Introduction and question second night results

Hello everyone

I spent some time reading the section for new members, lots of great info there, thanks!

My story is basically that I've been feeling tired during the daytime for many years. As a teenager, my friends would pick on me for being apathetic, and since then, symptoms just got worse up until now.
I've complained about this to every doctor I've been to, multiple times. Funny thing is they would just order blood tests and when the results wouldn't indicate any cause for sleepiness, they would just dismiss it, or say it was mild depression.

I feel some anger and sadness, because no doctor ever thought about ordering a sleep study or even suspected sleep apnea.

Some months ago, my wife filmed me during my sleep, because she was worried at my weird snoring and gasping for air. Thanks to that, I started to do some online research and self diagnosed myself with sleep apnea.

I currently live in a small town in Brazil as an expat. I actively searched for a sleep doctor and made an appointment. After telling her of my symptoms, she ordered a sleep study, already suspecting a case of sever sleep apnea.

The results showed I was having 52 apneas per hour and multiple hypopneas! I was frightened at those results, but at the same time reassured and happy I was right because it meant I could get treatment.

The doctor ordered a CPAP machine, and I went to a sleep technician from who I'm renting a machine while I'm waiting for the Resmed S9 I ordered online, because it was significantly cheaper than buying from the ST.

My symptoms are headaches, difficulty to concentrate, lack of patience, daytime sleepiness, most days I nap for 2-3 hours in the afternoon. I try to avoid driving long distances, but short ones are ok, I don't feel sleepy. My work performance is suffering and I have a review coming up. I wonder if I should mention my sleep apnea, as I suspect they will complain about my poor productivity. ( I love my job )

I've been on the CPAP for 2 nights and I do feel some improvement and I was able to keep the mask on for 6-7 hours. However I still feel tired during the day, which is expected.

I just checked my results for last night and the readings are as follow:

The machine is set on auto, from 4 - 10, the doctor had prescribed a pressure of 10.

Pressure: 9.6
Leakage: 0.30L/s
IAH: 13.5
IA : 3.3
IH: 10.2

So it's looking good, isn't it? Apneas are in the tolerable level, but the hypopneas could be improved? Any suggestions?

Thanks and looking forward to getting more involved as I continue my recovery journey.

Welcome to the forum.

Yes, the hyponeas need to be reduced in numbers.
If you are using the machine in auto adjusting pressure mode with the minimum of 4 and the maximum of 10 cm then most likely it is the minimum of 4 cm that is not quite doing the best job. If you need 10 cm of pressure the machine can't increase that 4 cm to 10 fast enough to prevent the airway collapse.
Increasing the minimum pressure to a more optimal level to give the machine a better head start holding the airway open would likely reduce the obstructive apnea and hyponea events. They would be better prevented from ever happening in the first place.

thnka Pugsy, I'll try increasing it by one or two points tonight.

PS: I feel most symptoms listed here : wiki/index.php/CPAP_Adaptation_Stages

Welcome to the forum! I am a new user too, was diagnosed on Jan. 27, got my machine and started cpapping on Feb. 3. A little over two months later, I'm still feeling tired, but I can tell that I'm getting better sleep and I'm no longer napping every day. It does take a while, sometimes months, to get used to it all, and I'm feeling less tired than I was three months ago. I do think I have a little more energy, too. So hang in there, and come back here as often as you need to for info and to ask questions. I wouldn't be where I am today if I hadn't found this forum and the many wonderful, supportive people here.

library lady wrote:Welcome to the forum! I am a new user too, was diagnosed on Jan. 27, got my machine and started cpapping on Feb. 3. A little over two months later, I'm still feeling tired, but I can tell that I'm getting better sleep and I'm no longer napping every day. It does take a while, sometimes months, to get used to it all, and I'm feeling less tired than I was three months ago. I do think I have a little more energy, too. So hang in there, and come back here as often as you need to for info and to ask questions. I wouldn't be where I am today if I hadn't found this forum and the many wonderful, supportive people here.

Hi and thank for the encouraging words! I need all the energy I can get with 2 young kids

thesleepermustawake wrote:The machine is set on auto, from 4 - 10, the doctor had prescribed a pressure of 10.

As Pugsy pointed out, the two parts of this sentence don't work properly together. Auto machines increase pressure slowly in steps following multiple untreated events. That means the machine isn't preventing events, it is reacting to past events that have already happened. This is hard for most people to understand at first, and it seems to negate the point of auto adjusting pressure.

