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

[SeePak]

Hi Jukka.

The APAP machine will give you as much pressure as you let it!

There are differing views, even by experts, about auto pap control.

If it works for you, great!

But a constant pressure , or at least a narrow range should easily get rid of most events AND allow restful sleep.

The people here have experience to the contrary, and extra pressure is almost always prescribed.

I just dont see it working.

But you will need to try out and verify for yourself.

Just stay focused, whatever you try, on how you feel, rested? fatigue during day?

Then go from there.

The mucus you have, i wonder if you are a mouth breather?

That causes lots of problems.

Flow limits, ah , that is another thing.

I have restful sleep with FL of .4, and usually 0.2 or around there.

That is not a focus for me.

Here on this site it is, and they have experience and data to show that it matters.

I think if you give the lower pressures a chance, forget about the charts a bit and go by how you feel, you will be on your way.

However, you do have high volume breaths and high respiratory rate, not sure what is going on there.

Others here have lots of experience to give suggestions there.

me, i would check out Patrick McKeown and Breathwork exercises.

My life has changed dramatically for the better.

Much less anxiety, procrastination, energy, and on and on.

Please check out, this will give you more bang for the buck than anything else.

[SeePak]

Jukka, for the mucus problems and reflux...

Do not lay down after eating, that is a big one!

Have you tried probiotics?

Do you use iodized salt?  Iodine is the focus here, may be low?

Allergy to dairy, wheat, cocoa etc?

Have you tried oil of oregano, eucalyptus, anise, peppermint?

Careful treating acid reflux, cause it is usually caused by non closure of a sphincter ring in the esophagus.

Treating with antacids, when you have LOW stomach acid, will exacerbate your condition and create other problems!

Breathwork exercises that allow the vagus nerves to stabilize will most definitely help you.

This work will allow the parasympathetic system to reach Rest/Digest state and over the long haul will alleviate and repair many of your issues.

Hope you check out and get some relief !

[JukkaKV]

Yes, I am a mouth breather (at least when sleeping). I am using full face mask because my mouth opens most often when sleeping.
I have also dentistry overbite (not sure is this the correct word).

Actually I have started a new diet about a month ago in guidance with my nutritionist: glutein free, no dairy products, no eggs, also no oats to prevent mucus.
This has decreased development of mucus at least to some extent.

I try not to eat anything at least 2 hours before bedtime. I have seen some people say it should be even 4 hours.

Probiotics I have tried but no help.
I am using sea salt but I think it is not iodised. I need to check and try this.

Oil of oregano, eucalyptus, anise, peppermint - I have not tried these. Should they be taken before going to bed or does it matter?
I need to check if these are available in pharmacies.

I will check Patrick McKeown and Breathwork exercises.

Thanks a lot for giving me hope! I had almost given up that I must live rest of my life with these symptoms.

[SeePak]

Jukka

Mouth breathing is bad for so many reasons and I hope you look into Patrick to see why.
Yes it is hard to eliminate it while sleeping however during the day we have no excuse to mouth breathe and with a little consciousness of effort you will have immediate results I saw results in 2 days!

Please don't give up hope.

You just have to find a way to sift through the information and figure out what is right and what is not so right

I have learned so much in the last few years even though I've been doing it all my life looking for answers much like everybody else it is not until recently discovering breath work that everything is falling into place

I have a saying and I want to post a thread that says

" try something you know won't work"!

For a little context on that one the first 20 plus times that I tried something that my amygdala was trying to tell me was not going to work it did work!

Okay I know that doesn't sound normal and I don't know what it says about me I assure you I'm telling you the truth! LOL

Hang in there I can tell you have the right mind to go forward and take the necessary steps to take ownership of your being.

Peace

Sorry forgot to ask specifically what was the pressure settings that the Sleep Clinic said got rid of your obstructive events?

Also, the herbs and tinctures i mentioned are only stop gap, treating sypmtoms, giving possible relief.
I have use oil of oregano hoping to eliminate congestion nasal wise.
It did not really work.
What does work is Breath holds !!
seriously, you must check that out for sure.
Mouth breathing CAUSES nasal congestion !

[JukkaKV]

"Sorry forgot to ask specifically what was the pressure settings that the Sleep Clinic said got rid of your obstructive events?"

The Sleep Clinic had preset it to min 6 cm and max 14 cm. I think it is the standard for most people to start with.
After that I have tried this and that.

