Hi Everyone. Help Needed

[borsuke]

Hi everyone.

I see that you create a great society. So needed in situation when no doctor is able to help in any way

It have taken me 4 months to see some actual results with the APAP therapy.
After testing many masks, settings and solving tens of problems with try and error I can see some good results!

However its far from perfect stil.
Some days I am lucky enough to rest in 8-9 hours.
It is very rare though. Normally I need 10-11 hours to get rested.

I am wondering if you are able to get any hints from the attached charts.

Generally I can notice that when I am changing positions from left to right during the night frequently I am not waking up rested.
I thing that the turning during the night is due to the fact that I waken up already - not sure though.

I have following observations:

1. Sometimes when I wake up in the night I notice that my mouth was open - when I sleep on my back it is always open. I am sleeping on my sides mostly. I notice it once a few days but I might not notice most of those events.
2. Sometimes the back strap slides up and mask falls off a bit. I am using Philips "Headgear Strap with Arms" - it is 10x better than the one from ResMed. It may happen like 0-2 times a night. Again it may happen more often but I am not sure. Maybe charts can help with it.
3. Another theory I have is that when I am stressed up I am having shallow sleep and then I am turning around, waking up frequently and not getting good enough sleep.

The attached chart from OSCAR is quite interesting. I thing that most of the night was not too bad (not 100% sure, maybe you can see anything there still).
I have waken up around 3:15 went to toilet. I have had a bit of a time to thing about something little bit stressful. The rest of the night wa not good. I was turning around a loot.
All in all I feel very tired after around 8 hours 30 minutes of a sleep.

I would be very grateful for any help!
Is there anything that you can read from the charts? Any other ideas?
Maybe you can hint witch of my theories is the one to focus on?

Thanks in advance!

[Pugsy]

Do you take any medications of any kind? Even OTC? If so, what?

Do you have any other physical or mental health issues going on that might impact how you sleep or feel?

Exactly what symptoms are you having during the day that you wish you didn't have?

[borsuke]

When I wake up its so so but with passing hours I am more and more tired.
I would like to do so many things but I feel powerless.
I have creative work and I am not able to perform my usual tasks.
When I go back to sleep and stay in bed for 2 more hours. I will wake up like every 30 minutes but later I will perform very well during the day.

In terms of mental health:

• I had depression. One year ago with doctor we decided that I do not need any more drugs for that.
• I had 4 years of psychotherapy and I am about to finish it within few months.
• I have bipolar disorder. Not an extreme case but I take drugs and I am meet with doctor every few months.

In terms of drugs:

• Lamotrix for the bipolar disorder.
• Milurit - Gout (inflammatory arthritis)
• Lipanthyl for blood-cholesterol
• Mesopral for heartburn
• Nebilenin for supraventricular contractions
• Jovesto for allergy to dust mites

I might have restless leg syndrome - but I am not 100% sure about it.

I am 36 years old so interesting health condition, right?

[Pugsy]

Medication side effects could be playing a part in your unwanted symptoms.
https://www.mayoclinic.org/drugs-supple ... 067449?p=1

And your heart meds might be impacting sleep quality...trouble sleeping is listed
https://www.mayoclinic.org/drugs-supple ... 071459?p=1

I know you can't just go stop taking these meds but maybe knowing that they may be a factor in unwanted daytime symptoms will help you accept that part. Something to talk to your doctor about.

Even your gout meds can cause fatigue and tiredness
https://www.webmd.com/drugs/2/drug-8610 ... al/details

Your OSCAR software reports are fairly decent and there's nothing blatantly in there standing up screaming "fix me and you will feel better".
Can you verify what your settings are because your graphs don't match the settings seen on the left side.
I don't see evidence of EPR and the starting pressure shown don't match the graphs and it is saying ramp is off.

Looking at the graphs I would suggest adding EPR and an increase in the minimum pressure but then on the left side settings it is saying that is what is being using.
So...why do the graphs not match up with settings????

[borsuke]

Thank you Pugsy!!!

I would never think of looking in to the drugs! That is very helpful!! I think there is some room for improvements too.

On the graph the EPAP was disabled from the view. I am attaching it now.
What is there that I should keep an eye on when looking on those charts? Everything I understand is that I should look for a leaks.
However I observe the leek on the chart all of the time.

Another interesting thing is the minimum pressure. When it is too low it is difficult for me to breath. At the beginning 7.5cmH2O was fine.
However with a time I find I have to set it higher now and then. Now I need 9,5 to not suffer from air starvation.
I am afraid it will go even higher and higher still.

Thank you again for your support!

[Pugsy]

While you are having some leaking going on it is well within the parameters of what the machine can compensate for.
Now some people find that they wake up often even when the leaks aren't necessarily going into large leak territory where the machine might run into trouble compensating for leaks.
Do you think leaks are waking you up???? If so then they should be worked on even if they are below large leak territory which is 24 L/min. Anything that is disturbing our sleep is unwanted...even tiny leaks that cause us to wake up are a problem but not so much because they are affecting overall therapy but because they are messing with our sleep.

Generally I can notice that when I am changing positions from left to right during the night frequently I am not waking up rested.
I thing that the turning during the night is due to the fact that I waken up already - not sure though.

If you are remembering doing a lot of tossing and turning during the night then it means you are waking up enough to form a memory of changing position. The wake ups themselves can cause your overall sleep quality to be messed with because you are probably not getting the needed amount in each sleep stage. Not feeling well rested would be expected outcome when we have a lot of wake ups causing us to go back to stage one of sleep.

Which begs the question "what is causing the wake ups"??? I don't see it being related to the airway collapsing at least based on this report. That's why I always ask the medications question because often meds will mess with sleep quality and cause wake ups. Then I ask the "are the leaks waking you up"...even if the leaks aren't big enough to impact the therapy so much...they could be impacting sleep quality and causing wake ups.

Are you tossing and turning a lot because of pain or discomfort? I have that problem myself but I know the cause and it's plain old ordinary arthritis pain that isn't so easy to fix sometimes.

How long have you been trying cpap?

[Janknitz]

Sometimes when I wake up in the night I notice that my mouth was open - when I sleep on my back it is always open. I am sleeping on my sides mostly. I notice it once a few days but I might not notice most of those events.

There are a few things that you might try:
1. Use pillows to position yourself so you don't end up on your back. Some people sew tennis balls into the back of a pajama shirt or wear a stuffed backpack to bed.
2. Use a soft cervical collar to support your chin to keep your mouth from falling open.
3. Use a single piece of vertical surgical tape from chin to upper lip to keep your jaw supported.
4. Some people find a chin strap helpful.

Sometimes the back strap slides up and mask falls off a bit. I am using Philips "Headgear Strap with Arms" - it is 10x better than the one from ResMed. It may happen like 0-2 times a night. Again it may happen more often but I am not sure. Maybe charts can help with it.

1. If your hair is long enough, put a pony tail just above the back strap.
2. You can sew or glue some velcro inside the back strap. Use the stiff hook side facing your head. That may reduce the sliding and it's not uncomfortable.

Another theory I have is that when I am stressed up I am having shallow sleep and then I am turning around, waking up frequently and not getting good enough sleep.

Me too, but are you doing anything about your response to the stress? Meditation, relaxation exercises, sleep hygiene like lowering the lights before bed, avoiding screens, etc.? My husband and I both find that taking glycine--an amino acid supplement, helps us sleep. And if it's legal where you are, I've started taking a 1/2 of a THC gummy which seems to be sustaining my sleep a little better though inconsistently.