Help understanding OSCAR Data - Feeling Tired all day (not sleepy)

[elsanti1976]

Hi everyone!

First, I would like to thank everyone here and specially the pioneers who started this website, I cant thank you enough for building a place in which us, patients, can share, and look at other people experience, in such a beautiful manner.

Now lets get to business. Im a male, 47 years old, 290 pounds, 1.81 cm

After a big scare, I was driving with my family on the highway, and fall asleep for a nano-second, fortunatly nothing happend, I course correct immediatly, and that was It. But I had to do something.

I was diagnosed with sleep apnea in september, and the AHI I got on my test was 60 events/hour

In october I started treatment with an Resmed AirAirsens 10 Autoset, with humidifier, and a Resmed Mirage FX Nasal Mask

Since I started I started "lurking" in this forum, learned about OSCAR and start gathering data.

My experience is kind of bittersweet.

My AHI on average is below 1 everynight, and Im not beeing sleepy during the day anymore. Thats the good part, I presume the treatment is working.

My problem is that im feeling not sleepy, but very tired during the day.

I was expecting this to be a "magic pill" in the way that I would awake everyday feeling refreshed and full of life, but that has not been the case.

Mi average sleep time is 6 hours, my doctor told me I should get to 8 hours, but Im not able to do so. I do not have problems to fall sleep, but it looks like I have problems staying sleep, if that makes sense....

I know this is a common issue, and I have seen many threads here about this.

I finally decided to post this, and also Im attaching OSCARS screens.

I really appreciate you guys helping me out on this one

Warm regards!!!

[Deborah K.]

Your beginning pressure is too low for an adult.  Those low numbers are for children.  You would feel better and have better therapy if you increased your low pressure to 7.  Try that, then post another Oscar report.  That will help us help you.

[elsanti1976]

Hi Deborah! Thanks for your response. 
I read your post after I woke up, but since last night I went to bet late, I was very sleepy, so opportunity an anxiety met, and I decided to take a little nap in the morning with your settings.

It was only one hour and a half, so I cant say a lot about how rested I feel, I need more nights for that. But the steadiness of the pressure data, compared to the night, really shocked me!! (in a good way I believe)

Just wanted to check in with you, I will keep you posted on my progress. 

Thanks again!

[elsanti1976]

Good morning guys, here is the screen after last night.

It is just one night, so I cant say a lot about how I feel, however I do no feel any different than previous nights

I would highly appreciate any inputs on this data.

Thanks in advance!

[srwilsn3]

The flow limits grab my attention. Perhaps a more knowledgeable member can share their expertise.

That said, continue to use your machine. It can take days for small changes to accumulate so that we feel better.

[Dormeo]

How would you feel about turning the ramp off or at least setting the ramp minimum to 7? That's not going to be a magic bullet, but it'd be a good idea anyhow.

Can you try changing the time you go to bed? Possibly if you went to bed at, say, midnight, you could still sleep until 8 a.m., which would give you some more sleep than you're getting now.

Alcohol can help people fall asleep faster, but later in the night it can disturb sleep. Do you drink alcohol in the evening? If yes, how close to bed-time?

I'm also struck by your saying you no longer feel sleepy during the day but do feel tired. Sometimes people have more than one kind of problem going on at the same time. It might be good if your regular doctor would run some tests to make sure you're OK in a variety of areas: thyroid, testosterone, iron, Covid, Lyme disease (if it occurs in Uruguay), autoimmune disease, especially connective-tissue diseases, vitamins D, B6, and B12. And the normal blood panels would be good too.

Also, are you taking any medications? If yes, what are they?

The next time you post a chart, could you put all and only these graphs into a single screenshot:

Events
Flow rate
Pressure
Flow limitations
Leaks
Snores.

Like srwilsn3 I'm curious about your FLs, and it'd be easier to understand what's going on if we could see those six graphs in one screen shot.

[Deborah K.]

I suggest that you turn your ramp off altogether.  You are getting no therapy during that time.  Your flow limits are not a problem.  It would be good though to set your charts up the way the Oscar people advise, with flow limits where you now have mask pressure.  

As to feeling tired, that takes time to overcome.  Hopefully, you will be able to sleep more hours than you presently sleep as you adjust more to your therapy.  You probably have a sleep deficit to overcome.

