Used CPAP for 1 month, results unchanged and tired

[axesnipas]

So... I'm frustrated and I'm confused. Maybe you folks can give me some insights.

I was diagnosed with OSA based on a score of 6 apnea/hypopnea events per hour during a sleep study, with an O2 rating of 82%. I'm also exhausted and unrested after virtually every night's sleep. That's gone on for at least a year.

I finally received my CPAP on Aug 26th and have used it diligently. I was told my insurance would only cover it if I did at least 4 hours per night and I've met that nearly every night. Often I keep it on for 6-7 hours (average is 4.9 hours). I need my sleep problem solved, so I'm doing my very best. My setting is 11cm H2O.

I'm tracking my mask fit percentage, my time and my AHI events on the vendor web site (http://www.sleepmapper.com) and my phone. In general, my AHI events are all over the place, but often they are higher with the CPAP than they were during the intial test / diagnosis. My 14 day average is 5.9, with some scores in the 9 & 10 range. The coordinator at the sleep center I'm working with claims I shouldn't worry about that. I also am not well rested, so I don't feel like the CPAP is helping me either. Early on I had trouble with mask fit and leaks, but after shaving off my goatee my mask fits are consistently above 95%.

Question 1: why are my AHI scores unchanged or even up, even with 100% fit?

Question 2: why am I still exhausted if the CPAP is supposed to help me sleep better?

Question 3: if I move from my back at all, for example to my side, the mask slips and begins to leak excessively (enough that I feel it on my eyes and hear it).

Last night I used a prescribed oxygen sensor to check my O2 levels. That will be turned in today to the doctor for analysis.

Sorry for the wall of text but I would really like to get this working for me.

[49er]

Hi axesnipas,

Welcome to the forum.

If you could use the links in my signature to register your equipment, download sleepy head software (alot more helpful than sleepmapper software) and post screen shots, members with expertise can help you analyze your data and optimize your setting to get you on the road to feeling better. Unfortunately, many sleep professionals are clueless about these issues and it sounds like the coordinator may be one of those folks.

Hang in there and don't give up.

49er

So... I'm frustrated and I'm confused. Maybe you folks can give me some insights.

I was diagnosed with OSA based on a score of 6 apnea/hypopnea events per hour during a sleep study, with an O2 rating of 82%. I'm also exhausted and unrested after virtually every night's sleep. That's gone on for at least a year.

I finally received my CPAP on Aug 26th and have used it diligently. I was told my insurance would only cover it if I did at least 4 hours per night and I've met that nearly every night. Often I keep it on for 6-7 hours (average is 4.9 hours). I need my sleep problem solved, so I'm doing my very best. My setting is 11cm H2O.

I'm tracking my mask fit percentage, my time and my AHI events on the vendor web site (http://www.sleepmapper.com) and my phone. In general, my AHI events are all over the place, but often they are higher with the CPAP than they were during the intial test / diagnosis. My 14 day average is 5.9, with some scores in the 9 & 10 range. The coordinator at the sleep center I'm working with claims I shouldn't worry about that. I also am not well rested, so I don't feel like the CPAP is helping me either. Early on I had trouble with mask fit and leaks, but after shaving off my goatee my mask fits are consistently above 95%.

Question 1: why are my AHI scores unchanged or even up, even with 100% fit?

Question 2: why am I still exhausted if the CPAP is supposed to help me sleep better?

Question 3: if I move from my back at all, for example to my side, the mask slips and begins to leak excessively (enough that I feel it on my eyes and hear it).

Last night I used a prescribed oxygen sensor to check my O2 levels. That will be turned in today to the doctor for analysis.

Sorry for the wall of text but I would really like to get this working for me.

[Julie]

Two things - one is that you might want to look into something like a PapPillow.com - it has cutouts for masks when you side sleep, which is much preferable anyway because back sleeping provokes more events. Second, the business about 'compliance' is strictly to show your insce. co that you're using the machine (so therefore they should keep paying for it), but the fact is that you have OSA and need to be treated, insurance or not, so make a point of using the machine every single time you sleep, including naps. The more you use it (or the more you don't sleep without it) the better off you'll be and hopefully feel better. Taking it off once compliance time is reached is counterproductive to your getting better.

[Wulfman...]

It can take MONTHS of good and sufficient therapeutic sleep before any "recovery" could be noticed. ( quality and quantity )
It doesn't happen in a night or a month.
This has been developing for many years and won't disappear until you pay off your sleep debt.
And, the therapy needs to be optimized before that clock/calendar starts. Lousy therapy doesn't contribute to good results.

From all that I've read on here, "Sleepmapper" isn't all that great to see results.

Get "Sleepyhead" software and see if there's a difference. There will probably be more details.


Den

.

[PoolQ]

We really need to know what equipment you use. There are many CPAP machines and TONS of masks.
There are therapy settings that can be changed and also comfort settings that let you sleep while using the machine. If you are not comfortable you will not sleep well.

[Chevie]

a score of 6 apnea/hypopnea events per hour during a sleep study, with an O2 rating of 82%

I never heard of anyone with an AHI that low having such low desats.

What other health problems do you have going on?

[ChicagoGranny]

I never heard of anyone with an AHI that low having such low desats.

