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joshuao CPAP Therapy Thread
#1
joshuao CPAP Therapy Thread
.Hello!

I'm new here, so first off hi. This board has been very useful so far in learning stuff but I'd finally like some advice of my own.

First I'll just get some details out of the way

History: Diagnosed with OSA 2 months ago. Sleep study showed mild OSA (average AHI of 14 in the night, and 19 when supine).
Since then I have been mostly learning to deal with mask leaks and humidity, both of which I'm pretty content with now.

Machine: Resmed Airsense 10 Autoset
Mask: Nasal Cradle - Resmed N30
I use a cervical collar, and full mouth tape currently
Current pressures: 7-14cm with fulltime EPR of 1

Now to my issue: I'm still feeling groggy during the day. It definitely improved since I started, and I've had some strings of days where I've felt really really great, but most days I still feel the grogginess and "slow thought" that I had pre-CPAP.

As well, I do have some issues with aerophagia, not the agonizing pain that some people have. It's really not that bad for me at all, but I do wonder if it could be disrupting my sleep without me realizing it.

I get a solid 8 hours every night, usually with no conscious wake ups and have a fairly good sleep routine I think.

Now that I've got my leaks under control and am happy with my mask, my AHI is very good, almost always under 1.
I'm wondering if there is anything else the experts can see from my charts that could be a sign of issues.
I do fundamentally accept that there might be more issues than sleep apnea at play, but I'd like to try and optimise this first

I've attached charts for the past 3 days, I make a note at the end of the day of how tired i was during the day, and I scored these days as a 3/5, 4/5, 3/5 (higher being worse Smile)


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#2
RE: joshuao CPAP Therapy Thread
A few more sleepy days later and I'm increasing my EPR to 2 in some vague hope of addressing the miniscule amount of hyponeas that are registered.
(Like I said, I am out of my diagnostic depth here Too-funny ).

I was reflecting today on the periods I did feel like my sleep was good (a month ago or so), and frustratingly it was actually in my earlier days, where I was battling leaks each night and had fairly frequent interruptions waking me up in the night, and yet somehow I was better rested than now!
Since then I've changed 2 things:
- Moved to nasal cradle mask (+  tape), this is far more comfortable for than my previous full face mask, with much easier to control leaks. I can't imagine this can be the cause of my recent fatigue but... who knows
- I increased my minimum pressure from 5 to 7. This was in an effort to reduce OA's (which were frequently around 2-3). This did indeed work, but it did cause aerophagia, which I still have some (but not serious pain) issues with to this date.
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#3
RE: joshuao CPAP Therapy Thread
After some reflection I've decided to go forth with the hypothesis that it's my aerophagia causing disruption to my sleep.
This was something I really hoped is not true, since it seems to ultimately be one of those "trade-offs" between controlling OA and reducing aerophagia, where the dice of life might end up with "You're destined to never have a great sleep!"

I slept with pressure 6-14 last night (incidentally without cervical collar, not sure if that mattered) and it made a large difference:
1. I have no aerophagia
2. I woke up multiple times in the night, including to urinate (this was a common thing before CPAP but stopped on higher pressures)
3. I slept in for 9.5 hours instead of my usual 8.
4. My AHI was ~2.6, which is higher than it ever is with minimum pressure 7.

Given that, my plan is:
1. Reduce my EPR to 0, I added it in in some hope it would control aerophagia, but I think the low pressure is doing that anyway.
2. Stick with this for 5 more days and see how I feel across those nights.
3. Bump up my minimum pressure by the smallest increment and see if I can strike a balance.

Some meandering thoughts that people may or may not have an answer to:

1. I doubt there's any studies on this, but just in forum members experience is there any connection between cervical collar and increase/decrease in aerophagia?
I wore it initially to help combat mouth leaks, but my mouth tape does that completely anyway, so now it's just a confounding variable.

2. It's at this point I'd really like an objective measurement of sleep quality. Some measurement of arousals (I assume that's the main factor?) that would pick up both "aerophagia-induced bad sleeping" and "OA induced bad sleeping".

3. I guess the autoset algorithm is fairly "dumb" if reducing the minimum pressure has such a big impact on my AHI (and sleep overall). In theory I would expect it not to get down to this sub-therapy levels of pressure once it's witnessed some events, but I guess it really is just reactive.
I'd be tempted to ditch it, but I imagine aerophagia is a function of "pressure over a certain threshold for a given time" so autoset is probably best for me.
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#4
RE: joshuao CPAP Therapy Thread
Always post an updated chart especially after you've made a pressure adjustment.

My experience with Aerophagia is to set your machine at Cpap mode starting at a lower pressure, or set it close to your median pressure reading. I would set it at 7cm. This way you control the pressure swings. It may be the higher pressure that causes you to swallow air.