[arch]

These numbers are really good, I think your therapy is already better than most CPAP users ever get. That said, I bet you can get even better by continuing to increase your minimum APAP setting by 1 until your 95% flow limit is below 0.05.  I bet you could get to 0.00 actually.

It's the same thing you would do to treat those hypopneas you're having anyway. You are a good candidate to get to CPAP mode instead of APAP if you want as well. It could make your sleep more comfortable/cause fewer wakeups.

[Edit] your leak rate is too high, you need to address that first. Probably mouth leak, likely need mouth tape, chin collar, or consider a full face mask.

[PeaceLoveAndPizza]

Please post the same chart, but this time replace “mask pressure” with “respiration rate”. I’m looking for the arousals to see how well flow rate and respiration spikes align.


Also, please give the wiki section on optimising therapy a read. Much useful information there.

https://www.apneaboard.com/wiki/index.ph...ng_therapy

And, as Dormeo and DebK said, ramp is not your friend unless absolutely needed to fall asleep.

BTW, the way we like to see the charts as Dormeo said is explained in the link in my signature “Organise your OSCAR charts”.

[elsanti1976]

I can hardy thanks for all the good advice and warm comments from you. Thanks from the bottom of my heart.

I will try to quote each one an respond:

That said, continue to use your machine. It can take days for small changes to accumulate so that we feel better.

Thanks for the encouragement!

How would you feel about turning the ramp off or at least setting the ramp minimum to 7? That's not going to be a magic bullet, but it'd be a good idea anyhow.

I will give it a go this very night!

Can you try changing the time you go to bed? Possibly if you went to bed at, say, midnight, you could still sleep until 8 a.m., which would give you some more sleep than you're getting now.

Usually when I get early, I do ending up waking up early. The chart I posted previously is not representative, it was UFC fight night yesterday and I went to bed very late! 

Alcohol can help people fall asleep faster, but later in the night it can disturb sleep. Do you drink alcohol in the evening? If yes, how close to bed-time?

No alcohool here!

I'm also struck by your saying you no longer feel sleepy during the day but do feel tired. Sometimes people have more than one kind of problem going on at the same time. It might be good if your regular doctor would run some tests to make sure you're OK in a variety of areas: thyroid, testosterone, iron, Covid, Lyme disease (if it occurs in Uruguay), autoimmune disease, especially connective-tissue diseases, vitamins D, B6, and B12. And the normal blood panels would be good too.

Before starting using the CPAP, I was yawning and falling sleep everywhere, at job, in the bus, in a classroom. After I started using it, that didnt happened any more, ocassionaly I feel the urge to take a nap in the afteroon, but I would choose that forever compared on what was before.

Another thing that changed remarakbly was no more cervical pain in the morning, 70% of my mornings started with some aspirin because cervical pain was terrible. Since I started the CPAP that went away, and I havent changed my sleeping position, wich is stomach sleeping.

Also, are you taking any medications? If yes, what are they?

Nope, no meds here.

The next time you post a chart, could you put all and only these graphs into a single screenshot:

I will for sure! Thanks a lot!

I suggest that you turn your ramp off altogether.  You are getting no therapy during that time.  Your flow limits are not a problem.  It would be good though to set your charts up the way the Oscar people advise, with flow limits where you now have mask pressure.  

Got it, I will try that tonight.

These numbers are really good, I think your therapy is already better than most CPAP users ever get. That said, I bet you can get even better by continuing to increase your minimum APAP setting by 1 until your 95% flow limit is below 0.05.  I bet you could get to 0.00 actually.

Thanks for that! I do feel that therapy is doing me good, one thing I didnt mentioned is that I monitor my BP at the morning, and it was borderline hipertension before CPAP and now is all in the green zone.

It's the same thing you would do to treat those hypopneas you're having anyway. You are a good candidate to get to CPAP mode instead of APAP if you want as well. It could make your sleep more comfortable/cause fewer wakeups.

Well, thats indeed an option, but I would probably talk it to my doctor before, I think that would be a big change!

Please post the same chart, but this time replace “mask pressure” with “respiration rate”. I’m looking for the arousals to see how well flow rate and respiration spikes align.

You got it, I attached those here.