Cpap since 2016 but still tired; Plz help

Hi everyone,

I've been using a APAP since 2016 since a sleep study diagnosed me with an AHI 12. I started with a loaned S9 Autoset and bought a Airsense 10 Autoset later on. I have always used a Swift FX Nano nasal mask since then.

The APAP eliminated my morning headaches and frequent awakenings with full bladder but I still feel tired and usually need caffeine and nap to get through the day.

Could you please look at my graphs and tell me what I could try to improve my treatment?

Are my leaks acceptable? I sometimes open my mouth during the night as you can see and I seldom wake up with a somewhat dry throat. Would a full face mask improve anything or would I just suffer with an awful dry mouth?

Should I try having a septoplasty for my deviated septum? I never saw any evidence that someone's apnea had improved after septoplasty/turbinate reduction.


Things I tried:
- Mouth taping. Didn't notice a significant difference in leaks so I stopped because of the lack of results and also because I've reflux and was scared of something bad. Maybe I should try another nasal mask?
- Chin straps (the 2 generic chinese neoprene I could find here in Brazil were uncomfortable and didn't seem to do anything worthwhile)
- Naphazoline nasal drops (stopped continuous use because of the well known cardiovascular side effects)
- I'm not a good candidate for oral appliance because I have TMJ disorder (according to a dentist, one joint is bigger than the other. My jaw hurts a little every now and then but it doesn't bother me so much.)


Treatment information:
- APAP pressure: 7-12
- Tube: Slim (started trying a heated tube yesterday due to minor condensation in my mask b/c of the air conditioner)
- Humidifier level: 7
- Medications: Fluticasone furoate nasal spray (b/c of deviated septum), pantoprazole (for acid reflux)
- I am young (28) and thin


Thanks a lot everyone! I've been lurking in the forum since 2016 without posting, but all the posts I read here have been a great help in my treatment. Most doctors are often clueless about apnea treatment and most people simply don't understand our suffering from being constantly too tired to do what we want.

Hello and welcome. You mention us looking at your graphs, but I'm not seeing any images. Is that just me? While we're waiting for you and others to sort through that, can you tell us what non OSA issues your doctor has already investigated and ruled out? - Thyroid? Anemia? Vitamin D? B Vitamins? Limb Movements? Is your reflux controlled and do you sleep at a slight incline to help with that?

Good luck at sorting through things. It will be interesting to see if there are any clues in your data.

cyberdreamer wrote: ↑

Wed Jul 17, 2019 9:50 pm

Could you please look at my graphs and tell me what I could try to improve my treatment?

Yes. There is plenty of help here. Please attach the graphs in this thread and stick to this one thread until your therapy is optimized.

Welcome!

Sorry about the graphs. I was waiting for the thread to be approved to add them. Here they are.

More graphs

More

Do you take any medications of any kind? If so, what?

Some nights you have a lot of breaks in therapy? Why?

If your leak line didn't improve when taping then maybe a lot of that leak is mask movement.
Or did you mean that when you taped the leak line improved but your fatigue didn't?

Could you do last night's detailed report for me please?
Turn off the calendar on the left side...and the pie chart as well (preferences/appearances..remove check mark for show pie chart).
Omit the mask pressure graph and include the Flow Limitations graph instead.
Don't really need two pressure graphs and maybe something of interest will show up on the FL graph.

kteague wrote: ↑

Thu Jul 18, 2019 3:31 am

Hello and welcome. You mention us looking at your graphs, but I'm not seeing any images. Is that just me? While we're waiting for you and others to sort through that, can you tell us what non OSA issues your doctor has already investigated and ruled out? - Thyroid? Anemia? Vitamin D? B Vitamins? Limb Movements? Is your reflux controlled and do you sleep at a slight incline to help with that?

Good luck at sorting through things. It will be interesting to see if there are any clues in your data.

