Where Did My Doc Go Wrong - Why Am I So Tired

[Another Scot In Africa]

HELP!

Thank goodness I found this forum. I thought my sleep was now as good as it's going to get, but after reading some of the strings, I think there's much room for improvement in my sleep patterns.

After years of complaining to the GP about my zombie-like lifestyle, and his useless prescriptions, (daytime Provigil and nightime sleeping tablets), I was eventually sent to a neurogolgist after falling asleep at the wheel, and from there to a sleep lab for the polysomnogram. That was last October. The results were as follows for the 8.12 hour test:
Diagnostic Titration
Stage 1 NREM 11% AHI 92.83 Stage 1 NREM 10% AHI 4.07
Stage 2 NREM 78% Snoring Events 463 Stage 2 NREM 33% Snoring Events 3
Stage 3 NREM 0% Desaturations 706 Stage 3 NREM 21% Desaturations 75
Stage 4 NREM 0% Respiratory Events 690 Stage 4 NREM 6% Respiratory Events 32
REM 11% Obstructive Events 533/690 REM 30% (Rebound)
Epworth Sleepiness Scale 19/24

The problem is, after 10 months on CPAP AutoSet, I'm still tired, my brain is so fogged and I'm starting to wake up with headaches again. I send the data card to the agents every so often because the software is'nt available. (I see that it is from Australia, so it's next on my shopping list - I've just ordered a downloadable oxymeter). The last results from the data card were:

Pressures: Minimum Pressure 4 cm Maximum Pressure 20cm (Median 9.9cm; 95th Percentile 11.9cm; Maximum 14cm)
Leak (l/min): 3.6l/min; 95th Percentile 21.6 l/min; Maximum 39.6 l/min
Apnea Index: 1.0
Hypopnea Index: 9.8
AHI 10.8
Time in Apnea: 0.3%

Why am I so tired?
How do I get this fog in my brain to clear up?
Is there anyone out there who can help me?

[harry33]

welcome
if you have a nose only mask and you breathe thru mouth when asleep you get no CPAP benefits

you also get a very dry mouth and tongue on waking

tell us about your mask

[Pugsy]

Off hand with the 10 AHI I would say that something is missing in the therapy. I have had 6 AHI and felt awful.

So..
if leaks are under control, though remember what you are seeing reported are actual leaks so you may be leaking enough to impact therapy with those larger leak numbers,
then the other suspect would be pressure.
if you are using the auto unit with a minimum of 4 cm of pressure and letting it find its way to the pressure needed, it averages around 10 cm and goes up to 12 cm and 14cm, occasionally.
With 4 cm minimum pressure then the machine takes too long to get to the events that it wants to prevent at the 10 and 12 cm mark.

Can you please confirm exactly what settings are used?
EPR use?
Minimum and maximum pressure settings?
Ramp used?

If your minimum is indeed 4 cm, I would increase it to 8 cm and see what happens. That way the machine has a head start on those events that happen at 10 and 12 cm.
If you are using EPR, it reduces the pressure upon exhalation so it also reduces therapy pressure.

[Another Scot In Africa]

I have an AutoSet Spirit II and humidifier, and a Mirage Ultra Mask. I don't know how to get into or change the settings - the equipment didn't come with the clinician's manual. Donyou know how how would confirm change the settings?

[ozij]

Pressures: Minimum Pressure 4 cm Maximum Pressure 20cm (Median 9.9cm; 95th Percentile 11.9cm; Maximum 14cm)
Leak (l/min): 3.6l/min; 95th Percentile 21.6 l/min; Maximum 39.6 l/min
Apnea Index: 1.0
Hypopnea Index: 9.8
AHI 10.8
Time in Apnea: 0.3%

When my bottom pressure is too low, I get more hypopneas -- and hypopneas can cause desaturation just like apnea can. As it is your spending half your night (median) at a pressure close to 10 -- or more.

If I had your results I'd take the following steps to figure out how to continue:

First, I'd Raise the minimal pressure to 6 - 7 or 8 or more - depending of how tolerable a lower pressure was for me.

If I saw no improvement in a week, my next step would be an attempt at fixed pressure, starting out at 11.8, and lowering only it that is a very big bother.

Me reasoning is as follows:
With a median at almost 10, half the time may be spent moving back an forth from 4 to 9.9 and back. Those pressure changes may be causing arousals, and tiring. An HI of 9.8 with you continued exhaustion means the machine is not carrying out its intended job of preempting your hypopneas.
By raising the minimum you may avoid may of those hypopneas, and have more restful sleep.

Moving to fixed: The Autoset has a built in rule that keeps it form responding to any hypopneas, and limits its response to Apneas to those that occur below a pressure of 10 -- it's doing a great job wiht your apneas, but not with hypops; Your breathing pattern: snores, flow limitations -- does manage to drive the machine up to 11.9 -- but does not keep it from going down too low. We don't know at which pressure your hypopnea a appear - so taking the machine's 95% (or something close to it) is a good point for starting.

O.

[schwawi]

I dont have your manual, but if you start a new thread asking for the manual in the subject line, I am betting you'll have many replies with offers to send it. Thats' how I got mine......