Watch that for a day or two, then start moving the pressure up in small increments.  
If and when you start to feel Aerophagia, then you know at what pressure that may be happening.
OpalRose
Apnea Board Administrator
www.apneaboard.com

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#5
RE: joshuao CPAP Therapy Thread
Thanks for the advice about always attaching a chart for a pressure change, I've attached the aforementioned night's chart here.

Your idea for investigating the aerophagia sounds good, so I'll go ahead and do that.

I'll sleep tonight with a constant pressure of 7 and see how it goes with increasing the pressure after a couple of days.

Thanks!


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#6
RE: joshuao CPAP Therapy Thread
Hello, another update from me! (I am taking this very slowly to make sure I know how I feel on a given set of settings)

I incremented to 7.4, where I've been for 10~ days now, and I am still sleepy during the day, and up to 9h~ sleep each night which is very high for me.

My AHI continue to looks just fine (1.08 for this 10 day period), and aerophagia-wise I am doing pretty much fine.

Have attached the graphs, but fear there's nothing on there useful given how good the numbers are... I was really hoping if I remove the aerophagia while having the apnea under control that would be perfect for me!

In lieu of any other suggestions I'm going to up my pressure to 7.6 for 10 days and see how that goes.

Would really like to be able to actually see arousals/if I'm getting the stages I need.


PS: In this time I did buy an O2 sensor to see if maybe my oxygen levels are disasterous for some reason and maybe that's why I'm sleepy, alas,  it seems fine from the numbers as well.


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#7
RE: joshuao CPAP Therapy Thread
Little update of my journey here, my issue remains my residual daytime sleepiness despite good AHI numbers.

Increasing Pressure

I increased my pressure to 7.6cm H2O, and that seems to be the tipping point, I toughed it out for 5 days, but experienced quite painful aerophagia each night, definitely not restful nights for me. (chart attached)

7.4cm H2O still left me sleepy during the day (though again, I am not 100% sure the OSA is the problem since it's hard to isolate)

Sleep Tracking

I did buy an Apple Watch since it's sleep tracking algorithm is apparently pretty good.
I'm having less deep sleep than an average person, but not massively so, and plenty of REM.
I don't think trying to track sleep stages like this has been fruitful really, there's nothing so obvious as to be a red flag.

Future Plans
Well, I am not really sure where to go from here.

- If my poor sleep really is caused by my residual AHI, then I suppose I need to find a way to tackle that while handling the aerophagia.
  I have tried out some of the tricks to reduce aerophagia, with middling success, but I didn't try them out systematically so there could still be some gains there to be had.

- If my poor sleep is some other "PAP therapy induced arousals" (whether that's general disturbance from the pressure, or aerophagia specifically), then I really have no idea how to identify that without an actual EEG (if that can even track such disturbance).

- If my poor sleep is completely unrelated to the PAP therapy, and actually I just happened to have both OSA /and/ another sleep issue, then that is going to be quite difficult to untangle!


My concrete next step is: return to a full face mask, ditch the mouth tape, and head back to my original setting of 5-20cm H2O.
This was my very first setup, and I had lots of issues with leaks and general discomfort, but I /think/ I was sleeping better actually!
I want to validate that memory (since maybe I was just in my post-treatment high of not feeling truly terrible all day)

Any ideas are welcome though!


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#8
RE: joshuao CPAP Therapy Thread
@joshuao

When you had your sleep study done was there any significant periodic limb movements? There should be a PLM index a little further in on the results page.

A PLMI of more than 5 and less than 25 is considered mild, >25 and <50 is considered moderate, and >50 is severe.

PLMD can be why a person is still tired even after getting PAP therapy dialed with low AHI.
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#9
RE: joshuao CPAP Therapy Thread
Hi @Sleepy Quixote .
Alas, I checked my sleep study and there's no sign of any measurement of that for me.
At least anecdotally I don't think I'm much of a restless sleeper.
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#10
RE: joshuao CPAP Therapy Thread

A small "fun" update here. Mostly just for interests sake rather than being particularly useful for my issue!

Figuring that aerophagia is probably my main enemy causing my poor sleep, I thought "Why not try sleeping on my back since it might be better for aerophagia".

The result was the highest AHI I've ever seen (35~ for the period I was on my back)! Far worse than even my supine score (19) in my sleep study, which is odd.

Also fun was: I could see it quite clearly on my sleep tracking from my watch, I simply got 0 REM or deep sleep until I moved to my side at around midnight.


For your interest (again, this result isn't really relevant to my issues, just fun), attached are a chart of this disaster night, and a hypnogram of a usual night, and this night.

Needless to say, I won't be sleeping on my back again!


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