The real value of auto machines is when someone has no idea what their needs are, or when someone has occasional nights or periods during the night where they need higher than normal pressure. In this case the machine can react by adjusting the pressure a little above normal until the unusual need passes. An auto pressure range of something like 8 to 12 would typically be much more effective than 4 to 10 for someone with a fixed pressure requirement of 10.

djhall wrote:

thesleepermustawake wrote:The machine is set on auto, from 4 - 10, the doctor had prescribed a pressure of 10.

As Pugsy pointed out, the two parts of this sentence don't work properly together. Auto machines increase pressure slowly in steps following multiple untreated events. That means the machine isn't preventing events, it is reacting to past events that have already happened. This is hard for most people to understand at first, and it seems to negate the point of auto adjusting pressure.

The real value of auto machines is when someone has no idea what their needs are, or when someone has occasional nights or periods during the night where they need higher than normal pressure. In this case the machine can react by adjusting the pressure a little above normal until the unusual need passes. An auto pressure range of something like 8 to 12 would typically be much more effective than 4 to 10 for someone with a fixed pressure requirement of 10.

Thanks djhall,

This was set by the physiotherapist who rented me the machine. She probably doesn't really know what she's doing.
I'm going to increase the max pressure up a bit to 11 or 12 tonight.

I am starting to feel my energy levels coming back so that's a good thing

Hi thesleepermustawake and welcome.

One should always take care when changing pressures. Does your machine store efficacy data for you to analyze? If not, I would only bump the lower setting 2 to 3 points and wait a week to see what happens.

While you are at it, please fill in your equipment in your profile. Even your (and especially your) rental equipment.

-tino

Tino2You wrote:Hi thesleepermustawake and welcome.

One should always take care when changing pressures. Does your machine store efficacy data for you to analyze? If not, I would only bump the lower setting 2 to 3 points and wait a week to see what happens.

While you are at it, please fill in your equipment in your profile. Even your (and especially your) rental equipment.

-tino

I found it in the menu but it says "no data", maybe it's disabled in the clinical settings?

I'm now at min 7 and max 11.4

I swapped to using the large size nasal pillow, which is more comfortable but I had more leakage, even though the results reported very low leakage??

Pressure was 10.2
IAH was 15 with IA at 3 and IH at 12 ( more or less )
The night was a bit worse than the previous even though I managed to keep the mask on from about 9.30pm to 6am this morning. Nose was a bit sore when I took of the mask.
I didn't wake up feeling rested, still feeling "foggy"

thesleepermustawake wrote:I didn't wake up feeling rested, still feeling "foggy"

With AHI still of 15 I wouldn't expect you to feel any different.
Even with AHI less than 5.0 we often don't feel the good numbers. You don't even have good numbers yet to stand much of a chance of feeling better.

There's so much more to feeling better than just AHI or slapping the mask on.
Frequent wake ups for whatever reason...mask leaks or whatever.
Mask leaks...even tiny leaks which may not show up as anything all that exciting on the software reports can be a problem if the leaks cause a lot of wake ups.

It will be good when you can get the S9 and be able to use the software to see in more detail what is going on during the night.
I suspect your minimum pressure is going to have to be in the 8 to 9 to 10 cm range before we start seeing much of a reduction in that AHI.

I forgot to ask...are you using EPR? If so, at what setting? EPR reduction during exhale can also impact the therapy pressure effectiveness.

Pugsy wrote:

thesleepermustawake wrote:I didn't wake up feeling rested, still feeling "foggy"

I forgot to ask...are you using EPR? If so, at what setting? EPR reduction during exhale can also impact the therapy pressure effectiveness.

Yes it's set to 3

With EPR set to 3 then when you exhale your pressure drops by up to 3 cm...it can't ever go below 4 cm so when using 6 cm minimum it will drop to 4 cm...when using 7 cm it drops to 4 and with 8 cm it drops to 5 cm...and so on.
That drop in exhale is enough that there is a chance that the airway will collapse during exhale...so when using EPR often people have to increase the minimum pressure a little more to compensate for that drop.

So if you want to keep EPR...might need more minimum pressure...or you might try reducing EPR if you are comfortable with a reduction or even turn it off.

ah, ok. I'll try turning it off tonight It was set by the technician