Actually at some point I suggested if I should decrease the max value but they said they don't take any responsibility if I go and change the pressure settings myself.
The general guideline is that no one should not change the settings but in practise many people adjust them by themselves.

[SeePak]

Jukka.

That was not my experience with sleep clinic and overnight stay.
There is no standard for everyone that i know of !! 
( for instance, there is a theoretical paper written by Patrick McKeown and others called The Phenotypes of sleep apnea. check that out. )

The sleep clinic titrated pressure from 4 cm up until they saw that i had no obstructive events, which in my case they said was 6 cm, and they suggested  to 7 cm anywhere in there.

Now that is not perfect, cause things can change easily from night to night, but it is a start.

So in your case, if they used 6 cm as a minimum pressure, i would assume, thru my experience, that 6 cm gets rid of obstructive events for you, at least once it did that !

So if this is the case, i would start with that as a min. pressure.

Now for max. pressure, there are all kinds of philosophies and  thoughts.

The one i follow is....

Use the minimum amount of pressure as possible to reasonably get rid of most events.

Over time, that will get sorted out.

however, the auto pap is NOT the way to figure it out, IMHO and many others in this field of expertise. ( i do not have the expertise, but realistically, this is pretty easy to see how it works,)

In your case, if you were my patient, or wife, or friend, and you are my friend i hope  LOL

I would suggest a pressure like i suggested for you and go from therre depending on events and HOW YOU FEEL #1

[Geer1]

I got an email from a member asking me to weigh in because your case reminded them of my own. Taking a quick look through it does seem similar so I'll offer a few thoughts.

Regarding the apnea if your average night is the same as two examples posted it appears your apnea is treated even at minimal pressures however significant flow limitations are present. Some times higher pressure helps flow limitations but sometimes you just need some assistance to breath through the restricted airway. EPR as others have recommended provides that assistance by increasing the pressure when you breath in and then dropping the pressure when you breath out, I would try EPR of 3 and you can slowly work your way up to that if it feels uncomfortable. 7-15 with 3 EPR is probably a good setting to try. Humidity settings and hose temps can have a big effect on nasal congestion as well, harder to titrate since it is different for everyone. I would first find a decent pressure range and then stick with it and you can try playing with humidity settings then to see if it helps (try to be methodical with one change at a time for a few nights to tell if there is actually improvement rather than multiple changes or changing every night).

My main issue wasn't apnea which is why I don't post much here anymore. My main issue was digestive issues and like yourself I suffered from nasal congestion and reflux. I had nasal surgery, used rinses and sprays daily and none of that worked. Eventually I did a low fodmap diet for my digestive symptoms and during that I found out that the main cause of my congestion and reflux was dairy. Cutting it out of my diet allowed me to come off all the sprays etc and eventually I even stopped using my CPAP machine (after having two in clinic sleep studies that indicated I didn't have apnea, at least anymore). I am a strong believer that nasal congestion, reflux and digestive symptoms like bloating, constipation or reflux etc are common signs of food intolerance. Other non specific symptoms like poor sleep, fatigue, depression, anxiety etc are also common symptoms.

The hard part is determining what foods you are intolerant to and if there are any other factors at play. In my case dairy was the main one and after cutting it out my congestion and reflux improved obviously. I was still having some digestive symptoms so tried gluten free and realized it had some effect as well. I was feeling better but symptoms still started getting worse until I found out I had a chronic giardia infection and treated it. That allowed my digestion system to finally start healing and my food tolerance started to improve although 1.5 years later I still get minor (but cumulative) effects if I eat dairy or gluten so I still avoid both of them.

The only way to determine problem foods is via elimination diets of which there are many different types. Low FODMAP is a common one that is focused on complex carbs our bodies have difficulty digesting (and that bacteria then feed off and release gas which causes bloating and other digestive symptoms), this can be beneficial for a lot of people but it isn't the best one for food intolerances specifically. The most common food intolerances are also the most common food allergies so diets low in food allergens like the Paleo diet are good options to try. Autoimmune paleo is probably the best but also hugely restrictive. Then there are other food intolerances like salicylates, amines or sulfites that are a bit trickier to diagnose. The key is to try different diets or parts of diets and cut out the foods for 6-8 weeks and see if symptoms improve and then slowly reintroduce foods one at a time until you find which one (or combination) causes symptoms. Sometimes it can be obvious (like dairy was for me) and sometimes it can be more challenging if the symptoms are minor but cumulatively get worse over time (like gluten does for me). It might take a few iterations of diet and reintroduction before you are sure something is causing issues.

