100% compliant to CPAP, still tired, can I do something ?

Dear all,

Age 38, 1m74 and 80kg, I've been through at least 11 years of severe apnea and just discovered it since 3 month. I've been using CPAP since 2 months 10 days, and easily get 100% compliant with my Mirage FX nasal mask (except the last period when I have had a stuffy nose and switched shortly to a non-compliant full face mask)

But during these 2 months 10 days, the best day of me is still only 70% of my younger self. Most of the morning and noon I find my head foggy and brain processing speed so low, also short term memory is bad.

Is there brain (hippocampus) damage, or is there something I could do better ?

Here is my sleepy head info (click this for full resolution http://extrazoom.com/image-60853.html?heuln50x50 )

My oximeter data is not so reliable, I've used it only 2-3 times.

What do you eat?

You are doing well to have such good compliance and low ahi. You might want to use sleepyhead to check your data, but I'm not sure youd find anything helpful to explain the tiredness. Of course, 2 months isn't that long, so it might simply be that with more time, you find you improve a bit more - or find it easier to see the improvements.
Did you have blood tests done before your sleep study to check things like your thyroid? There's a lot of health stuff that relates to tiredness, which cpap won't help. But there are also a lot of life style things,which good cpap will hopefully give you a bit of energy to tackle.

My apnea is OSA, therefore normally CPAP should help.

I take note everyday, several times perday how foggy my head is, and how tired is my brain in the evening. And I must say that with CPAP is my fogginess 30-50% reduced. But I expect much more.

My blood test is checked extensively recently, because doctors think that I have Hepatitis B. But then nothing else special in my blood, only that the doctor suggests me to reduce weight a bit since there is fat in
my liver.

But no, I'm not obese: 1m74 with 80kg (i'm 38 now) is just normal (although I must say that I have been only 60kg at the age of 20)

First thing is to get the hepatitis confirmed or otherwise, because it can definitely make you feel tired. The second thing is to be sure your low pressure setting is high enough - it's just barely above 'default' for the machine and it strikes me that while your AHI may look good (not disputing it) you might feel a bit better if the setting were just raised by 1-2 cms, but I'll probably get told off by others who swear by AHI alone. It certainly won't hurt anything at that level to experiment for a couple of nights however.

Looks like you tried fixed 6 cm pressure only for a few days when first starting therapy and have been using 8 cm fixed since April 13th and when you changed you saw a drop in the AHI to below 1.0 for the most part.
I don't know that using more pressure will yield better results in terms of how you feel but it wouldn't hurt anything to try maybe 9 cm.

Do you take any meds of any kind? If so, what?

Sometimes there's a lot of truth to the "give it time" advice. While "giving it time" though we can investigate other possible culprits for not feeling the good numbers so much.

Finally...the one thing that your machine doesn't report in fixed cpap mode is Flow Limitations...FL flagging is turned off when cpap mode is used so you potentially could be having some flow limitations that could maybe be causing some low level arousals which could maybe affect how you feel during the day.
A lot of "maybes" with the FLs but it wouldn't be impossible.
It's a drawback to using cpap mode fixed pressures...your reports will show 0.0 FLs but that doesn't mean you didn't have any. FLs aren't part of the AHI either so a person could have a large number of FLs and a low AHI.

I think your machine may have a short term trial in apap mode where FL flagging is turned on.
I would think a short trial in apap mode might be worth a try so that you will get FL flagging turned on.
You can either use a small range of pressures (like 8 minimum to 10 max) to see if the machine wants to increase the pressure for any reason or you could use 8 min and 8 maximum to mimic what you are doing now but with either the FL flagging will be turned on.
Maybe a week in apap mode...see what happens with the FL flagging.
Now it may be that you won't have FLs in numbers that might be a problem but it's worth at least checking it out.

Did you know about apap mode with the 461 machine? I think it is 30 days with the ability to reset for more 30 day segments.

I think I read somewhere that when you reset the 461 to get another 30 days apap, the memory clears.
If compliance is being monitored, this might not be a good thing.

chunkyfrog wrote:I think I read somewhere that when you reset the 461 to get another 30 days apap, the memory clears.
If compliance is being monitored, this might not be a good thing

I think it can be reset up to 5 times and yes, if compliance is being watched might not be the best thing to do since the procedure to do the reset involves erasing all prior therapy data.
The 30 days are cumulative though...so a person can use 7 now and then go back to cpap mode and later (like a month or 2 or more) still have 23 days remaining in the first 30 days.

Model 461...the 1 denotes maybe outside the US supplying and compliance may not be that big of a deal for someone outside the US...except maybe the UK and their NHS where they get their panties all in a wad with the patient maybe changing anything.

I set pressure to 10 (was 8 ), and slept 9h20 min yesterday. This morning i feel less pain on my head (the area after my two ears) than normal.

It could be because I slept enough, or it could be due to a higher pressure.

My AHI is the same (0.4), other indices: Vibratory Snore, Hyponea, RERA (what is that ?) Are the samr as before.

Question
- How can I see the Flow Limitations ?
- Somedays I see the Flow Rate, sometimes not. Why ?

Thanks

jaw wrote:How can I see the Flow Limitations ?

You have to be in auto mode for anything (if they occur) that the machine thinks is a FL to be flagged and it would show up on the events graph...see the FL on the left side?

jaw wrote:Somedays I see the Flow Rate, sometimes not. Why ?

I suspect that you are not putting the SD card back in the machine after you check the data.
The flow rate graph data files are NOT stored on the machine and must go directly to the SD card.
No SD card in machine...no flow rate graph. Some nights the SD card is forgotten and left in the computer (you aren't alone in doing this) and those nights the flow rate graph will be absent.. once you put the SD card in the machine and let it write the stored data to the SD card.

Pugsy wrote:

jaw wrote:How can I see the Flow Limitations ?

You have to be in auto mode for anything (if they occur) that the machine thinks is a FL to be flagged and it would show up on the events graph...see the FL on the left side?

My machine only supports C-Flex+, is that considered an Auto mode ?

Pugsy wrote:

jaw wrote:Somedays I see the Flow Rate, sometimes not. Why ?

I suspect that you are not putting the SD card back in the machine after you check the data.
The flow rate graph data files are NOT stored on the machine and must go directly to the SD card.
No SD card in machine...no flow rate graph. Some nights the SD card is forgotten and left in the computer (you aren't alone in doing this) and those nights the flow rate graph will be absent.. once you put the SD card in the machine and let it write the stored data to the SD card.

I understand it now, thanks

The PR System One model 461 has a short term (30 day) trial of auto mode.
You have to go into the clinical setup menu to see that choice though.
You have been in there where pressures are changed...where "mode" is offered and it's set to cpap....see if you can highlight mode and and turn the knob to auto trial mode.

CFlex + has nothing to do with auto mode...it's just an exhale relief setting.
In auto mode it's called AFlex.

While there is a sleep deficit thing that you might still be experiencing, if you are still tired in a month, then something ELSE is probably going on. In my case, it's RLS (restless leg syndrome). See either your sleep doc or your primary to work out what else could be going on.

jaw wrote:I set pressure to 10 (was 8 ), and slept 9h20 min yesterday. This morning i feel less pain on my head area after my two ears than normal.

If you have pain in the occipital area of your brain then it might be "occipital neuralgia" and it should be tested by an MRI or CT scan of the skull.



Has your auto been rear ended by any chance?