2 Weeks of Treatment (a few OSCAR charts included)

Hey all,

Two weeks ago I started treatment with BiLevel PAP. Untreated, my AHI was 94. I felt dead. I couldn't drive for more than 15 minutes at a time. I couldn't stay awake through movies, even in theaters. Waking up was nearly impossible and took at least an hour before I could manage to wake up enough to get out of bed.

Fast forward to today. I don't feel refreshed at all in the morning, but getting up isn't as hard. I still feel kind of bad in the morning. However, I am significantly less likely to fall asleep throughout the day. On Thursday, I drove 2 straight hours to a friends house. We then went out and I had a few drinks. Then we decided to go see Toy Story 4 at 11:15pm. I didn't even feel sleepy during the movie. It was awesome. I also feel pretty lucky at how well I've adapted to treatment. I've heard a ton of stories about people waking up without their mask on, large constant leak issues, general discomfort. I haven't had any issues other than my torso being really sore the first few days, I'm guessing due to my lungs expanding.

Here are some charts from the last 5 days. I don't really have any questions or concerns since I hear the morning grogginess might stick around for a while. But if you have any thoughts on the graphs, let me know. I switched to autopap after a week of the prescribed settings just to test it out. I kept the epap at the prescribed 16 and set the max ipap to 23. At some point it must have switched to 20 max ipap. I don't know how that happened. I definitely did not change it, but I might leave it as is. Looking at the charts for the 2 weeks, it was super rare that it went above 20, while set to 23 max, and it never made it to 22. Anyway, here are the charts (the 20th and 23rd might be higher since I didn't sleep in my normal bed):

Kroldor wrote: ↑

Sun Jun 23, 2019 2:47 pm

Hey all,

welcome to the zoo! and what an awesome debut. glad you are taking to it so quickly and easily.

as little as i know about apap, i know even less about bilevel. so i leave it to others to comment about that.

may you have continued good luck!

zonker wrote: ↑

Sun Jun 23, 2019 3:17 pm

Kroldor wrote: ↑

Sun Jun 23, 2019 2:47 pm

Hey all,

welcome to the zoo! and what an awesome debut. glad you are taking to it so quickly and easily.

as little as i know about apap, i know even less about bilevel. so i leave it to others to comment about that.

may you have continued good luck!

Thanks! Yeah I'm really glad to be off to a good start.

What wonderful results! As your body adapts, you are likely to notice continued improvement. It MIGHT be dramatic, but it is more likely to be gradual. You’re relearning how to sleep, and you’re doing it with weird stuff going on all night. But the weird stuff will seem less weird, your sleep architecture will rebuild, and you will get out from under your sleep deficit.

Your chest soreness is probably from your muscles, which aren’t used to working so hard to breathe. Glad they feel okay now.

A note: don't be discouraged by the occasional night of high AHI numbers... everyone has an off night now and then. Many factors affect sleep.

And congrats on starting treatment! It WILL provide you with lasting health benefits. Improvement may be gradual, but I think for many (most?) of us here, that has been the norm. A few have the 'miracle cure' response, but you have likely built up a significant sleep debt, and it will take time for your body to pay that off.

Welcome!

It looks like the nasal mask isn't sealing, or you're mouth leaking. Either way I would fix it and you may want to try a mask that covers the mouth later, if it is hard to fix. You were sleep labed on the machine and the script was min epap 16, PS4? I think the lab got it right. You could increase the PS to increase the tidal volume and decrease the breath rate a bit. You may need to also reduce the min epap with this. There are charts on the net for height and tidal volume. Put it past your doctor, you can try changing the pressure settings if you want to, you can always come back to this.

This titration guide will help
https://www.resmed.com/us/dam/documents ... er_eng.pdf

ajack wrote: ↑

Mon Jun 24, 2019 3:24 am

It looks like the nasal mask isn't sealing, or you're mouth leaking. Either way I would fix it and you may want to try a mask that covers the mouth later, if it is hard to fix. You were sleep labed on the machine and the script was min epap 16, PS4? I think the lab got it right. You could increase the PS to increase the tidal volume and decrease the breath rate a bit. You may need to also reduce the min epap with this. There are charts on the net for height and tidal volume. Put it past your doctor, you can try changing the pressure settings if you want to, you can always come back to this.

This titration guide will help
https://www.resmed.com/us/dam/documents ... er_eng.pdf

I think the lab got the settings right as well. I don't have any interest in changing the tidal volume or anything really since I'm not in any discomfort or anything. I tried like 10 different full face masks at my DME, and they all felt terrible. Unless they were super tightly strapped to my face, they kind of ballooned out with the exhale and they leaked considerable. I have a beard so that probably doesn't help. Are the leaks bad? The resmed app says they're not a problem. The big leaks are likely from times I'm waking up or taking the mask off to use the bathroom. Is the normal venting factored in there at all?

That's some high pressure! I suffer even at 12 cm... how does it feel breathing at 20?

Diotima wrote: ↑

Mon Jun 24, 2019 3:03 pm

That's some high pressure! I suffer even at 12 cm... how does it feel breathing at 20?

i know you ain't askin' me, but i'll speak up anyway!

like anything else, you can get used to it. my minimum pressure is currently 15.4. and i leave the max at 20. haven't hit 20 but will occasionally peak at around 17.

when i first started, there was now way i could EVER breathe against that pressure. four years later, voila!

