Still Tired after 1 year + Analysis

[ozij]

What would you learn from testing lesss than 6?

[Jimmy-Bills]

If there are even fewer leaks (and fewer large leaks) than with 6 or more.

[ozij]

When you make decisions about your therapy, please look at the correlations between the flow chart, the flow limitations and the leaks.

The aim of the therapy is to have you breathing smoothly and getting up well rested.
All the charts show you are not breathing smoothly. All the charts show flow limitations accompanied by leaks.
You say you are still tired.

Do whatever you think you have to do to make you flow as even as possible and your sleep as restful as possible. Don't make rapid changes. Stay on a setting for a week or so. Keep a log of how you feel.

[robysue1]

First of all, I want to support what ozij has said: You need to make careful changes and stick with each change for several days so you can really evaluate what difference (if any) the change made. And you need to keep a log of how you are feeling.

You also wrote:

Thank you for your answers.
I thought the leakage problem was solved since I had gone from sometimes 15-10% of Large Leaks two weeks ago to 2-1% (even 0.5%) by putting constant pressure.

There is in fact a point where chasing the last bit of leak becomes a futile battle. If your large leaks are staying in the 1-2% range for the entire night and they are not waking you up, then it's pretty safe to say you've got the leaks under control and you don't need to worry too much about them. But if leaks are waking you up, they're a problem even if they are small, pesky leaks.

So at this point, how often do you think the leaks are actually waking you up?

Next, in terms of AHI, your numbers are good. The switch to CPAP seems to have helped the flow limitation graph, but you still have flow limitations. And you made too large of a jump of pressure on one night (the night you used 7.4cm) and the leaks went up and you said you felt nauseous the next day.

You've also been experimenting with EPR=1 and EPR = Off as well. And you still feel fatigued.

You also recently asked:

So, Am I testing 6.4-6.6 for example? Or I can also test less than 6?

If I were you, I'd be cautious. I'd make one change at a time and I'd leave the settings alone for at least 4-5 days unless there was a big disaster like you had when you went from 6.2 to 7.4. Then back off to the previous setting, get things stabilized and try to make a smaller change after at least 2 or 3 days with settings that you know you can tolerate in terms of sleep and comfort.

Since you seem to have done as well with fixed pressure and EPR = Off as anything you've tried, I would recommend starting at one of these two places:

Settings #1: Straight CPAP at 6.4, EPR = Off.

Settings #2: APAP at 6.2-6.6, EPR = Off.

Stick with whichever set of settings you decide to try for at least 3-5 days and record how you feel each day. Then look at the data and start asking what is the next single change I want to try? The answer to that could be another small increase in pressure. Or it could be to turn EPR = 1, but you don't want to do both at the same time.

Finally, now that the leaks seem to be under control, start thinking about your sleep hygiene as well: Do you go to bed and get up at the same time every day? Do you have a relaxing bedtime routine? Do you fall asleep within 15-20 minutes of going to bed and turning the lights out? Do you read in bed? Do you watch tv or play with your phone in bed? Do you get frustrated and have a hard time getting back to sleep if you wake up in the middle of the night? All of those come into play in how well rested we feel in the morning.

[Jimmy-Bills]

Thank you for all these valuable tips. I will change a parameter every week.
For now, I'm at constant pressure (6..
No real improvement, yet I sleep a lot.
I will try another setting next week. I also receive my mouth strips at the end of the week.
I'll keep you informed.

[robysue1]

Thank you for all these valuable tips. I will change a parameter every week.
For now, I'm at constant pressure (6..
No real improvement, yet I sleep a lot.

It is worth posting the data. Are the leaks still decently under control? Is the AHI consistently under 5? Is the AHI consistently under 3?

But just as important: Are you sleeping no worse than you were before you changed the pressure to 6.8?

I will try another setting next week. I also receive my mouth strips at the end of the week.
I'll keep you informed.

Please do. And if you want feedback/advice on what the next parameter/setting to try should be, be sure to post some data from the current settings and give us information about how your sleep subjectively feels at the current settings.

[Jimmy-Bills]

- Concerning the leaks, it is always very low since the constant pressure (except Wednesday, where the rate is close to 15%, see screenshot).
- The AHI is always below 3.
- No improvement with constant pressure at 6.8 (same as 6.2).
Yesterday, after work, I dozed off at 5:30 p.m. for 40 minutes.
I was hesitating to either put APAP 6.2-7 or constant pressure 7 for the next change.

