First Sleepyhead Data - Please Help

[IronSooner]

So, I finally got a chance to plug in my USB off of my CPAP and get my numbers. I have been using the machine for about 2 weeks, and honestly feel at least as bad as I did before I started using it. I use the mask fine (I have a full face mask because I am a mouth breather). I wish I was starting to feel better, but the truth is that I am just as sleepy thoughout the day (possibly worse), and am not sure the mask is helping. At a min, I think something else is a problem. Here are my numbers. Can anyone spot a problem? Thanks.

30 day numbers (actually just two weeks):

Hours per night: 8.01
AHI: 2.7
Obstructive Apnea Index: .11
Hypopnea Index: 2.59
Flow Limit Index: .48
Average Leak Rate: .42
90% Leak rate: 2
% of time above leak limit threashold: 0
Average Pressure: 7.39
Min Pressure: 7
Max Pressure: 12.5
90% Pressure: 8.5

Machine: FP Icon
Mask: Air Fit F10

Thanks so much!

[Pugsy]

Nothing stands out on that data that you've shown as needing a bunch of work.

How's your general sleep quality? Do you find yourself waking often during the night? Have trouble getting to sleep or staying asleep?
Do you take any meds of any kind? If so, what?

[IronSooner]

I dont take any meds (drink about twice per month, but thats it). However, I do wake up several times per night. I thought the CPAP machine would stop that? Most times, when I wake up, I dont get up. I just wake up for a minute or two, but its enough that I remember waking up the next morning. That probably happens four or five times per night. Once or twice per night, I wake up enough to go to the bathroom. So, I probably wake up around five or six times per night, that I remember. When I use a movement app for sleeping on my phone, it shows me moving in the bed about once per hour. I really thought the CPAP would fix that, but maybe not?

Thanks again for the help!

[IronSooner]

Prob should note that on a scale of 1-10 in tiredness, with 1 being the most awake I have ever been, and 10 being can't remember the last time I slept, I'm about an 8-8.5. My eyelids hurt because I am so tired (literally), but when I wake up each morning, I am just as tired or moreso than when I went to bed. It's very frustrating.

[sc0ttt]

What did your sleep test say?

[Pugsy]

What was your AHI prior to beginning cpap therapy? Do you know? How low did your oxygen level go?
If you don't have a copy of your sleep study telling you this information and more...get it.
Did you have a home sleep study or in lab? Did you have an in lab sleep study titration where they put you on the machine to find the right pressure.

Waking up during the night isn't always caused by sleep apnea...it's called bad sleep and the machine can't fix bad sleep if the bad sleep is caused by something that is unrelated to the sleep apnea itself. People often expect/hope/wish that the cpap machine will fix the bad sleep but sometimes it can't.

What we do is try to maximize what he can and improve on anything that we can improve upon in hopes that we improve how we feel.

Fatigue...common complaint.
Lots of potential causes for fatigue besides sleep apnea...so make sure you go through the least of other known culprits.
OSA isn't the only cause out there.

Waking up during the night...that's actually normal...some of the awakenings we remember and some we don't. We do try to limit the number whenever we can because it messes with the normal sleep cycle. 5 or 6 times that you remember probably points to more times that you wake up and don't remember. Figuring out what is causing them and fixing the problem can be difficult though.
If the wake ups are related to apnea events then we hope that effective cpap therapy will reduce the wake ups.

On your daily graphs...while your AHI is acceptable are you seeing any clustering of apnea events? We can't tell about clusters when just looking at overall stats. It wouldn't be impossible for a person to have a few clusters of events which could impact how a person feels but still have a nice low AHI because other parts of the night are apnea free.
The 2 most common causes for any clustering of events are supine sleeping or REM stage sleep where the pressure is not quite sufficient to prevent the apneas from happening.
So look for clusters on the daily detailed reports.

Another cause of awakenings during the night is sometimes left over side effects from meds...and that's why I asked that question. If you aren't taking any meds then we rule out that potential suspect.

Google Sleep maintenance insomnia...that's where a person wakes up often or more than they would like and also google good/bad sleep hygiene to see if there's anything bad you are doing that might be a potential factor.
Often it isn't any one single thing but instead a combination of things.

Talk to your doctor about the inability to stay asleep...see if he has any ideas that might help. Maybe a short term trial of some meds would be worth talking about.
The reason I mention this is that I also have a problem with sleep maintenance insomnia but I have a known reason for it.
Pain...If I move it hurts and I wake up...if I don't move it hurts and I wake up. My doctor and I have come up with a little bit of meds to help with the pain on one side and help be sleep a little deeper too...so it lessens the frequent wake ups. I still wake up probably a dozen times a night for brief periods but that's hugely better than 50 or 60 wake ups without the meds.
My OSA is very well treated but it doesn't help the pain (long story which I won't go into now) so while the wake ups from sleep apnea are pretty much eliminated I have other issues that present a problem.

If you haven't had a comprehensive physical in a while...get one and make sure you get not only the usual labs but include vitamin D, thyroid and hormone levels...especially if you are a guy...testosterone.

Finally...sometimes this cpap thing just takes time and a month really isn't very long in the grand scheme of things. Since we don't have a choice except to keep using it even though we aren't seeing the results we want we continue to use the cpap and while using it make use of that time to check out every other known culprit that might be part of the unwanted symptoms we are having. Sometimes the improvements are very gradual and it takes months to really notice much benefit.
I know we read about people having the overnight miracle but those people are really just very lucky and in a very small minority. Most of us haven't even come close to the overnight miracle.