Hi, thanks for you answer. All my blood tests have been perfect so far. The GI doctor I went to last week was the first to ask for B vitamin tests and I'm waiting the result of those. I have been taking pantoprazole for the reflux for a year and I am talking with this doctor for what to do next. Hopefully, I can stop taking the medication this time. When I tried stopping the med last time, I had severe rebound reflux.

Pugsy wrote: ↑

Thu Jul 18, 2019 7:40 am

Do you take any medications of any kind? If so, what?

Some nights you have a lot of breaks in therapy? Why?

If your leak line didn't improve when taping then maybe a lot of that leak is mask movement.
Or did you mean that when you taped the leak line improved but your fatigue didn't?

Could you do last night's detailed report for me please?
Turn off the calendar on the left side...and the pie chart as well (preferences/appearances..remove check mark for show pie chart).
Omit the mask pressure graph and include the Flow Limitations graph instead.
Don't really need two pressure graphs and maybe something of interest will show up on the FL graph.

Hi!

I take Veramyst (fluticasone furoate, a steroid nasal spray) and pantoprazole (Proton Pump Inhibitor for acid reflux).

I usually wake up at least once for no apparent reason. I use the bathroom and lie down again. I also have been suffering from insomnia the past few weeks.

The leak graphs looked very similar when I tried taping a few months ago.

I attached the graph from last night. I didn't have trouble sleeping last night but I had severe condensation in the mask because the weather was a lot colder than usual. I woke up with burbling sounds in the tube and had to wipe the mask and exchange the tube. I was using a new heated tube but with tube temperature set to disabled and the usual humidity level of 7 I use with the slim tube. With the slim tube, I was always having to wipe minor condensation in the mask when I woke up during the night but the condensation wasn't enough to bother me.

P.S: I talked to an ENT today and (like the others I've been to) he recommended septoplasty with turbinate reduction and said my neck, jaw, throat, etc looks normal. He doesn't guarantee the procedure will cure apnea but that it'll defintely improve my breathing and let me stop using the steroid nasal spray every night.

If you have ugly leak lines when taping...and the tape didn't come off your lips...then the ugly leaks aren't from mouth breathing and are instead coming from the mask moving around and losing the seal.

It is possible that leaks (even small leaks) from any cause can disturb sleep. Anything that disturbs sleep quality or sleep architecture and keeps us from getting the normal progression through the sleep cycles and the needed amount of sleep in each sleep stage will certainly make us feel like crap.

Insomnia...either sleep onset insomnia (trouble falling asleep) or sleep maintenance insomnia (trouble staying asleep) messes with the sleep stages. Not an easy beast to tame.
Often medications can be a factor in making insomnia worse...I don't have time to research your meds to see if they might be a factor but they aren't well known to cause problems. Some meds I know off the top of my head if they are troublemakers or not.
Some meds are well know to cause fatigue...I don't remember if yours will do that or not.
Research your medications for known side effects and read from multiple sources and see if it is possible that your meds are contributing to fatigue or insomnia.

So you may not be feeling so great because your sleep quality isn't so great but figuring out what is causing the poor sleep quality and fixing it is easier said than done sometimes.

Finally...fatigue...long list of culprits for causing fatigue and not just meds or sleep apnea....or even related to sleep at all.
Other health conditions or bed comfort or outside factors can also play a part.

My suggestion for now....since those leaks may not be mouth breathing after all....maybe consider a new mask that is more stable and less likely to move around on the off chance that the leaks you do see happening are impacting your sleep quality. Worth considering.

cyberdreamer wrote: ↑

Wed Jul 17, 2019 9:50 pm

The APAP eliminated my morning headaches and frequent awakenings with full bladder but I still feel tired and usually need caffeine and nap to get through the day.

google "sleep hygiene" to insure that your diet and other things aren't messing with your sleep.

as to keeping lips closed without tape-

viewtopic/p1089718/viewtopic.php?f=1&t= ... s#p1086296

and try flonase for your nose. otc, it is.

good luck!

