2 months on APAP: hitting a wall at 4pm : barely functioning. OSCAR images inside

[diabellical]

age: 37
height: 6'1
weight:170
health: fine otherwise

Time on cpap: 2 months
Type: Philips Respironics Dreamstation APAP
Mask: Dreamwear Full Facemask
Compliance: good

PROBLEM: my exhaustion is profound. It hits around 4pm at which time I become non-functional. It is impossible to get work done, be a functioning family member etc. Until then I seem to be reasonably alright. When I started the APAP the time from wake to 4pm was more full of energy. Now I'm getting tired throughout the day. AHI has on average risen since the first two weeks.

Please let me know what OSCAR data you need in addition to the data I have provided.

Included:
1. Summary Data
2. Example of two different days where pressures were very different but similar results.

[Pugsy]

Try increasing your minimum pressure to 7 cm and see what happens.
You have a lot of "clutter" showing up on your reports that could be impacting overall sleep quality.
FLs and RERAs along with the OAs and hyponeas all point to the airway either collapsing or trying to collapse and could be causing sleep disturbances impacting the restorative powers of sleep.

[diabellical]

I've upped it to 5.5 from 4 which corresponded to a decrease in performance. So I'm hesitant to keep going since it should A-uto adjust.

[Pugsy]

It's a well known fact that Respironics auto adjusting algorithm is a bit on the slow side and often people need to increase the minimum to get better results.

If you don't want to try an increase in the minimum pressure then I suggest you talk to your doctor about your issues.

[diabellical]

I'll give it a shot then post the data. Thanks

[diabellical]

Note: I did experiment with nasal mask, which could explain some leak as opposed to around the mouth usage. Higher min pressure used. I'm mainly surprised at the higher ahi around non-leak periods.

[Miss Emerita]

Could you reformat this most recent chart so that we can see these graphs:

Events
Flow rate
Pressure
Leaks
Snores.

To fit them all into a single screenshot, you can grab the horizontal gray bars that separate the graphs and push them up.

Thanks!

[diabellical]

Here ya go. Thanks for the help.

apap-EFPLS.png (136.79 KiB) Viewed 988 times

[diabellical]

Here is results with new Nasal Pillows mask. I remember no leaks of any kind. Woke up with no leaks. Not sure why those leaks were showing early on. NOTE: I WAS AWAKE UNTIL 3.

CPAPnewNasalPillows.png (149.38 KiB) Viewed 961 times

[Miss Emerita]

Strangely enough, it looks like your maximum pressure is 7.5, even though on the left panel it says 12 or 15. Even with the conservative PR algorithm, your pressure should have gone up with your big batches of obstructive apneas. Could you double check what your maximum is?

[Miss Emerita]

I just learned from Pugsy that the problem might be a PR feature called EZ start, which limits the maximum pressure for a period of time at the beginning of therapy. Could you check whether it's on? And if it is, turn it off and let's see where the pressure "wants" to go with a true maximum of 15.

Pugsy provided this image of the description of the EZ start function, if you want more information.

[Pugsy]

Anytime we see a Respironics pressure line not going up when it obviously should be going up or we would expect it to go up because of the flagged events I always suspect EZ-Start hindering things.

So when we see the pressure not going up and a truckload of apnea events happening....always look to see if EZ-Start somehow got turned on and if it did....turn it off. Dumbest idea Respironics ever came up with was EZ-Start.

[diabellical]

I’ll disable ez start and report back in a couple nights. Thanks.