AHI looks good, but still feeling bad

[SarcasticDave94]

While a Ramp of 6 maybe isn't affecting things too much, it does lock your therapy pressure out every time you start or restart therapy. In this OSCAR that would be 4 restarts.

What exactly does feeling terrible mean regarding therapy? Is there any discomfort or pain wearing the mask? If there is, this will indicate the mask is on too tight. Being at therapy 8/5 with EPR 3 full time, you're at the lower end of pressures, so I'm not sure what exactly the terrible feeling comes from.

If it's the feeling of being tired, understandable because you're treating Apnea, which infers past problems getting well rested sleep probably several years before the current treatment. Unfortunately, years of bad rest cannot be undone in a few days, weeks, or even a few months. There is required a long term dedication with therapy or you'll lose the benefits.

Then there's the addressing proper sleep hygiene as well. Sticking to a schedule, no screen for a while beforehand, etc. Other illnesses and medications also affect sleep, so those need to be accounted for as well.

[nh00]

I'll try with ramp off. By feeling terrible, I mean: when I wake up in the morning, and throughout most of the day, my entire body is screaming at me to go back to sleep and get more rest. I am beyond exhausted. This is how I feel without CPAP therapy, so I'm used to it, but it's difficult emotionally to not feel better yet. I have no issues tolerating the mask itself.

I think I have a decent sleep routine, but I would expect going from >30 AHI on my sleep study to where I'm at now should make some difference, even if I have slightly lousy sleep hygiene. I do take a number of medications as well, but again, I would think there must be some improvement even if I have a few problems left over.

[nh00]

I would try a straight Cpap pressur and see how you feel. 

Set min7
Max7

Leave all the rest alone.

I realized, I never asked why you recommended having a constant pressure - was there something in my data that indicates this is what I need? I'd like to understand it as best I can. Anyway, the only thing I see that's "off" in my data is my flow rate, 0.42 at 99.5% seems like it might higher than most. I'm not sure what to make of that. I'll try to continue at a constant 8 unless someone recommends otherwise.

[staceyburke]

You seemed to be having a problem with the pressure changes so I wanted to see how a static pressure would help make your sleep better.  The older machines were all static pressure machines and many people do very well on them.  So I need to know if this seems better to you or are you doing worse?

[nh00]

I think I am doing a better job of sleeping through the night (i.e. fewer wake-ups) but I think I am feeling more tired overall. Perhaps the quality of sleep is down even if the length is up.

[staceyburke]

You have used various settings and your apnea is controlled. You are goi g to have to pick if a static pressure or the variable pressure with a different min and max pressure is best for how you feel 

The only thing I would say is you need to pick one and stay with it for a few WEEKS.  It won’t help to change back and forth every other day. 

Please post if you have questions and keep us posted with how you are doing.

[nh00]

staceyburke, I understand your advice about not switching things up all the time. But using the static pressure made me feel *really* terrible, so I tried to go back to basics: 6-11 cmH2O, no ramp. And, yeah, that didn't work either. I know 6 is probably too low a minimum pressure for me, especially with an EPR of 3, so I'll try to work my way up. I wanted to see if the changing of the pressure disrupted my sleep, and if 11 was too low of a maximum pressure - it seems like it's high enough for me most of the time.

Besides feeling physically exhausted, I am really struggling with the emotional exhaustion of this process, I just want to not be tired all the time

[staceyburke]

Nhoo,  Cpap is not  magical machine that you hook up and the next day you feel great.  It like being a coach potato for 5 years and going to workout in the weight room one day.  You have to continue what you do and your body adjusts and you start to feel better.
 
Take the cpap and EPR.  If you have high flow limits it stops you from getting into deep sleep and can wake you up.  We turn up the EPR to 3 BUT you start to get treatment emergent central apnea that you never had before the use of EPR.  It takes about 2  to 3 weeks for your body to adjust to treatment of EPR and the different amount of CO2 in the blood – the treatment emergent central apnea goes away.
 
You need to choose which of the setting is best for you and stay on it for a while to allow your body to adjust.  Your AHI is good and what I believe you need to do is to decide your best treatment and stay with it for a couple of weeks so your body adjusts.