Very unrefreshed in the morning with CPAP. UARS suspicion

[dekaneros11]

Hi guys, getting back with some questions to this thread after setting EPR on 3.

As mentioned, when having EPR set on 1 or 2, i was waking up with pretty severe brain fog, but at least the tensions in my head and chest i was waking up with prior to CPAP use were subsiding. After 5 days on EPR 3 with 10cmH2o pressure, i've been waking up less and less brain foggy (but with a still considerable amount), but the tensions came back unfortunately, almost everyday i woke up with or developed a headache during the day, and with a strong tension in the chest that somedays evolved to anxiety during the day. 

The first night i used EPR 3, i think i had the infamous "REM rebound" possibly the first time, because i had around 4-5 dreams in the same night and woke up with a pretty good mood. The mood got worse over the next days and here i am. 

My OSCAR charts look quite fine, the flow limitation is clearly lower, and the flow rate chart looks better, even though not perfect. Attaching pics below.

I'm quite baffled because during these 2 months of CPAP i was able to say that even though i wake up with extreme brain fog, at least physically i feel better. But now somehow i feel the same as before physically and comparable or worse brain fog. Also, i wouldn't say that many other things changed in other aspects of my life. I'm curious what you think about this. Thank you.

[DaveSkvn]

To start off with, the EPR does seem to have made a difference to the flow limitations - though 26 Jan with EPR 2 was in the same ball park. From the detail graph, at the zoom level you show, its looking pretty regular without major issues.

There remains the issues of "brain fog", "tension in the chest" and headaches.

You mention "brain fog" when you wake up. If you wake up feeling yuk but, after forcing yourself out of bed and moving around for 15 minutes, it lifts and you remain alert for the rest of the day then I would just deal with that. Outside CPAP world, there are "morning people" and "non-morning people". I don't think CPAP guarantees that you will wake up feeling great. If the "brain fog" persists or returns during the day then there is a problem.

I'm not sure what you mean by "tension in the chest". Do you mean "shortness of breath" / difficulty breathing? I'm in no way medically qualified but its not something I associate with CPAP. It could be something like Asthma or COPD which could be made worse by EPR and/or higher pressures.

Headache is something I've experienced and it makes life miserable - but I tended to associate it with a bad night and loads of apneas. Your graphs show nothing untoward.

I would suggest you try a couple of nights each at 9 and 8 (with EPR 3). I've found higher pressure does not make much difference. The reduction in flow limits from EPR was evident and stable as I dropped from 12 to 9 - for me a higher pressure was not necessary.

If that doesn't clear things up, I'd go and see a doctor to look into the "tension in the chest". I would try and look at it as a separate ailment - try not to assume its sleep related or that CPAP will handle it - though CPAP may interact with it.

Good luck.

[dekaneros11]

Hi Dave, thanks for the suggestions.

The "tension in the chest" thing feels like a less aggressive form of anxiety, like i wake up in a sort of a fight or flight state, which sounds in line with SDB. So getting on CPAP and starting to wake up better from this point of view, made a lot of sense, but seeing this coming back makes me pretty confused. 

The headaches have gotten worse by the day with EPR on 3, and i've had better and worse nights during this time.

And the brain fog - man oh man. I'm almost non functional for at least half of the day. Sometimes it gets better through the evening, sometimes the whole day feels like a dream. I would say i can count on 1 hand the times i was "alert" in the last couple of weeks. Even trying to write this message now and tie my words together feels hard. 

What i believe happened on lower EPRs is I was having a ton of light sleep for some reason (this was what my sleep tracker also said, but i tend not to rely too much on them) and maybe the settings were good enough for controllling the light sleep. So i was waking up better physically but much more groggy because lthe lack of deep/REM. On EPR 3 maybe i'm finally getting to deeper stages of sleep, which is great and the brain fog is a bit better, but maybe the settings can't control the airway that good during REM and i have more arousals -> cortisol spikes -> anxiety in the morning. This is the only way i can explain what i'm feeling, so please correct me.

I was thinking of getting the pressure lower as well, 9 with EPR 3 is next.

[dekaneros11]

Hi everyone, 

I was able recently to rent a Bilevel machine. It's a SEFAM S.Box Duo, which i found out a bit too late that doesn't support OSCAR, but found some help with its software on this forum. 

Since i was trying an EPR 3 on CPAP, i tried a PS of 4, with IPAP on 12 and EPAP on 8. The inspiratory sensitivity is high enough to not feel effort when switching from the expiratory pressure, and the expiratory sensitivity is as low as possible, since i feel the machine cutting my inspiration before falling asleep.

I'll keep fiddling with pressures/settings, but i'm curious, what does this type of flow limitation suggest? I haven't seen these while on CPAP.


Thank you

[DaveSkvn]

There's a taxonomy of flow limitations in the Oscar guide.

https://www.apneaboard.com/wiki/index.ph...low_shapes

It seems to have the same 2001 source as this (from 2015).

https://www.sciencedirect.com/science/ar...0516#f0015

Personally I wouldn't put too much effort into linking specific wave shapes to physical goings-on in your airway. I seem to have most of the classes of flow limitations at some point through a typical night. It changes by position / sleep stage etc.

Your inspiration (bit above the line) starts well but reaches an early peak and then falls off abruptly. Its not what you want. It would be what you might expect if the machine is cutting pressure support too early.

[SenatorBirch]

Dave, also wanted to say thanks for the Glasgow tool !

I've been on the forum for some time, to support my son who has suffered terribly for many years with UARS (and later, more stuff).

At his insistence I was recently tested, diagnosed with a 42 AHI, and am on my second week of 0.5 - 1.5 AHI with the ResMed Airsense 10 Autoset.

I am not sure if I feel much different, so my son mentioned your tool. I've looked at just a single night's data, and while I have no idea yet whether it will help me tweak my treatment, I have no doubt it will help some.

Thank you for sharing this.

[mcrick]

Dave, thank you for making this tool. I used it to analyze around 200 nights of sleep data and found some very interesting trends for myself.

   

   

   

Code:

Correlation Matrix:
             GlasgowIndex       AHI        FL      EPAP      IPAP    PS/EPR
GlasgowIndex      1.000000 -0.036026  0.283992  0.487941  0.207711 -0.662546
AHI              -0.036026  1.000000  0.189133  0.020179  0.059479  0.070534
FL                0.283992  0.189133  1.000000  0.306820  0.140689 -0.397216
EPAP              0.487941  0.020179  0.306820  1.000000  0.888274 -0.467608
IPAP              0.207711  0.059479  0.140689  0.888274  1.000000 -0.009360
PS/EPR           -0.662546  0.070534 -0.397216 -0.467608 -0.009360  1.000000

Correlations with Glasgow Index:
PS/EPR   -0.662546
EPAP      0.487941
FL        0.283992
IPAP      0.207711
AHI      -0.036026

Correlations with AHI:
FL              0.189133
PS/EPR          0.070534
IPAP            0.059479
GlasgowIndex   -0.036026
EPAP            0.020179

Correlations with Flow Limitations (FL):
PS/EPR         -0.397216
EPAP            0.306820
GlasgowIndex    0.283992
AHI             0.189133
IPAP            0.140689

So I found that I am best off with more PS/EPR and less EPAP (likely because more gives me aerophagia). Very curious to see how this plays out as I fiddle with my PAP settings.