One thing to note is that this stuff is pretty much all cumulative especially if bad enough to cause nasal congestion, reflux, poor sleep etc. It is not uncommon to take weeks to notice improvement because your body has to first start healing itself before you start to feel good. Likewise if you are very sensitive to something cheating and eating it even once a week can keep you from feeling good, you really need to commit to these tests and do them properly if you want to get good clear results. Cheating often just draws out the agony because you have to keep doing more and more tests unclear of what is actually helping. Also another important note is these should be done as elimination and reintroduction diets, if a food doesn't cause you noticeable issues you shouldn't avoid it.

Anyways to summarize your flow limitations aren't great and EPR should help. If I had to guess I would say Apnea probably isn't your main issue although it could definitely be contributing. Food sensitivities commonly cause congestion and reflux and it appears you have already somewhat confirmed dairy is one for you, the only way to reliably test is by performing food elimination and reintroduction diets. One of the keys when battling health issues like this is trying to treat all your symptoms at once rather than one at a time, eat healthier, sleep healthier, get more physically active, improve mental health etc. If you only treat one factor at a time sometimes you don't get the full benefits because other factors have already been negatively effected and are not causing their own issues.

[JukkaKV]

Hi Geer1,

Thank you for your reply. I was impressed with all the information you provided.
Your case sounds indeed very much similar to mine.

I feel also my main issue is digestive problems, not apnea.

I strongly agree what you said:
" I am a strong believer that nasal congestion, reflux and digestive symptoms like bloating, constipation or reflux etc are common signs of food intolerance. Other non specific symptoms like poor sleep, fatigue, depression, anxiety etc are also common symptoms."

This sounds so familiar to me. I have suffered from these symptoms for years.

As I mentioned, I have been following a dairy-free and gluten-free diet for some weeks now.
I feel it has given me at least some relief to my symptoms already. I understand it will take time to notice improvement.

Actually following is very close to the plan we have agreed with my nutritionist:
"The key is to try different diets or parts of diets and cut out the foods for 6-8 weeks and see if symptoms improve and then slowly reintroduce foods one at a time until you find which one (or combination) causes symptoms. "

So it seems I am on the right track.

In addition to changing my diet, I will also try to find the optimal settings for my CPAP treatment.

[Geer1]

You haven't mentioned much about mental health symptoms but if they are present they can be a significant factor as well.

One thing that doctors and even some counsellors and books etc do a poor job of explaining is that our mental health and in particular anxiety is a natural defense mechanism that evolution has built into us and that it can be triggered by both real physical threats as well as perceived threats caused from stress etc. This defense mechanism triggers our sympathetic nervous system which physically and chemically changes the way our body functions. These changes can be helpful for dealing with periods of short term stress/threats but it can disastrous if it stays active for extended periods.

When it comes to chronic health issues I think it is common for mental health to be affected and unfortunately this can lead to a negative feedback loop that is hard to break. The issue may start as chronic stress, an infection, disease etc which causes its own issues and symptoms and these may cause sympathetic nervous system activation on their own but if not just feeling poorly can make a person stressed etc which then triggers this response. This is especially critical when it comes to digestive issues because one of the symptoms of sympathetic nervous system activation is to shut down digestion, as some people explain it sympathetic nervous system causes the fight or flight response whereas parasympathetic response is rest and digest. An inactive digestive system then causes its own problems with SIBO, microbiome imbalances, infections etc which then cause their own symptoms which then cause mental health to degrade further in a negative feedback loop that is hard to break.

In my case I have come to realize how much of an effect this can have. After feeling better after diagnosing food intolerances, giardia infection etc and getting into good shape both physically and mentally I went through another period of high stress at a new job and symptoms such as digestive issues, poor sleep quality and poor muscle recovery started to come back and then those of course made the stress even harder to deal with and symptoms were slowly getting worse. Having gone through this before I had an idea on what to do and with the help of antidepressants, sleeping pills, stress reduction, sleep hygiene, diet improvement and exercise I got things back on track again before they spiraled too far. Now I try to make sure to keep myself in better balance and address stress before it starts to cause other symptoms.

[SeePak]

Hey geer 
agree with everything you say above having included much the same in a lot of posts, and the one thing I see missing from your regimen is Breathwork which immediately reduces anxiety and stress!
A la Patrick McKeown 

Check it out!

And a lot of success stories for reversing sleep apnea.