Tired of being tired

[Pugsy]

Couple of things come to mind when I see your reports.
Leak line is obvious...kinda ugly for parts of the night and for other parts of the night while technically under the 24 L/min red line, it is still pretty ragged and points to lots of leaks even though not all go into large leak territory.
The other thing is the rather short hours of sleep on the reports.
Even under optimal conditions (minimal leaks etc) short hours of sleep is going to impact how a person feels the next day. I personally think that a person likely needs at least 7 hours of good quality sleep to have a decent chance of feeling better the next day. I know some people feel great with less but I think most people will see a deterioration of how they feel with less than 6 hours of sleep.

You can see the yellow "unknown" events during large leak...so the machine is sensing the events but doesn't know what to call them and a couple of large leak times with nothing showing which might be from the leak being so large that the machine can't even sense an event. Times with that much of a leak are relatively short lived though so I don't think that the entire AHI numbers are totally off because of the machine maybe not even recording an event. If it is missing a few...it isn't a truck load.

Your leak line is pretty ragged. Do you find yourself waking often during the night for any reason...leak or whatever? How many hours of sleep is the machine showing as an overall nightly average? Is it closer to your stated 7 in that 5 to 7 hours you say or is it closer to the 5?

Fragmented sleep for any reason will sure end up with us feeling pretty yucky the next day...even with 7 or 8 hours of sleep.
If it isn't good quality sleep then no amount of hours will fix it.
If your reports were my reports...first thing would be to try to reduce the leak line raggedness and get more time under the red line. That amount of ragged leak line would most likely be waking me up and thus disturbing sleep quality.
Masks and leaks are the hardest part of this therapy.
So leak line needs to be improved upon and also hours of sleep needs to be improved upon but you gotta have good quality hours of sleep first.

My personal thoughts...your leak is likely impacting sleep quality and maybe causing fragmented sleep...and that along with short hours of sleep on the machine is probably a strong suspect for feeling yucky during the day. It probably isn't the sole reason but likely a good portion. While the AHI is probably technically under 5...it all goes back to what we say when we say "numbers aren't everything" and a nice low AHI doesn't guarantee anything. Heck, even a nice 0.0 AHI and a nice 0.0 leak and 8 hours of totally uninterrupted sleep doesn't guarantee anything either but we have to start somewhere and try to improve things.

FWIW...when I first started therapy and got my AHI well under control and my leak line was near perfect...I still felt like crap because I was waking up 20 to 30 times a night...not from sleep apnea stuff though...it was from pain. Once we figured out something to help with the back pain every time I moved in bed then I started feeling better during the day. It wasn't perfect but it was better.

So you get the standard speech we give when someone has a good AHI but still feels like crap...optimize your therapy first and that includes getting the leaks under control...and includes getting more hours of "good" sleep...then you get to work on the other possible causes of feeling like crap during the day and the list of possible culprits for that is quite long. Work on what is obvious first and then start the other detective work...meds, general health, bed comfort, hours of sleep, fragmented sleep, etc, etc.

[RogerSC]

[quote="Roxy"]I have attached some of my more recent charts. Please help
/quote]

A few thoughts. First off, you've changed masks a lot. Do you also change the mask type in your Autoset? I'd say that your most immediate problem is the mask leaks, pretty obvious, but until you get those under control I don't know how you're going to make progress. The reason that I ask about changing your mask type in your CPAP machine when you change mask types is that the machine is calibrated for different baseline leak rates for different kind of masks, and as has been mentioned, Resmed doesn't give the absolute leak rate, it gives a rate relative to its current baseline rate.

I find nasal pillows to be a lot less leaky for me, being a side sleeper (and also having facial hair *smile*). Don't know if you've tried something like the Swift LT and/or Swift FX? The Swift LT allows the tubing to be routed over your head, which works well for me when I'm sleeping on my side. IThe Aloha mask is another nasal pillow mask.

