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[Treatment] Therapy is helping, but only a little - good AHI numbers, bad sleep
#1
Sad 
Therapy is helping, but only a little - good AHI numbers, bad sleep
Hi guys, I've been on CPAP since November.
Unfortunately things are not so good. I no longer feel the need to sleep 24/7, but I am still pretty tired and I wake up with headache 50% of the time. Today was absolutely the worst, I feel like I can no longer live normally with such problems.
I use F20 and N30i. I feel like F20 is a lot better than me. I avoid full face masks, as they were making my GERD a lot worse and they were uncomfortable. 
At the beginning I had a problem where I was taking my mask a lot during the night. My doctor prescribed me nasal steroids and now it is million times better - I pretty much take my mask off only when I feel the need to go to the toilet.

Would you mind taking a look? If the format is not suitable for the forum, I can share sleephq reports/OSCAR screenshots.


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#2
RE: Therapy is helping, but only a little - good AHI numbers, bad sleep
Adding OSCAR screenshot:


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#3
RE: Therapy is helping, but only a little - good AHI numbers, bad sleep
You need to lower your flow limits. FL are apnea only are not timed long enough (at least 10 seconds) so they are not counted in you AHI.

you need a couple changes to help lower your flow limits.

First turn on EPR to full time
Next set EPR to 3
Last set min to 7

You will sleep better.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: Therapy is helping, but only a little - good AHI numbers, bad sleep
Thank you for your suggestion. I have changed the settings and tried them for 2 days. At first I found it much easier to breathe when I go to sleep. Unfortunately I woke up with headache, brain fog and I do not feel refreshed. I do not think this helped me much. Is there anything else I could change to feel the benefits of therapy?


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#5
RE: Therapy is helping, but only a little - good AHI numbers, bad sleep
Added missing screen shot


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#6
RE: Therapy is helping, but only a little - good AHI numbers, bad sleep
Hi guys, after fiddling with settings and using suggestions from other people I've changed my settings and had a little better sleep, but unfortunately I still wake up as a zombie. It feel like therapy is only helping me for like 40-50%. Would someone mind looking at my results? I really wish to wake up refreshed someday  Dont-know


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#7
RE: Therapy is helping, but only a little - good AHI numbers, bad sleep
Hi tiredsleeper Smile

EPR has a lag in timing between the end of expiration and the beginning of inspiration so please turn it off and set the machine mode to cpap @ 9cm of pressure, try this setup for 30 to 40 minutes before bed tonight to see how you are breathing and if you are able exhale comfortably. If so you should sleep better with less arousals, then send us a chart, you are having leak spikes so please try to sleep on a flat pillow as well.
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#8
RE: Therapy is helping, but only a little - good AHI numbers, bad sleep
By 9cm pressure you mean min or max? Could you send me an image of pillow you'd like me to use?
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#9
RE: Therapy is helping, but only a little - good AHI numbers, bad sleep
(08-07-2024, 04:07 PM)Phaleronic Wrote: Hi tiredsleeper Smile

EPR has a lag in timing between the end of expiration and the beginning of inspiration so please turn it off and set the machine mode to cpap @ 9cm of pressure, try this setup for 30 to 40 minutes before bed tonight to see how you are breathing and if you are able exhale comfortably.  If so you should sleep better with less arousals, then send us a chart, you are having leak spikes so please try to sleep on a flat pillow as well.

Phaleronic, could you explain your thinking some more?  As I'm sure you know, normal breathing during sleep includes a lag between the end of exhalation and the beginning of inhalation.  That's the time the flow-rate trace is at the zero line.  ResMed's EPR starts with the beginning of inhalation and increases pressure during inhalation; then during exhalation it drops by the number of cm H2O the EPR is set to.  The pressure stays at the lower number until inhalation begins again.  Is that the lag you have in mind?  What do you think is harmful or disruptive about that?  

I will note that EPR reduces flow limitations, and in fact it did a good job of reducing the OP's flow limitations.  Without EPR, the flow limitations are likely to increase again.

Also, why do you recommend a fixed pressure?
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#10
RE: Therapy is helping, but only a little - good AHI numbers, bad sleep
I have tried turning down the EPR and setting mode to CPAP with pressure set to 9. Honestly, I did not see much of a difference - it's not good both ways, so I just switched back to the previous settings (they were more comfortable). Does anyone know what more can be done?


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