Pugsy wrote: ↑

Thu Jul 18, 2019 12:49 pm

If you have ugly leak lines when taping...and the tape didn't come off your lips...then the ugly leaks aren't from mouth breathing and are instead coming from the mask moving around and losing the seal.

It is possible that leaks (even small leaks) from any cause can disturb sleep. Anything that disturbs sleep quality or sleep architecture and keeps us from getting the normal progression through the sleep cycles and the needed amount of sleep in each sleep stage will certainly make us feel like crap.

Insomnia...either sleep onset insomnia (trouble falling asleep) or sleep maintenance insomnia (trouble staying asleep) messes with the sleep stages. Not an easy beast to tame.
Often medications can be a factor in making insomnia worse...I don't have time to research your meds to see if they might be a factor but they aren't well known to cause problems. Some meds I know off the top of my head if they are troublemakers or not.
Some meds are well know to cause fatigue...I don't remember if yours will do that or not.
Research your medications for known side effects and read from multiple sources and see if it is possible that your meds are contributing to fatigue or insomnia.

So you may not be feeling so great because your sleep quality isn't so great but figuring out what is causing the poor sleep quality and fixing it is easier said than done sometimes.

Finally...fatigue...long list of culprits for causing fatigue and not just meds or sleep apnea....or even related to sleep at all.
Other health conditions or bed comfort or outside factors can also play a part.

My suggestion for now....since those leaks may not be mouth breathing after all....maybe consider a new mask that is more stable and less likely to move around on the off chance that the leaks you do see happening are impacting your sleep quality. Worth considering.

I have slept last night with micropore tape covering my lips and the graph is attached to this post. I still had leaks, so you're probably right!! Do you have any suggestions for other masks? Do you have experience with the Dreamwear? (The first breaks in the graph before 2:30am was me researching the risks of septoplasty and turbinate surgery instead of sleeping )

I see. I'll stop all supplements and research the meds I'm taking.

I'll keep trying everything to narrow down what's causing the fatigue.

Thank you very much for your help, Pugsy and everyone else!

zonker wrote: ↑

Thu Jul 18, 2019 2:14 pm

cyberdreamer wrote: ↑

Wed Jul 17, 2019 9:50 pm

The APAP eliminated my morning headaches and frequent awakenings with full bladder but I still feel tired and usually need caffeine and nap to get through the day.

google "sleep hygiene" to insure that your diet and other things aren't messing with your sleep.

as to keeping lips closed without tape-

viewtopic/p1089718/viewtopic.php?f=1&t= ... s#p1086296

and try flonase for your nose. otc, it is.

good luck!

Thanks for the tip. The spray I'm using is very similar to Flonase and it seems to help with the congestion.

Yes, I have had some experience with the Resprionics Dreamwear masks...all the models...some more than others though.
Which model were you looking at?

I could make them all work and liked it well enough I suppose but I discovered that the smallest frame was still a bit too large for my head so there were some mask movement issues because of the overall frame size being a bit too large and allowing movement.
I could get it managed well enough with some wraps which were okay but added more "stuff" on my head which I really prefer as little "stuff" on my face and head as possible. So the DreamWear was never in the running for my primary mask....for that reason and the other reason is I prefer a diffused venting system that isn't noisy and doesn't bounce off anything to hit me in the face. While I like a fan blowing on me...I don't really like the vented air blowing in my face.

If you look at the mask I am now using (in my equipment profile which BTW maybe you could fill out yours) the Bleep mask has zero headgear so nothing on my head. All I have is a little nasal thing glued to my nose at night. About as nothing on my face and head as I could ever expect to get.

I experiment with masks just for the fun of experimenting with something new and different. That's how come I was trying the various DreamWear models. Just to learn what they were like and not so much because I was really in the market to change mask models at the time.

cyberdreamer wrote: ↑

Fri Jul 19, 2019 11:23 am

]

Thanks for the tip. The spray I'm using is very similar to Flonase and it seems to help with the congestion.