Sleepy and tired

[Cantgettosleep]

I've been worse, I changed my mask last Saturday to a respironics Amara view, and got better. I was using a nasal mask and using chin straps, mouth tape, super glue on the lips. The new mask made some real difference.

But as for today, I woke up sleepy. After lunch, praying for nap and tired (I'm retired).

My machine is an old s8 compact, I set it with 11, due some sleepy study many years ago, and confirmed by a S9 autoset that I used until may last year, that gave up to ghosts.

Due to my sleepiness and fatigue, I could manage to buy a S10 autoset, used, with 2 years used by the previous owner. It is still on its way, maybe one more week to arrive.

I have a neurological condition, Normal pressure hydrochefalus, and made an implant of a valve 2 years ago. I got many problems after this surgery, my neurosurgeon had diffucult times adjusting the valve, last year, one ventricle was completely collapsed and the other was big. After some adjustments, now it is better, the collapsed ventricule is almost normal, and the other is a little bit bigger, so still a ventricle assimetry.

I read some articles linking sleep apnea disease with NPH, but the doctors are not in agreements who is the culprit of the other. Is that anybody here with these diseases, like me?

My questions are, do the S10 can show if the pressure I'm using now is ok? I'm asking this because if I'm using the wrong pressure, lower or bigger, that can explain the sleepiness and fatigue.

Other doubt, I can't afford right now a sleeping study, I'm planning next year, and I know that the S10 can not replace the sleepy study, but do you think it can show if there is something wrong?

Another thing, I curious about my 02 saturation on my sleep. How can I connect a sensor to show it on the machine? Which equipment is necessary?

I apologise for the long post, but I'm really struggling with these problems, and sorry for the bad English, I'm not a English native speaker.

Cheers

[ozij]

An AS10 Autoset can help you monitor the effects of the pressure on your breathing, you did well to buy it.
If it doesn't come with an SD card, make to buy one - you don't need much space on it.
The card can be read by software.

Please read the very first post on this forum:
viewtopic/t172378/StickyIf-you-want-CPA ... l#p1260774

[Cantgettosleep]

The machine came yesterday and I had my first night with it. It has 2800 hrs.

The first thing to note is that I was using the mask too loose before. I had to tight it a bit in order to the machine give the smile face. It is a bit uncomfortable, I have beard, so maybe it make the adjustments worse. I will remove the beard and see if gets better.

I set min 9 and max 20.

AHI 5.2. A little bit high. Center 1.1.

Pressure 17.8. I never thought that I'd need such a high pressure.I hope I'd not need a bibap.

I was using 11 in the S8 brick and the mask was loose. That explain the sleepiness and fatigue I was feeling.

I'm feeling a little better today.

Next post I will upload the graph, I still don't know how I'm gonna do it.

Thanks God I could manage to buy an autoset.

Cheers

[ozij]

The machine came yesterday and I had my first night with it. It has 2800 hrs.
[...]

I'm feeling a little better today.

Congratulations!

[Cantgettosleep]

The machine came yesterday and I had my first night with it. It has 2800 hrs.
[...]

I'm feeling a little better today.

Congratulations!

Thanks ozij!

I hope I will get even better with the proper adjustments.

I'm reading lots of good information here, thanks to all of you that help us here. The only fact that we can have a conversation with people that understand our problem is already a relief. Many people think that if you have 8 hours sleep you are good to do whatever you want. Unfortunately it's not like that. They don't understand how is feeling like a zombie.

Cheers

[Cantgettosleep]

Oscar graphs for last night

OSCAR 14 OCT 24.jpg (409.11 KiB) Viewed 19496 times

EPR 3
Umidity 4. Still dry mouth. Changing to 8.
Ramp auto

Leaking after pressure rise

I'm gonna get rid of my beard, see if it helps.

I'm gonna rise min press to 13, see if can diminish H and OSA. What do you think?

I always have problems with centrals. Don't know what to do.

