling like a dogs breakfast in the morning. Not enough to explain it though, but it is a contributing factor.

Consider reviewing your sleep hygiene. Sometimes we all miss the bloody obvious.

https://www.sleepfoundation.org/sleep-hygiene
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#5
RE: Foggy, headache, and still tired each morning
June 09

June 10 & 11.  I've been sick since the morning of the 9th, but I've been trying to get as much time as possible each time.

Still just a zombie until 4pm-5pm.        


Attached Files Thumbnail(s)
       
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#6
RE: Foggy, headache, and still tired each morning
(06-08-2024, 10:00 PM)PeaceLoveAndPizza Wrote: I do not see anything that stands out as being RLS related. 

How does RLS show up on OSCAR charts?  I'll go back in history to see if I can find any.
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#7
RE: Foggy, headache, and still tired each morning
RLS shows up as PLMS during sleep. I would expect to see more arousals. There is nothing of significance there.

Other than a few arousals your OSCAR charts are brilliant. Few flow limitation spikes, no leaks, nice smooth flow rate. About as good as you can get. I do not see anything else we can do with CPAP short of slowly bumping up both pressures to see if it helps. I do not think it will make any real difference though as things look grand.

You should get your O2 checked during sleep. An Apple Watch, Fitbit, Oura ring, many devices can give some guidance. That is about all I can think of there. Others have more knowledge about vitamins and such, so hopefully will offer some advise.

Hopefully you feel better soon. Once you get out of the brain fog of feeling unwell, think about putting some focus on sleep hygiene. There must be some other cause of the fog and that would be the next thing to ponder.

https://www.sleepfoundation.org/sleep-hygiene
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#8
RE: Foggy, headache, and still tired each morning
Ask and ye shall receive.  I've added my Wellue data to previous charts. (1/2)

           

(2/2) Wellue data

2024-06-10-Oxy shows when I was just too stuffy and took off my mask in the middle of the night yet left on the ring.  It's clear how much CPAP helps with nightly relaxed breathing.

       
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#9
RE: Foggy, headache, and still tired each morning
Everything looks quite grand. Nothing I see that needs attention. Maybe one of the more experienced folks sees something I do not. 

For now, I would just stay the course and give it time. You could try creeping up your pressures by 0.2 every few nights to see if things improve. Sometimes a small change is all we need, but until you try it we will not know.
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