Also, with ResScan, you can change the scale on any of the graphs by using the "Tools" menu choice -> Options and then "Detailed Graph Ranges" to set the top of the range as appropriate. For example, your AHI graphs are pretty useless because they're all compressed into the bottom of the scale. I've found this to be very useful to get see what's really going on, when I customize the graph scales so that they are appropriate for the space allotted. There are lots of other things that you can do with ResScan as well, like changing the order of the graphs so that the ones that you look at the most are on top, etc. There's a tutorial video about it around somewhere, I don't have a URL for it at the moment, but I'm sure that someone else does.

I'm certainly wishing you luck, that you find the mask and mask configuration that gets your leaks under control *smile*.

[Roxy]

All of those masks were ff masks. The cpap only has settings for ff, nasal and pillows not for a specific mask. When I tried a nasal pillow, the air came out of my mouth even with the pap cap

I am a side sleeper

[Wulfman...]

I agree with everything Pugsy said.
In addition, the type of bed pillow you use with this therapy can make a huge difference with leakage. The typical fiberfill pillow can allow the head to sink in too deeply and push the mask out of alignment and create leaks. There are some bed pillows that just work better with this therapy. Properly sized masks are also very important. And, if they're adjusted too tight, they can leak badly, too.

Den

.

[Roxy]

I typically go to sleep at 11:00-11:30 and wake at 6:30 so I sleep for 7-7 1/2 hours. On weekends, I sleep for 8-9 hours and still feel tired. I agree that the leaks are a problem. I have tried a few different pillows and find that the pillow with hulls in it works best as I can easily rearrange the shape of the pillow. I usually wake two to three time a night but fall back asleep pretty quickly. I do have swift 11 nasal pillows and also opti life pillows at home from when my husband had tried cpap (but did not stick with it). I always considered myself a mouth breather but even with a head cold, I was able to breathe pretty well with cpap. I wonder if I may be able to use the nasal pillows with a chin strap or pap cap. Would the swift or opti life be better for a side sleeper or is it just a matter of trial and error? Would these masks work with pressures of 12-15?

It is amazing that neither the sleep doctor of respiratory therapist at the sleep center have ever looked at the detailed data, even with me requesting that they do so. I can't believe that they were so unintereste or maybe lazy that they couldn't be bothered to look further than the machine happy face mask fit and ahi!!! I think that it is time to look for a new doctor.

[Pugsy]

Would the swift or opti life be better for a side sleeper or is it just a matter of trial and error? Would these masks work with pressures of 12-15?

You could use either with those pressures. I have used nothing but nasal pillow mask and my pressures on the APAP were 10 cm starting out and I often saw up to 20 cm. From a pressure stand point there is no reason that you couldn't use a nasal pillow mask. People who use 20 cm or more are able to use a nasal pillow mask.

Your 12/31 report showed 3 breaks in the therapy line...so at least 3 wake ups that caused you to turn the machine off and then back on. I suspect that your sleep is more fragmented than you think it is.
At this point you might do better with a nasal pillow mask if you can sleep better...even with a little mouth breathing the leak might be more stable and less disturbing overall.

[Roxy]

When I wake up, I usually go to the bathroom which is why the machine is turned off briefly

[Pugsy]

When I wake up, I usually go to the bathroom which is why the machine is turned off briefly

The point is....you wake up. Fragmented sleep for any reason disrupts the normal sleep cycles that the body needs to best use the restorative powers of sleep. It doesn't matter if you wake up and just lay there till you go back to sleep (either a minute or lots of minutes) or if you get up...you have disrupted the sleep cycle progression that the body needs.
That's why I say that fragmented sleep for any reason is unwanted.

Though...one question does come to mind ...when you wake up and decide to go to the bathroom...is it because the bladder is full and thus possibly bladder discomfort that woke you up??? or is it that you wake up and decide might as well go pee since you are awake?? The reason I ask is that nocturia is a sign of untreated or less than optimal treatment of OSA. If your bladder is full with each wake up then perhaps the OSA is still a significant contributor to symptoms.

[Roxy]

I wake up and decide that I might as well pee. So I guess it is the apnea not being treated fully. I am going to try the nasal pillow tonight and see what happens. I already changed my machine settings to nasal pillows. It will be interesting to see what my graph will look like tomorrow. If only the docotr would spend half the time the people on this board spend helping!!!!