You know I thought for sure that I would be one of those lucky people who found that cpap therapy made me into a new woman...boy did I ever get a rude surprise. I thought...I am educated about this stuff...willing and able to do it...no problems with sleeping with a mask and a hurricane blowing up my nose...this is going to be a walk in the park because I know I have the right attitude to make it work....it wasn't that way.

The 2 main symptoms I saw leave that can be directly attributed to sleep apnea was the killer morning headaches and the getting up to pee every hour on the hour (and with a painfully full bladder each time)...that was the sum total of the miracle that I saw and it took about 2 months to get that. The fatigue and poor sleep quality...gradually improved...about 6 months into therapy I decided that cpap wasn't helping the pain wake ups so we decided to work on that aspect.
It took quite some time to optimize the pain control..meds, new bed, better sleep hygiene was all involved.

Oh...one other thing that might be a factor in sleep quality and the wake ups...now while I sleep through some massive pressure changes myself not everyone is so lucky. It looks like you are using apap mode with auto adjusting pressures from the stats. If that's the case it wouldn't be impossible for the pressure changes themselves to be a factor in disturbing your sleep.
Some people are just super sensitive to the least little change in things.

You are using the F & P Icon? Sensawake may be also a factor...sometimes that drop in pressure when the machine thinks you are awake can be a disturbing factor.

Couple of things to maybe consider trying at some point...if you are using SensaAwake...turn it off.
Also while it doesn't look like your apap range is huge and there doesn't appear to be wild swings...maybe run either cpap mode for a couple of weeks or really tighten up the apap range so that any pressure variations which might be a factor in sleep quality are removed. Some people are really sensitive to the least little change in anything and you might be one of those people. Sometimes small changes make a bigger impact than people think...and also small things can be big problems too.

Looks like I wrote a book again...hope I didn't confuse you too much. Try to answer those few questions above as the answers may give us more ideas to help you.

Oh..one more question...the wake ups...any idea why?....do you have issues with pain, arthritis, or other health problems?

[IronSooner]

I didnt get a sleep test this time. I had a cpap before, but had a weight loss surgery, and lost enough weight that the dr said I didnt need the machine anymore. Well, I gained about 25 lbs back, and began having serious tiredness issues. I went back to the sleep dr, and he gave me an auto cpap. I am beginning to think that not getting a sleep study was a mistake.

I have had two sleep studies, but the last one was over two years ago.

[Pugsy]

Gottcha...no recent sleep study.

Any clustering of those events?

[IronSooner]

Great stuff pugsy! Thanks so much! I'll try to answer what I can here on my phone, won't have computer again until the morning. First, I do have clusters. Could be a factor. I dont have any other predisposed conditions, but need a physical to make sure. I have suspected poor diet, too much carbs, etc. as a possible problem. Also, my prior sleep studies were in lab. Dr says he doesn't have the results anymore, as they are purged after two years. I think I'm gonna go get another one if I dont see improvement soon. I think I do have other "bad sleep" problems. Also, I dont use sense awake. Seemed like an odd feature so I turned it off. I am using auto on my machine for now.

[Pugsy]

When you get a chance can you post an image of one of the detailed daily reports that shows those clusters?
If you don't know how we talk about it here. There's some examples too.
Main thing to see is the AHI graph on the left and these graphs on the right...Events, Flow rate, pressure and leak. Turn off the AHI graph as it isn't needed so the leak graph will come into view. Preferences/graphs tab and remove the check mark.
For now...don't want or need to see the other graphs. You can resize the graphs for easier viewing. 4 graphs is plenty small enough.
Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779

[IronSooner]

This was two nights ago, and was probably one of the worst nights of "sleep" I have ever had. Last night was not good either, but I havent been able to upload any of that data yet. Do you see anything that stands out here? Thanks again!!

[IronSooner]

One question I just thought of: It is okay to breath through your mouth (or back and forth, mouth and nose) if you have a full face mask, correct?

[palerider]

One question I just thought of: It is okay to breath through your mouth (or back and forth, mouth and nose) if you have a full face mask, correct?

sure, other than drying your mouth out, it's fine.

[Pugsy]

That night is a bit ugly at times. The very first cluster the pressure went way up there...so the pressure change may have woke you up...or the ugly cluster could have woke you up.

That first hour or so though was the only really high jump in pressure on this night though. Odd that it climb back up so quickly after that first wake up unless you went immediately to sleep. The pressure line shouldn't increase like that while you are awake.
It's supposed to increase only for the response to the airway tissues collapsing and they don't/can't really collapse while a person is awake.

Now I don't know that the clusters are your problem....but they might be or they might be a factor and they would be worth trying to break them up a little more to see if it helps or not.
That's easy to do with just a little more minimum pressure. A little higher starting pressure does a better job of holding the airway open so that the airway tissues don't collapse as easily. Gives the machine a better head start.
Maybe just as little as a 1 cm increase in that minimum pressure would reduce those events and break up the clusters.
You are already starting out with a very low pressure...wouldn't hurt to try a little higher starting minimum. Might help and worth a try.

The 2 most common causes of needing more pressure (like for those clusters) are supine sleeping and REM sleep.
REM doesn't normally start so soon though...usually first REM is about 90 minutes after sleep onset so I doubt REM was involved with the first pressure increases but might be part of the reason for the clusters later on during the night.

One thing you might do if you have the presence of mind to do ....when you wake up during the night reach over and turn the machine off and right back on again. That way it will show up on the reports and you can get an idea if something is going on at the time period right before the wake up...like a cluster or a pressure change. Turning it off and then right back on again will give us a little break in that therapy flow rate line so we can know you woke up even if you don't get up.

[IronSooner]

I can certainly try to do that (turn the machine off and on when I wake up).

Do you know how to increase the min pressure on this machine? What number should I set it at?

Is there a possibility that this machine is not working properly?