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Still fatigued after year of treatment
#11
RE: Still fatigued after year of treatment
Thanks for your sleep reports. They are pretty self explanatory, zero centrales, and fairly moderate obstructives. Nothing to remarkable so far as I can tell.

A brief summary of your submitted graphs so far.

First graph of 3rd June, zero obstructives,  just one hypopnea. (Pressures 9/14)
Second graphs of 20th July again exactly the same results (Pressures 11.6/11.6.)

No real change so far.

I would suggest a slightly different approach, and would like to deal with the pressures seperately, 

Focussing firstly on the minimum pressures, it may be interesting to start reducing here initially,  to acertain how low you can go, before the hypopneas start to increase. The objective being to get a good base line.

Your first graph, with a minimum of 9, was adequately doing the job, but maybe go down to 8, or perhaps 6 or 7 to see what happens. Just enough to do the job.

After this minimum baseline has been identified, next I would attack the maximum pressure in the same way as the minimum, enough to keep the obstructives, and hypopneas in check.

If the gap between the maximum and minimum is not too wide, hopefully this will bring down the centrals. Defining "not to wide" is found hopefully by this trial and error method.

Usually flow limitations provoke these maximum pressures, not necessarily in reaction to control obstructives and hypopnea events, which are already being dealt successfully. 
(As a note, it would be helpful to improve visibility of your flow limitation graph by adjusting the y axis scale maximum to something like 0.2. we could maybe be able to see individual points of limitation peaks pushing up pressures, however it isn't always that obvious.)

EPR, I would be guessing on this one, it is important, most likely leave at 2 as now, but one step at a time.

(A further comment, it may be best to make one change at a time, and wait a few days so you can see the impact. If two or more are made, difficult to trace back which one is meanfully impacting therapy.







 
        
3rd June
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#12
RE: Still fatigued after year of treatment
Post script.

There is one extra point of a possible downside to be aware of:- 

Initially the central apneas may temporarily become worse as a result of only reducing the minimum pressure, without a corresponding reduction in the maximum pressure, thus widening the pressure differential even more.

But we need to find the minimum, and avoid if possible changing two variable at the same time.

However, once the minimum pressure "sweet spot" is established, then reducing the maximum can start, bringing the pressure differential back right down again, to act on what seems to be machine induced central apneas.

It is not an easy one, but hopefully will help.

Regards
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#13
RE: Still fatigued after year of treatment
(07-24-2023, 06:30 AM)OpalRose Wrote: Can you post the Statistics Page, complete with all the settings at the bottom.
Looking to see what you've used over time.
Thanks!

My thoughts are to bring the pressure lower in hopes that the CA's would be reduced.  
Then reintroduce EPR to help with FL.

Here's the statistics page

(07-24-2023, 11:18 AM)Expat31 Wrote: Post script.

There is one extra point of a possible downside to be aware of:- 

Initially the central apneas may temporarily become worse as a result of only reducing the minimum pressure, without a corresponding reduction in the maximum pressure, thus widening the pressure differential even more.

But we need to find the minimum, and avoid if possible changing two variable at the same time.

However, once the minimum pressure "sweet spot" is established, then reducing the maximum can start, bringing the pressure differential back right down again, to act on what seems to be machine induced central apneas.

It is not an easy one, but hopefully will help.

Regards

My script was initially 8-12 and was adjusted to 9-14 a few months later.


Attached Files Thumbnail(s)
   
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#14
RE: Still fatigued after year of treatment
Starrve,
I went back to read through your posts and missed your diagnosis of thalassemia.
Just doing a quick Google search, thalassemia can cause fatigue, weakness, and low oxygen levels.

It sounds like your symptoms haven't been alleviated with the use of Cpap, but I think you should get the sleep study done and keep using it. Have you been tracking your oxygen levels during sleep? What does your doctor say about possibly using supplemental oxygen?

Cpap use can't cure thalassemia, but should be able to help with the symptoms if dialed in correctly. You've received a lot of good advice here, and I think trying lower pressure might be more comfortable for you.

The CA's are probably treatment emergent and will lessen in time.

There wasn't much difference in AHI with the pressure settings you tried, so what did you feel more comfortable with, the 9-14 range or 11.6-11.6?
Do you notice the difference if lowering the EPR.

As stated above, the use of EPR may help bring down the flow limitation (which can disrupt sleep), but may also cause more CA's.

What pressure and EPR did you feel best with?
OpalRose
Apnea Board Administrator
www.apneaboard.com

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