[Treatment] Zonarik still a zombie after 5 months of CPAP : Therapy Thread

[Zonarik]

Good morning and thank you all for this community and the help you provide !

I (32,M) am almost 6 months into my CPAP treatment after a diagnosis in december 2024. The polysomnography showed 45.4 AHI per hour / 36.5 ODI per hour / 16.7 snores per hour.
Regarding AHIs, polysomnography indicates :
- 58 obstructive apneas with an average duration of 21s and a longest duration of 41s.
- 96 hypopneas with mean duration of 20s and a longest duration of 51s.
- 53 central apneas with a mean duration of 18s and a longest duration of 36s.
- 27 mixed apneas, with a mean duration of 25s and a longest duration of 48s.

The doctor prescribed a pressure range of 4-14cm. I struggled with the different masks, mainly because of my allergies. I finally got a full face mask (Resmed AirFit F20) that seemed to work well in mid-march 2025.
I followed the treatment religiously from the start, and adapted to CPAP fairly quickly. I couldn't wait to get back to normal life, to have energy, concentration, etc.

Unfortunately, despite all this, I still feel like a zombie. I sometimes have a good night (i.e. 7 AHI according to Oscar, I've never had less than 5 AHI since starting treatment in January) but it's far too rare.


I turn to you in desperation to see what can be done. The pressure range in now 7-16cm, I changed it myself last week hoping for an improvement (edit : changed it yesterday to 7-20cm).

I'm treated (combined therapy) and monitored for ADHD by 2 neurologists for several years: methylphenidate in the morning and atomoxetine in the evening.


I have attached screenshots from OSCAR of the 3 last days of sleep. I can provide all the informations you need to help.

Thank you very much.

[ejbpesca]

Your Med (median) pressure reads 10.00 and 10.20.  According to some experts this indicates you may need to raise the Min. pressure.  I would raise it in steps in hopes of resolving more events.  There are articles by experts who feel the Med pressure under Statistics is a good pressure level for the Min. pressure setting.  Your APAP is tapping at the Max pressure.  Max can be raised to allow it to go higher.  The goal is to get the two balanced to create a smoother line on the pressure graph.  Raising Min may lessen the need for a higher Max.  

You have events in clusters that could be indicative of a sleeping position that may be pinching off the airway.  Some use cervical collars to prevent their chin from tucking down to their chest and restricting the airway.  You can search this forum and the net for Chin Tucking and CPAP to find more information on the very common topic of chin tucking.

You can see on your pressure line that when the clusters happen, the pressure line goes up and hits the top of the graph.  If chin tucking is occurring and pinching the airway, PAP therapy is said to not correct it.

I am writing about considerations, not instructions.   Other replies may come soon with specific instructions on how to get your AHI down.  Searching this forum may find for you similar OSCAR reports to yours and how high AHIs were resolved.

[Zonarik]

Your Med (median) pressure reads 10.00 and 10.20.  According to some experts this indicates you may need to raise the Min. pressure.  I would raise it in steps in hopes of resolving more events.  There are articles by experts who feel the Med pressure under Statistics is a good pressure level for the Min. pressure setting.  Your APAP is tapping at the Max pressure.  Max can be raised to allow it to go higher.  The goal is to get the two balanced to create a smoother line on the pressure graph.  Raising Min may lessen the need for a higher Max.

 
First of all, thank you for your answer !
Alright then, I'll increase the Min pressure little by little. Could such a high number of AHI be the result of leaks ? Or what's Oscar is showing here is not indicative of that ?

You have events in clusters that could be indicative of a sleeping position that may be pinching off the airway.  Some use cervical collars to prevent their chin from tucking down to their chest and restricting the airway.  You can search this forum and the net for Chin Tucking and CPAP to find more information on the very common topic of chin tucking.

I bought a soft cervical collar and I started sleeping with it yesterday. I'll post an update after a few days : the impact of the soft collar should be almost immediate no (if it's indeed chin tucking ) ?

[jdougc]

I learned something from this video, about collars possibly pushing the soft tissues of the neck instead of the bone of the mandible.

https://www.youtube.com/watch?v=AkENdD-17zg

[ejbpesca]

Research Leak Rate and Large Leaks.  There is a Wiki resource at the top of this page.  You have 0.00% Large Leaks on your  OSCAR post 1 and the Leak Rate is at or below 5, 95% of the time.   24/L (24 liters per minute is acceptable)

Leak Rate is important but under the threshold of 24/L per minute is acceptable.  I'm not sure if the mask's exhaust port air is figured into the Leak Rate or not.  Some OSCAR reports include a red line at 24.  You are way below that.  Expect leaks to increase with pressure increases.  Adjustments to headgear may be needed to prevent them.  Leaks stay at an acceptable rate with few large leaks if a good seal is on the mask.  If, present run the mask fit test, move your head a bit, twitch your nose and mouth and if a seal is maintained then most likely leak figures will remain acceptable.  Intermittent short-term large leaks can occur due to movement and may or may not impair therapy, you have none on that OSCAR.   

If a collar prevents your chin from lowering to your chest and chin tucking is a cause of apneas there should be an immediate result of lowered apneas as a result of using a collar.  If you wear the collar and no improvement is found either the collar does not keep your chin up or the apneas are not caused by chin tucking.