Thanks in advance

[robysue1]

Leaking after pressure rise

Based on the the clusters of flow limitations and obstructive events (OAs and Hs), it looks like your minimum pressure is set too low. Setting the minimum pressure a bit higher will likely mean less steep pressure increases that can trigger the leaks. Also, if you are fitting the mask at your beginning ramp pressure, that also might be an issue.

I'm gonna get rid of my beard, see if it helps.

It may or may not help. My husband has a full beard and his leaks are usually well controlled. He uses a Fisher & Paykel Simplus full face mask.

I always have problems with centrals. Don't know what to do.

If the data you posted for October 14 is typical, you do not have a problem with centrals that is large enough to worry about. Seriously: Your CAI is 1.17 (about half of your OAI) AND you had only 8 CAs scored all night AND the cluster of 3 CAs scored around 5:00 AM all look like they're probably post-arousal "events" meaning they probably occurred while you were awake and drifting back to sleep. In other words, those 3 CAs most likely would not have been scored as any kind of sleep disrupted breathing event on an in-lab sleep test.

[ozij]

Agree with robysue.

[Cantgettosleep]

Leaking after pressure rise

Also, if you are fitting the mask at your beginning ramp pressure, that also might be an issue.

I guess not, for the mask fit feature already rises the pressure to maximun, I think

I'm gonna get rid of my beard, see if it helps.

It may or may not help. My husband has a full beard and his leaks are usually well controlled. He uses a Fisher & Paykel Simplus full face mask.

Thanks for the tip. I think on buying a new mask. But I trimid the beard to a minimum and the leakage got better, but there is room to improve. The mask I'm using is difficult to adjust, it is to tight for not leaking much, thus being very uncorfotable. But this is the least of my problems.

I always have problems with centrals. Don't know what to do.

If the data you posted for October 14 is typical, you do not have a problem with centrals that is large enough to worry about. Seriously: Your CAI is 1.17 (about half of your OAI) AND you had only 8 CAs scored all night AND the cluster of 3 CAs scored around 5:00 AM all look like they're probably post-arousal "events" meaning they probably occurred while you were awake and drifting back to sleep. In other words, those 3 CAs most likely would not have been scored as any kind of sleep disrupted breathing event on an in-lab sleep test.

I intented to say I had problems with centrals, historicaly. But you are right, it is quite normal now.

Last night I reaised min pressure to 15. What a terrible nigh. Lots of AO and H. I woke sleepy, but not as bad as I woke before this machine. I tried to get to sleep again, but couldn't suceed.

Pressure aroun 20. The machine can't go any further. Maybe I need a bibpap?

I think I slept with the back (belly up). I will try to sleep on the side tonight. If it don't work, I will try to use the device that I used 21 years ago, to advance the jaw (sorry if it is bad english, too tired to look for good translation of what I think in portugues).

any advice will be very appreciated, as I'm running out of options.

Edit: Theres a gap between 2:20 and 2:50. Don't remember a thing. There's lots of power surge in my neighbouhood lately, maybe this explains what happened. The machine automatically turns on after the energy comes back.

screenshot-20241017-132757.png (326.61 KiB) Viewed 19168 times

[robysue1]

Thanks for the tip. I think on buying a new mask. But I trimid the beard to a minimum and the leakage got better, but there is room to improve. The mask I'm using is difficult to adjust, it is to tight for not leaking much, thus being very uncorfotable. But this is the least of my problems.

Masks should never need to be tightened to the point of being uncomfortable. And don't dismiss an uncomfortably tight mask as "the least of my problems". Mask comfort is critical for becoming a happy PAPer.

Last night I reaised min pressure to 15. What a terrible nigh.

Well you increased your minimum pressure from 9cm to 15cm. That's way, way too big of a jump to make all at once. With that big of a jump in minimum pressure, it's not a surprise that you had a bad night. Try turning the minimum pressure down to something more reasonable---maybe 12cm. Or even 11cm. Generally I tend to recommend people make small changes in pressure, as in no more than 1 or 2cm at a time.

Lots of AO and H.

I strongly suspect you were not actually asleep during either of the major clusters of events---particularly the cluster in that short session between about 2:50 and 3:40. But it would not surprise me if you were pretty miserable during those 40 minute periods trying to get to sleep and not managing to actually get there.