It does seem like it would take some long apneas or clusters of apneas to get to 82%.

why am I still exhausted

What caused you to seek a sleep study in the first place?

How are you doing vis-à-vis these points ->

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps.
- Practice total abstinence of caffeine including sources like chocolate
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Optimize emotional stress in your life
- Use CPAP software to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular wellness visits to confirm there are no other medical problems.

[kteague]

Just want to co-sign you accessing your machine data for evaluation here. It could hold clues to any therapy issues. Also, do you have a copy of your detailed sleep study report? If not, get a copy. There may be clues in there too. Getting your mask to fit properly is a priority. As far as your oxygen study, if it shows any irregularities I would want it compared to the machine data to see if any drops were in conjunction with apnea events or large leaks, or if there's an unrelated issue. Sounds like you are on the brink of finding and addressing your problems. Hang in there and keeps pushing forward. It may be a very small change could turn things around for you.

[axesnipas]

Wow! I didn't expect so many responses and such detail. Let me try to summarize:

1. Equipment: mask = ResMed AirFit F10 (size Medium); CPAP = Phillips Respironix REMstar Pro 460P with humidifier

2. Sleephead: I'll work on that

3. PapPillow.com: thanks!

4. Other health problems: depression (treated by Brintellix), high blood pressure (treated), overweight (217 currently, should be around 185 - working on it)

5. Purpose of original sleep study: extreme fatigue (complete lack of energy and concentration), sleepiness, not waking rested, snoring.

6. Sleep habits: decent diet, decent exercise, no naps, virtually no caffeine, medication is Brintellix & blood pressure, plus Vitamin D supplement, emotional stress is fairly high, good therapy is why I'm here.

7. What does "good fit" mean? Until I get Sleepyhead, all I have is Sleepmapper and that tells me percentages. So is 80% good? 90%? I'm not even sure what target I'm supposed to be shooting at there.

8. Some results of the Pulse Oximetry report: Time <= 88% was 51.2 minutes; Time <+ 89% was 179.5 minutes; High SpO2 = 98%; Low SpO2 = 77%; Basal SpO2 = 89.7%; Awake SpO2 = 91% High Pulse = 101 / Low Pulse = 56bpm; Total Desaturation Events = 209, Average Events per Hour = 29. I wore the O2 sensor from 10pm until 5am but wore the CPAP from 10pm until 1:30am.

Thanks all! What an amazing resources you folks are.

[Julie]

Hi - have you tried any other masks? There are so many (see Cpap.com) and you may find others that work better for you, esp. if you try them on lying down as your face changes a lot then. Also, very many people find their BP comes down on Cpap (if effective), and you should get rechecked as the meds might be interfering with good therapy - at least you might be able to lower the dosage. You can download SleepyHead free from here or elsewhere, and it'll tell us so much more than you have available to you now... read the 1st Announcement on the main pg here, it'll tell you how to link downloads of SH graphs, etc. to this thread.

[Pugsy]

Brintellix is in the SSRI family of drugs used to treat depression.
You might want to dig deep into its potential side effects and also research SSRI meds and their impact on sleep as pretty much all SSRIs can mess with sleep architecture and anything that messes with sleep architecture can mess with how we feel during the day.

http://www.webmd.com/drugs/2/drug-16518 ... de-effects

https://en.wikipedia.org/wiki/Vortioxetine

Not saying that all your problems are related to the med but it might be a partial culprit in your unwanted daytime symptoms.

Also research whatever you are taking for your blood pressure as fatigue is often a common side effect with a lot of blood pressure meds.

7. What does "good fit" mean? Until I get Sleepyhead, all I have is Sleepmapper and that tells me percentages. So is 80% good? 90%? I'm not even sure what target I'm supposed to be shooting at there.

When using SleepMapper 100% means that for 100% of the night you didn't have any leaks that went into large leak territory.
If you see a 90%...that means for 10% of the night you had leaks that went into large leak territory.
Large leak territory at your pressure with your mask and machine is probably up between 80 -90 L/min.

[ChicagoGranny]

Purpose of original sleep study: extreme fatigue (complete lack of energy and concentration), sleepiness, not waking rested, snoring.

Now certainly all of these conditions could be caused, and are likely to have been caused, by sleep disordered breathing (SDB). And there are many, many cases of

medication is Brintellix

doctors mistaking SDB for depression/anxiety caused by a chemical imbalance ( ) in the brain that requires a drug to correct ( ) that chemical imbalance.

As you get your CPAP therapy to working well, it would be prudent to talk to your doctor about gradually tapering off this nasty drug.

Good luck,

[Captain Neon]

I went from 82 AHI to 30 AHI my first night with APAP and thought that I had slept for a week. My brain went into overdrive for two weeks after not having REM sleep for years. An excellent night for me is any that are < 3 AHI.

Oh to be only 217# again... Any chart that calls me obese for > 200# is no chart for me. Until I broke the 200# mark, I always had to rise slowly otherwise I would get dizzy. I was a long distance runner and lifted weights until I tore up some muscles in my leg in college. I dropped to 160# after working two jobs all summer (bicycle courier by day and packing house at night), I probably consumed > 6000 calories every day and still lost weight with all of my activity. When I came back to school in September, people asked me if I had just gotten out of the hospital because I was so skinny.