[Jimmy-Bills]

Review of the last days.
I kept the pressure constant for now. However, I changed the humidifier level from 5 to 3. I don't know if that helped but I feel a little better. I yawn less and I have less desire to take a nap.
- Saturday-Sunday, I had a correct energy. I managed not to take a nap. Yet I slept 7:30, I can not explain it.
- Monday-Tuesday, it was more complicated. I felt much more elsewhere, muddy, especially Tuesday. However, I managed not to go back to sleep and went to the gym on Monday when I got home from work.
On the other hand, it seems that the big leaks are back.
I see OSCAR's screenshots attached (which I can't really explain).
What do you think?

[Jimmy-Bills]

I received the strips for the mouth, I started using them. Looking at the results, fewer leaks. This sometimes peeled off at night with the saliva.
I added over it, (medical) tape over it. It always peels off a little during the night but less.
I also sometimes feel my mouth/cheeks swelling with air before falling asleep.

In terms of results: Much fewer leaks and 0% of large leaks.
On the home screen, the average leaks were lately 0.72,0.88,0.57 and 0.98 l/min. which I have never had in a year and a half.
I am attaching screenshots.

Energy level, it's hard to say, I had a pretty busy work week with travel. I also had to ring the alarm clock earlier than usual to get up.
Tuesday, I had a lot of energy, it had been a long time since I had felt that. It was not the case on Wednesday I yawned a lot. Yesterday and today was average, average +.
On the other hand, I had trouble waking up but I felt more peaceful, maybe the sleep was deeper?
We'll see if it works
I will report again in a week. I'll keep you informed.

[Jimmy-Bills]

Hello everyone,
I join you the last two nights in capture. I still use mouth strips with medical tape over them.
- There are far fewer leaks than at the start. However, it is very variable depending on the night, sometimes there is still and this night very little.
Are these leaks normal when using cpap?
Do these leaks disturb sleep?
(I'm not talking about the large leaks).
- I also feel that my nose is a little stuffy when I wake up, is it worth increasing the pressure?

[Jimmy-Bills]

Hello everyone,
I come back to you after several weeks.
I kept the pressure at 7 with EPR 1 (two weeks) then 2. It's generally the same, few leaks. However, I always feel tired during the day, not awake. I have trouble concentrating too.
I did a test yesterday, I set the pressure to 4 (still with EPR at 2).
I had a very similar AHI score to previous nights. I thought the apneas would increase as the pressure decreased. (However, same problem, I feel very muddy today.)
Is this normal? What can we conclude from this?

Thanks

[ozij]

I did a test yesterday, I set the pressure to 4 (still with EPR at 2).
I had a very similar AHI score to previous nights. I thought the apneas would increase as the pressure decreased. (However, same problem, I feel very muddy today.)
Is this normal? What can we conclude from this?

What would you learn from testing lesss than 6?

If there are even fewer leaks (and fewer large leaks) than with 6 or more.

So, what have you learned from your test?

When you make decisions about your therapy, please look at the correlations between the flow chart, the flow limitations and the leaks.

What happened at 4? What are your conclusions?

Did you try going up from 7 to 7.2? 7.2 to 7.4?
Did you ever ask your doctor to have your oxygenation monitored -- both when awake and when asleep?

[Jimmy-Bills]

Thanks for your reply.

What happened at 4? What are your conclusions?

With this test, there are almost no leaks. The average leak is close to 00 l/min. On the other hand, there are many more flow limitations than the other times...which means that the pressure is too low.

Did you try going up from 7 to 7.2? 7.2 to 7.4?

Not yet, I'll try that.

Did you ever ask your doctor to have your oxygenation monitored -- both when awake and when asleep?

No never, i will ask him.

[Kingsway]

Would it not be a good idea to try wearing a Pulse Oximeter overnight to monitor Blood Oxygen levels ?

eg: https://www.viatomtech.com/checkme-o2

[Jimmy-Bills]

Did you ever ask your doctor to have your oxygenation monitored -- both when awake and when asleep?

During my polysomnography, there was indeed an oximetric evaluation.
I'll give you the numbers:
- Number of desaturations per hour of sleep: 9.4
- Average saturation 92%
- Time under 90%: 0.7% of total sleep (3 min)
- Time under 88%: 0.1% of total sleep (0 min).
It is all I have.
Are these good numbers?

Would it not be a good idea to try wearing a Pulse Oximeter overnight to monitor Blood Oxygen levels ?

eg: https://www.viatomtech.com/checkme-o2

I looked at different oximeters compatible with Oscar. There's the Pulox PO-300 approaching $90.
Are there any cheaper ones compatible with Oscar?