Diotima wrote: ↑

Mon Jun 24, 2019 3:03 pm

That's some high pressure! I suffer even at 12 cm... how does it feel breathing at 20?

I use the ramp feature for 20 minutes so it gets to 20 after I fall asleep. It feels a little weird when I'm falling asleep, but when I wake up in the morning and it's blasting at maximum pressure, it honestly feels nice. It feels like I'm just breathing normally but better, like my airways are open more. It's probably because I adjusted to it all night while I was sleeping.

There wasn't a leak when you stopped the machine to go to the bathroom. If you did the mask fit function that blows high pressure. wriggled the mask and rolled around the bed and it didn't leak. Then it is probably mouth leak while asleep and is supported by some areas of 0.0 . I'd fix it, anything over 25 is serious, under still need sorting till its down. It's also whether it is on inhale or exhale. The flow and tidal volume chart, should give an answer.

You can read up about all the things to try and fix it. Or you can get a FFM and have a goatee and mutton chops. you won't get a seal on a beard, if it's that important, there are cpap wax products that fill the gaps between the hairs. Or use a nasal and tape up your mouth as a last resort, also one of the suggestions.

If you are happy with the settings I see no urgent need to change them or anything for that matter.
The leaks are well within the machine's ability to compensate and unless they are waking you up I wouldn't worry about them.
I wouldn't even worry about those very short periods in large leak. They aren't prolonged enough to really impact therapy all that much.
Whatever ajack told you...take it with a grain of salt. He means well but may not know nearly as much as he thinks he knows.

When you changed it to auto mode with 23 max IPAP and it magically reduced to 20....that's the DME doing the settings changes remotely.
They can do that with this machine.

Morning grogginess...do you take any medications of any kind? If so what?
About how many times do you wake during the night?
Any other health issues going on that might impact sleep quality or how well you sleep or feel during the day?

Pugsy wrote: ↑

Tue Jun 25, 2019 6:34 am

If you are happy with the settings I see no urgent need to change them or anything for that matter.
The leaks are well within the machine's ability to compensate and unless they are waking you up I wouldn't worry about them.
I wouldn't even worry about those very short periods in large leak. They aren't prolonged enough to really impact therapy all that much.
Whatever ajack told you...take it with a grain of salt. He means well but may not know nearly as much as he thinks he knows.

When you changed it to auto mode with 23 max IPAP and it magically reduced to 20....that's the DME doing the settings changes remotely.
They can do that with this machine.

Morning grogginess...do you take any medications of any kind? If so what?
About how many times do you wake during the night?
Any other health issues going on that might impact sleep quality or how well you sleep or feel during the day?

Thanks Pugsy.

I believe all the large leaks have happened after I've woken up so I'm not stressing about them. And yeah I've been surprising comfortable with the therapy.

I'm not so sure about the DME thing. It's not that I don't believe it's possible. I just don't think that's the case hear since the person who set me said she could not put it on auto mode at all due to my RX, so I imagine if they were going to change it, they would set it back to "S" mode. I also think she would have mentioned something like this when she suggested I don't change my settings. I know a lot of people have horror stories about DMEs, but mine is super nice. Maybe that's one of the benefits of living in the middle of nowhere lol. But anything is possible!

As far as the grogginess, I am wildly out of shape. I wake up maybe once a night to pee, and usually not at all. For medications, I take testosterone. That has helped with general fatigue. I've had sleep apnea for years, so I wasn't expecting a magical recovery after one night. I also need to go to bed earlier. I've only been sleeping around 6 hours a night.

You may simply need a little more than 6 hours of sleep or maybe you are like me and just not a morning person (I never have been my whole life) and it always take me a bit of time to "wake up" in the mornings.
But I know that when I get less than 7 hours of sleep....pretty much guaranteed to have my but be dragging a bit in the mornings.

The machine changing ....had to be the DME...no other way if you had it on auto showing over 20 cm a couple of times.
The reason they left it in auto mode but reduced IPAP max...that is essentially S mode with your current settings. While it is in auto mode it can't go anywhere with the current settings so it's functioning just like it was in S mode.

Give yourself some time. It may be that your body just needs more time to adjust to things. Not like you have much choice in the matter anyway....and maybe you will have some times where you get a little more sleep or better quality sleep (less wake ups from whatever) and you will be able to figure out what it is that your body needs to feel optimal.
With time and experience mask issues will hopefully lessen and be less of a factor in leaks causing wake ups.

If you are waking often during the night...even if you got 8 hours of sleep you probably wouldn't feel go great anyway.
Waking often disturbs the normal progression of all the sleep cycles so we don't get the needed amount in each cycle for the restorative powers of sleep to work their magic. Anything that wakes us up (and it doesn't have to be apnea related) often will mess with how we feel the next day. Sleep quality is critical to feeling the good numbers. I can have an AHI of 0.0 and 8 hours of sleep but if I woke multiple times during the night (and I do quite often from pain issues) I will feel like crap that day.

You are already miles ahead at 2 weeks of where I was at 2 weeks into therapy. You are doing great.

If you are of an age and gender where the prostate is a factor in nighttime wake ups to go pee...that in itself will affect your sleep quality.
So remember...every little thing that disturbs our sleep or wakes us up...is going to affect how we feel the next day.