[Treatment] Need help with severe fatigue and brain fog - AirCurve 10 ASV (Help with settings)

[MUARS]

Hi all,

Hope you are well,

I have been a lurker on this forum for a while now, and have been struggling to fix my severe fatigue and brain fog that I've had my whole life.
I'm a 23 year old male with a BMI of 24 so not the typical sleep apnea patient which makes finding sleep doctors who will take you seriously difficult here in Sydney.
I have a narrow Maxilla and a retrognathic mandible so those are the likely causes

I will list the interventions I have done so far to try and help my issues

- Rhino-septoplasty to improve nasal breathing
- Cpap, now using an ASV
- Drug induced sleep endoscopy that identified that my throat collapses when I sleep
- Three sleep studies, one at home and two in Hospital. Two found that I essentially get no rem sleep at all. I am still waiting on results for the third. I would attach the reports but I can only attach three files on this post. 
- l tried a tooth borne expander but it only tipped my teeth. Will be getting a bone borne expander around October
- I have been prescribed Modanafil for ADHD however I haven't found this to help much and am not sure if I truly have ADHD in the first place. 

I am going to be seeing an Maxilo-facial surgeon to likely get MMA surgery in a year or so after orhtodontics starting this year,
but in the meantime I need to sort something out so that I can be more functional day to day as the fatigue and lack of mental clarity are debilitating

I initially tried a Airsense 10 Cpap however I found it didn't make much difference even with a pressure setting of 12 and EPR 3. I purchased an Aircurve 10 Machine refurbished as I have read that ASV and Bileval machines help with UARS better however I haven't been able to find settings that work for me.

I would sincerely appreciate guidance as honestly I am getting desperate. This illness has robbed me of so much of my life and I just want to be able to
live free of this problem.

Kind regards,

MUARS

[OpalRose]

Welcome to Apnea Board!

No problem posting your sleep study. Just make a separate post here in this thread.

[Rich66]

As a user of the Aircurve 10 ASV, it appears to me that your pressures need resetting. I'd recommend a big change, then see how it works for you, then make smaller changes until you dial it in. Try as listed --

EPAP Min 7.0
EPAP Max 12.0
PS Min 3.0
PS Max 10.0

I think some of these are still too high, but you have to see what works for you -- especially with your specific health issues.

[MUARS]

As a user of the Aircurve 10 ASV, it appears to me that your pressures need resetting.  I'd recommend a big change, then see how it works for you, then make smaller changes until you dial it in.  Try as listed --

EPAP Min   7.0
EPAP Max  12.0
PS Min        3.0
PS Max       10.0

I think some of these are still too high, but you have to see what works for you -- especially with your specific health issues.

I've adjusted my machine to these settings and I'll see how I go, thanks for the advice!
I've also listed some pictures of my sleep studies, I can't post pdfs so I'll try and put the most useful information. Both studies show that I get no rem sleep but it looks like they made no attempt to measure RERAs unfortunately.

[MUARS]

Bump,

I tried those settings and haven't noticed a difference in my symptoms. When I get home this afternoon I'll post some screenshots of the last two nights

[MUARS]

Here are the screenshots of the last few nights, I played around with the settings to see if that makes a difference. I have noticed that my flow limitations have high degree of severity according the graphs and some look like complete obstructions that just don't last very long.

[REMhunter]

Did the fatigue and brain fog start with your BiPAP/CPAP usage or it was there the whole time?

If it's just started:
When I first started CPAP treatment, I had to "detox" from high cortisol levels.  It was miserable for 2 weeks, then upgraded to just poor.  After a couple of months, I felt so much better.  I'm wondering if you are having the same experience.  My reaction to the high cortisol levels mimicked some ADHD features, it's gone now.

[MUARS]

No I've had the fatigue and brain fog for as long as I can remember. As the sleep studies show I don't get REM sleep which I believe is due to my flow limitations. 

I'm trying different settings to see what works but I need some guidance nothing so far has made a difference and I'm not sure how to read the graphs. 

I really need some symptomatic relief because this fatigue is destroying my life

[Rich66]

Your leaks are a concern. Do you wake up with a sore throat. Have you tried mouth tape or loosening the mask, or tightening the mask. Have you tried lower settings than what was suggested. I noticed you tried stronger settings. The higher settings can cause the leaks which can disturb the sleep.

[MUARS]

I started with low pressures and built up to the ones I'm using now. I'm not sure if low pressures would help me I can post data from the AirSense 10 I was using a few months ago

With the nasal mask, even when it was quite tight it would leak when I moved. I'm pretty sure this is because I have quite an asymmetric face. I switched to a full face for the last two nights and this seems to have stopped the leaks.

I already mouth tape but haven't noticed a big improvement, I suspect the issue is due to my very narrow throat collapsing just enough to kick me out of REM but not for long enough to count as an apnea or hypopnea