Another Discouraged Newbie

[OakSeamus]

Newbie here looking for some help. I’ve had an issue for years where I sleep all night, but wake up exhausted. It is intermittent, some days I’m OK, and some days I’m so exhausted I can’t function. 4 years ago I did a sleep study and was told I did not have apnea. I recently did another one and was told I definitely do have apnea(36 AHI). I’ve been using a cpap for a month now. I’m not seeing any improvement in my energy levels. In fact I think it has been worse with the cpap. On the bright side I’m not snoring, so my wife is happier. I also typically wake up with a dry mouth and headache, but the primary issue is the fatigue.

The machine seems to think I’m sleeping great. AHI is well under 5 every night. I have no problem wearing the mask, and most nights I get 7-8 hours of sleep. My pulmonologist and respiratory therapist have both said stay the course and see if things get better.
I get fairly regular exercise, although it is getting harder and harder with the fatigue.

I am prediabetic. I have tried testing my glucose level every day, but I have not been able to find any correlation between glucose levels and fatigue.
I’ve seen a lot of discussion about it taking some time for people to see a benefit, but most of that seems to be around getting comfortable with the mask and getting a full nights sleep. That doesn’t seem to be my problem.

I’m currently using a Dreamwear nasal mask. I’ve ordered a Dreamwear full mask to see if that helps.
Any other suggestions for what I can try? I’ve attached an Oscar report for a day that was pretty bad.

Thanks for your help.

[Pugsy]

How many times are you waking up during the night besides the ones we see where you are turning the machine off and back on again?
Why?

[Julie]

Hi, for starters, under 5 is not the standard we go by... it's just the arbitrary number doctors came up with long ago to have 'something' to use, but most here, when well treated, are below 2. Leave the max at 20 so it won't 'cap' the min. if that needs to go higher at some point (it's the one that does the job, not the max).

You also have yours set at min. 5, pretty low for many, so raising that to e.g. 6 or 7 might be an idea, especially as you still(?) get a.m. headaches.

Do you take any meds - some can interfere with good sleep. And trying the full mask is a good idea, though whether or not you get the 'right' one first time out would be very lucky.

[OakSeamus]

Wow, quick responses. Thank you.

The times I turned the machine off are when I went to the bathroom, those are the only times I was awake. I turn it off because it blows air and makes a bit of noise. I'm trying not to wake my wife. Would it be better to leave it on?

I'm not taking any meds except for Advil sometimes for the headaches.

I have noticed some correlation between getting my AHI down to 1.5 or lower and having better days. Not great days, but better.

I'm not sure I have access to the min. setting. Do I need to have the respiratory therapist do that? Or is there a hack?

[Pugsy]

It's not really a hack so much as just knowing the secret handshake for getting into the clinical setup menu area.
Go here and request the clinical/provider manual for your machine via email attachment and in it you will find the button pushing combination that is the secret handshake to get into the clinical setup menu where you can change stuff if you wish.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

You can keep turning the machine off when you get up to go to the bathroom. It hurts nothing and it is noisy to leave it running and its also a good marker to know when you were awake or asleep just in case we question if the flagged events are awake false positives or asleep real events.
I just knew that if you turned it off you were awake so I am seeing some fragmented sleep and any fragmented sleep will mess with how we feel during the day no matter how many hours of sleep we get.

How old are you? Do you have the common prostate issues associated with men and the frequent peeing thing?

Everything you see flagged on that report except the CA/ClearAirway/Central Apneas point to airway related issues or reduced air flow or not so great sleep. Some parts of the night not bad and some parts not real pretty. Not a horrible report but when you add the OAs and hyponeas into the FLs and RERAs and snores....all point to enough little stuff happening to mess with sleep quality.
The usual fix for everything but CAs...a little more pressure minimum. I would suggest 6 cm and see what happens.

If your nighttime pee breaks aren't related to the prostate...they also might reduce if we can get that AHI and all that other clutter down a bit. Now if it is the prostate...cpap can't fix that.

[OakSeamus]

I'm 54. My prostate was check last year, and no problems. I usually get up once to pee, sometimes not at all.

Thanks for the secret handshake. I've set it to min. pressure 6. We'll see how it goes tonight.

[Pugsy]

Glad to help with the secret handshake.

I can't promise you but if you can get the clutter reduced (along with the AHI) your nighttime pee breaks might also reduce.
One the known symptoms of sleep apnea is nocturia and often when sleep apnea is the only cause and once the therapy is optimized the nocturia either goes away totally or is more rare.
The short version is that apnea events or restricted breathing causes stress on the heart which then dumps a load of a stress hormone called ANP, atrial natriuretic peptide, into the blood stream as a reaction. This hormone travels to the kidneys and triggers the kidneys to go into overdrive and we all know that when kidneys work hard they produce a lot of urine and the bladder gets full and we wake up because we need to pee.

When the heart is no longer under repeated stress there is less chance of copious amounts of ANP getting dumped into the bloodstream to go through the kidneys and less chance of copious amounts of urine to be produced.

So it's a maybe. It all depends on how much of your need to pee is from sleep apnea.
Before cpap I had the nocturia really bad but once my cpap therapy was optimized the nocturia essentially became non existent. It's very rare that I wake up during the night with a full bladder.
I have said getting rid of the nocturia was worth cpap to me even if it didn't fix anything else. Just not having to get up every hour or two with a painfully full bladder has been a huge blessing and overall improvement to my sleep quality.

If you still have issues once the clutter is cleaned up...then we dig a little deeper into why you aren't feeling as good as you would like because there's a lot more to feeling the good numbers than just getting them. The getting them part is relatively easy...the feeling them is a whole different can of worms sometimes.

[OakSeamus]

Well, that seemed to help. I feel better today despite being awake for 1.5 hours during the night (work stress more than comfort issues). Since my fatigue issues have always been intermittent, I'll have to see if it works consistently.

What is the disadvantage to increasing the minimum pressure? Comfort? I'm thinking about taking it to 6.5 tonight.

[Pugsy]

A relatively small change in the minimum doesn't really have any negatives to it unless it causes a problem. The most common problem is aerophagia or air in the gut issues and that's relatively rare. On an even more rare occasion more pressure can cause central apneas but again the chances of that happening are relatively small. Should it cause a problem we just back off a bit. No big deal.

A lot of people use more minimum pressure than they might need to technically keep the airway open and prevent collapse but it feels better to them and they sleep better and that's really all that matters. Doesn't hurt a thing.
Comfort is critical to this therapy. If we aren't comfortable then we don't sleep so great and when we don't sleep so great we don't feel so great during the day despite maybe a nice low AHI.

[OakSeamus]

I think I'm making progress, but I'm still struggling. I have slowly increased the min. pressure from 5.0 to 7.5 and switched to a full face mask. My AHI has generally come down. I have days where my AHI is below 1.0 and I'm still exhausted.

Oscar.12.10.20.png (294.27 KiB) Viewed 358 times

Oscar.12.4.20.png (284.55 KiB) Viewed 358 times

I have attached two oscar screen shots from nights when I was exhausted the next day. Today is not as bad as the 12.4.20 day.

Another question. What does altitude do to cpap therapy? I frequently spend time at about 5000', although I haven't since starting therapy.

Thanks for your help.

Seamus