any ideas on why I don't feel better with cpap?

[sleepseeker]

Hello all--I am looking for any suggestions on how to improve my cpap. I have daytime sleepiness, chronic sinus drainage, noctuira and tinnitus. I did a sleep study. Came back with AHI of 5.0 (19 obstructive, 1 central, 8 hypopneas during 5 hours of sleep). I had 66 arousals (9 from apneas/hypopneas and 57 spontaneous) for an arousal index of 13.3. I am using a Respironics Remstar Auto System One with a Resmed Quattro full face mask. I have tried nasal masks also. I am using CPAP pressure of 8.5. I have tried the A-flex as well as different pressure settings. Humidity is set at 3. I still wake up tired and wonder what I am doing wrong. Thanks for any help or suggestions you may have!

[Alshain]

Well, your not alone. I've been trying to figure out the same thing. So far I've been told I have to have patience and it can take a while to start working, but unfortunately that isn't my strong suit. The people here seem to know their stuff, so hopefully someone can help you out.

I will say, start by figuring out the forum features and add your machine like I have in my sig, this will help those who can help you, help you faster.

[Pugsy]

First we need to make sure that therapy is optimal...at least on paper..using software.
viewtopic.php?f=1&t=64906&st=0&sk=t&sd=a

Then start looking at the any number of issues that impact how we feel.
Xpap can only help with OSA issues.
Example..It won't help with my arthritis which wakes me up every time I turn over in bed.

Other causes for feeling like crap..here are some, there are many more.
Hours of sleep.
Fragmented sleep.
Bed comfort.
Meds.
Other general health issues.
Overall sleep hygiene.
Pain.
Other sleep disorders besides OSA.
etc

And yes it does take some people a long time to see any marked improvement despite good numbers on the report.
Those that see marked improvement in a short time are lucky and probably in the minority. I turn pea green with envy when I read about them.

[Gerald]

You must answer your own question....with charts and graphs generated by your own reporting software.

you must take charge of your own therapy by using good common sense....and the same tools that many of us use.

if you have no software that reports on your progress every night, you'll continue your poor results. You don't know what to change unless you have tools to measure it.

In my opinion, you need to keep your AHI under 2.5 every night......and you need to keep your O2 blood saturation levels at or above 93% all night...every night.

If you don't understand the above, get busy on a crash course by clicking on the yellow light bulb at the top of the page. Go after the knowledge like a pit-bull goes after a cat...and you'll find success. Buy the necessary tools...software....an oximeter....a CPAP machine that's full data capable (not the junk equipment that DME's palm off on the unsuspecting).

if you follow my suggestions, a whole new world will open up for you. You'll succeed...you'll learn to love your equipment...and you'll achieve great sleep.

Go for it!

G

[Goofproof]

I will say, start by figuring out the forum features and add your machine like I have in my sig, this will help those who can help you, help you faster.

Great idea, but please use TEXT not ICONNY,to idenify your equiptment, in this case a picture isn't worth 1,000 words. the pen is mightier than the ICONNY. Jim

Having the software is a must to getting the treatment tuned up.

[sleepseeker]

Thanks everyone for your responses. Based on your input I have just ordered the Encore software. I have a couple of questions. 1) Is a full face mask best for someone who has sinus issues? 2) Even though my AHI is on the low side (5.0), could the number of arousals that I have (arousal index of 13.3) account for my sleepiness? 3)And if I understand it correctly, would it be better for me to use a constant PAP pressure instead of a Flex setting because most of my arousals fall outside of apnea/hypopnea window and would not be corrected by my CPAP machine while in Auto? Thanks in advance for any advice.

sleepseeker

[Pugsy]

1) Is a full face mask best for someone who has sinus issues?

How bad are the sinus issues? Do you often have difficulty breathing through your nose? Mouth dry or sore throat in AM? If yes, full face might be better choice. With the software watch for big leaks. It will give you a better idea just how significant mouth breathing leaks might be.

2) Even though my AHI is on the low side (5.0), could the number of arousals that I have (arousal index of 13.3) account for my sleepiness?

Yes. Anything that fragments sleep can possibly impact how we feel because it can break the normal sleep cycle needed for full restorative sleep.

3)And if I understand it correctly, would it be better for me to use a constant PAP pressure instead of a Flex setting because most of my arousals fall outside of apnea/hypopnea window and would not be corrected by my CPAP machine while in Auto?

It is possible that pressure variations during auto mode cause sleep disruptions themselves. Depends on the person's sensitivity and the pressures. I often go from my 10 minimum to 18 and never know it. Someone else might go from 10 to 12 and be horribly awakened by the change.
It is possible that something else is causing the arousals. Sometimes it takes a bit of detective work to sort things out. When making changes don't be too quick to change again as we don't sleep the same every night and try to limit changes to a single change.

[CatherineF]

Maybe you don't feel better because you have UARS! You've got many arousals, resulting in fragmented sleep. Your pressure may be too low to cure UARS component of your SDB. What is more autocpap (if you use automode) is more harmful to people with UARS than helpful (Pugsy is right here), it also irritates nervous system more. Simple CPAP with c-flex on higher pressure can help you feel better. It is my personal opinion, no one has to listen to it, I am taking my issues into my own hands because most doctors know nothing about UARS! Btw

I have daytime sleepiness, chronic sinus drainage, noctuira and tinnitus.

those are all symtoms of UARS, nycturia can be a result of overreactive nervous system, not only high BP (sometimes I do have nycturia although I have very low blood pressure).

[Slartybartfast]

If that's the case, that you DO have UARS, then that's a condition that a Resmed Autoset might treat better. Resmed goes on and on about their ability to respond to flow limitations, as evidenced by the "flat-topping" of the flow-time profile that you can see with the software. Most machines will respond to snores and apneas and raise the pressure just high enough for them to cease, but that can still leave one with silent inspiratory flow limitations that fall just short of snoring, which can nevertheless disturb your sleep. I think only the S9 Autoset responds to inspiratory flow limitations.

You can read about it here: http://www.sleepguide.com/profiles/blog ... ent-of-the

[archangle]

Don't put too much faith in auto pressure. I find I feel better if I set my minimum pressure a little bit above where my machine sets me on auto.

[sleepseeker]

Thanks everyone for all the good info. I will continue to try different settings on my machine. My new software should be here soon. Also, I made an appointment with Dr. Park to consider surgical options.

sleepseeker

[gpap]

I didn't think I was feeling any better until I had to spend a week without my cpap.... By the end of the week I was a shambling mess.

I still have EDS and am taking nuvigil for it. It doesn't make me wired, but helps not falling asleep.

[robysue]

Most machines will respond to snores and apneas and raise the pressure just high enough for them to cease, but that can still leave one with silent inspiratory flow limitations that fall just short of snoring, which can nevertheless disturb your sleep. I think only the S9 Autoset responds to inspiratory flow limitations.

You can read about it here: http://www.sleepguide.com/profiles/blog ... ent-of-the

The Phillips Resprionics System One Auto also responds to flow limitations---at least according to PR's PR: The flow limitation stuff is at http://sleepapnea.respironics.com/techn ... ation.aspx, and a complete description of the PR System One Auto algorithm starts at: http://sleepapnea.respironics.com/techn ... rithm.aspx

Now, whether the PR System One is as aggressive in responding to flow limitations as the S9 is a whole different can o' worms.