I woke sleepy, but not as bad as I woke before this machine. I tried to get to sleep again, but couldn't suceed.

You got about 2 1/2 hours of solid, decent quality sleep between 3:50 and 6:30. That may be just enough decent quality sleep to explain why you woke up feeling a bit better than you did before this machine. What time is your normal wake up time?

But you woke up sleepy because you didn't get much sleep (of any kind) between 23:40 (when you turned the machine on) and 3:50 (when you turned the machine on for the last session of then night.

Pressure aroun 20. The machine can't go any further. Maybe I need a bibpap?

Your pressure hung out around 20 at two (extended) times during the night when it looks like you may not have been fully asleep. As in it looks to me like there are probably a lot of false events mixed into those two extensive 40 minute clusters. Now, I can't prove that you were awake or drifting between wake and very light sleep during those two 40 minute long periods where almost all of your events were scored, but if this were my data, I would zoom in on those two areas pretty carefully looking for evidence of post-arousal events.

I suspect that the significantly higher starting pressure of 15cm caused you to have a much longer latency to (real) sleep than normal. And that while you were trying to get to sleep, the machine kept flagging your (normal) wake breathing as "OAs", driving the pressure up to 20 and simultaneously creating even more problems with you being able to relax enough to get past sleep transition stuff and into real sleep.

As for bilevel: I don't think you need to start thinking in terms of a bilevel just yet. The night that you had your minimum pressure set to 9cm, your pressure barely reached 20 at only one point in the night, and your AHI was a lot lower. In other words, it is possible that the rather drastic increase in minimum pressure was enough to trigger some significant instability in your respiration last night. In other words, the periods of unstable breathing may have been made worse by having too much pressure to breathe against when you were not fully asleep, but also not fully awake.

I think I slept with the back (belly up). I will try to sleep on the side tonight.

It's often hard for people to try to force themselves to sleep in a position they don't want to sleep in. Ideally CPAP pressure ought to be able to allow folks to sleep on their backs with a minimum amount of trouble.

If it don't work, I will try to use the device that I used 21 years ago, to advance the jaw (sorry if it is bad english, too tired to look for good translation of what I think in portugues).

It is possible to use the oral device and the CPAP at the same time. And sometimes using both at the same time will allow a person to use significantly less pressure than just the CPAP alone and control the apnea far better than just the oral device by itself.

any advice will be very appreciated, as I'm running out of options.

My advice:

Set min pressure at 11 cm and use the oral appliance and the CPAP together for a few nights. I'd also keep a sleep log with impressions of how long it took me to get to sleep at the beginning of the night, how many wakes I remember during the night, and how long it took to get back to sleep after any wakes where it took a while to get back to sleep.

Edit: Theres a gap between 2:20 and 2:50. Don't remember a thing. There's lots of power surge in my neighbouhood lately, maybe this explains what happened. The machine automatically turns on after the energy comes back.

That gap could be a power outage: It looks like you were sound asleep at the time the machine stopped. Some people are capable of sleeping through a power outage even though no air is being blown into the mask, but many of us will wake up within a few minutes of the machine losing power because it does take a lot more effort to breathe through the mask when the machine is not blowing air through it.

To my eyes, it looks like you did wake up around 2:50 and that it took you quite a bit of time to get back to sleep. In particular, it looks like you probably turned the machine off around 3:40 with the intention of reducing the pressure back down to your starting pressure of 15cm, and that once the pressure was reduced to 15cm, you feel asleep and slept pretty decently for the rest of the night.

If power outages are a common occurrence in your area, you might want to invest in a battery back-up that can kick in when the power goes out.

[Cantgettosleep]

Thanks for your reply robysue, looks like you are very knowledgeable and wise.

I will follow all your advise, but I will set the pressure to 13, as 11 was the pressure I used with the S8 brick.

I like the idea of writing how I feel in a journal. Maybe oscar could have a space in the dayly report for it?

It's almost bedtime here in my city and I'm exausted , tomorrow I will reply to your comments.

Wish me luck

Cheers