Still feeling fatigue during the day even though using CPAP device regularly

[PeaceLoveAndPizza]

Based on what I see in the chart, give this a go..


Mode APAP
Min pressure 8
Max pressure 15
EPR 3 full-time
No ramp

That should be enough to give us a reasonable idea of a good pressure range for you and we can refine things from there.

[JukkaKV]

Hi Seepak,

Yes, I had the latest sleep study in 2022. See the results below (translated with Google translator):

"All-night apnea index AHI 28.8/h (moderate sleep apnea AHI 15-30/h). Slept 86% of the recording time supine, with AHI 33.0/h, in other positions AHI 2.2/h. AI 22.5/h, central AI 2.7/h. Longest apneas lasted more than a minute. Average oxygen saturation 94%. ODI3 26.8/h. Less than 90% saturations 5% of the recording time. Snoring about 15%."

I have had therapy for 2,5 years now (sorry, did not find how to edit my original post).

[SeePak]

Juuka

Do you ever sleep on your side, and is it comfortable?

Do you have other charts you can share from Oscar?

I am wondering now if the prescription of 6-14 was due to sleeping on your back, possibly needing more pressure at that time.

If that is correct, it could be very advantagious for you to try sleeping on your side.

You have large breaths and high frequency, i was originally thinking that was from the higher pressures

[JukkaKV]

Hey SeePak,

Yes, I sleep most often on my side but I feel is easier for me to fall asleep on my back.
Quite often I fall asleep on my back, then wake up and continue the sleep on my side (sometimes not able to catch the sleep any more).

I can share some fresh charts from Oscar and try to sleep on my side.
Regarding the night for November 8th I don't recall any more how much I slept on my back.

I have set it now min 6 and max 8.

I believe the large breaths with high frequency could well have been caused due to the higher pressures.

Let's see how it goes.

[PeaceLoveAndPizza]

That is not enough pressure based on the chart. It is your therapy so do what you want.

[SeePak]

Sweet dreams Jukka.

[2SleepBetta]

Based on what I see in the chart, give this a go.. : Mode APAP, Min pressure 8, Max pressure 15, EPR 3 full-time, No ramp. That should be enough to give us a reasonable idea of a good pressure range for you and we can refine things from there.  [As edited by 2SB in my probably naive thought that it might save server space. True or false?]

I agree with PLP who is ahead of me with the "15" pressure. First, I wanted to see the effect of the single change I thought most important, though pressure was peaking at and challenging the "12" pressure.

My first impression of the graphs was that the A11 could not respond with increased pressure fast enough from such low pressure. Mucus buildup, I assume, waxes and wanes and likely complicates titration. 

It seems to me mid to late-sleep's showing of time, 0310-0730 at lower pressure with less FL, signals that, aside from possible positioning issues, we have to deal not only with usual anatomic airway factors as background but also with intermittent mucus interference: must address both factors the best we can unless, you, Jukka can find a way to control the mucus factor. Diet? Over the counter nostrum? Prescription? Allergens? (I happen to share troublesome mucus problems, so may make too much of it.) 

That rogue, extreme, unanchored FL debris (at end of that highest first series of FL): What is that about? I've never seen such before. Is that cloud a tech/hardware aberration or something else?

[JukkaKV]

I attached my graphs from last night.
I had set pressures to min 6 and max 8.

I was sleeping on my side from 22.40 to 03.20. 
Between 03.20 and 5.40 I was mostly awake.
Then I was sleeping on my back from 05.40 to 07:00 (around).

Based on the pressure graphs I would understand max pressure 8 is not sufficient, right?
I can see also some RERA events when I was sleeping on my back. Flow limit has been relatively high at that time as well.

Quote from 2SleepBetta: "It seems to me mid to late-sleep's showing of time, 0310-0730 at lower pressure with less FL, signals that, aside from possible positioning issues, we have to deal not only with usual anatomic airway factors as background but also with intermittent mucus interference: must address both factors the best we can unless, you, Jukka can find a way to control the mucus factor. Diet? Over the counter nostrum? Prescription? Allergens?"

I agree with 2SB, it is not only anatomic airway factors in my case.

Last night I had also mucus problems, most likely because I had some ice cream in the evening (about 3 hours before bedtime). 
I have suffered from mucus problems for several years. We have tried to find a solution for the mucus issues with occupational health but no final breakthrough yet. I have reflux as well. 
Some foods (especially spicy and greasy) increase the mucus. I am following a pretty strict diet these days but occasionally I slip up.

I have also raised head of my bed about 5 cm. It seems reflux medicines don't help at all.  
I have read pepsin (coming from stomach) could be main trigger for the mucus.

Next night I could  try with the settings suggested by PLP:
Mode APAP
Min pressure 8
Max pressure 15
EPR 3 full-time
No ramp

This is quite close to what I have tested before but min value a bit higher.

I am starting to think there is not much that can be done by changing the settings because I have the mucus problems as well.
Anyway would be better to have the settings as close to optimal as possible.

It seems there are very helpful people on this forum. 
Warm thanks to everyone who has commented on my post!

[SeePak]

Jukka

How do you feel?
Rested?
Tired?
Same as ever?
Besides having the positional event your chart looks at least as good as it was when you showed us it at first so no harm done there I don't think.
You do still show high minute volume and respiratory rate though.
Good luck in your testing.
Peace

[JukkaKV]

Thanks for asking SeePak.

I feel a bit more tired than usual.
Also my head did not feel good when I woke up, possibly due to thick mucus in airway.

Yes, it is true AHI is about the same as normally.

The graph shows pressure is 'knocking' the max limit 8 cm. Based on that I was thinking max pressure could be higher.

BTW, what should be the Flow Limit value when it is 'normal'?
It seems when sleeping on my back FL has been around 0.8 but much lower (under 0.17) when sleeping on my side.

Maybe I will try to sleep couple of nights with the higher max value and then check the graphs again.