More than one year with CPAP/APAP and no progress

Hi from France ! And sorry for my English.

I've been diagnosed with sleep apnea by the end of 2020 when I did polysomnography which showed 27 AHI. No desaturation.
I am 51 years old man, average build with a little belly, no serious health problem but anxiety (I take antidepressants and other similar drugs) and insomnia.

I know how to adjust my Resmed setting, here are details for last night :

- Resmed Airsense 10 with Auto APAP
- Full Face mask
- Min. pressure 7.4
- Max. pressure 12
- EPR 1
-> AHI 3.3

My doctor initially set pressure to 8 (constant) but my sleep was not very good and I often woke up tired.
Then they decided to set it to 10 and after 12 EPR 1.

I use Excel Worksheet to notice all my different settings (EPR in particular) and physical shape.
I tried a lot of setting with my machine (maybe an error of my own).
AHI is often below 5 however, average is 4, regardless the setting.
But no logic at all !! Impossible to get a good setting which is going well for more than 3 days.
Sometimes it's okay for one or two nights, and the followings are terrible (I sleep but I am exhausted at wake up).

However it seems I feel a bit better with auto settings.

It really begins to worry me !!
I really need help and I thank you for that...

Here are screenshots of Oscar for last night :
And the night before :
What do you think about it ?

Regards

How many times do you think you are waking up during the night?

Take any medications of any kind? If so what?

otterley wrote: ↑

Thu Sep 23, 2021 12:26 pm

What do you think about it ?

I think your min should be 11, EPR 1, max 20.

See how that does for you.

Yes I often wake up one or two times per night. Without fail one time around 1am. Don’t know why.

Max pressure I tried was 12 fixed. But central apnea became worrying.

About medication I take melatonin around 10pm. Go to sleep at 11 max.
I take diazepam. A few drops. Sometimes I add some antihistamine sleeping pills. I tried many meds.

For years antidepressant. Sertraline at the moment.

otterley wrote: ↑

Thu Sep 23, 2021 2:17 pm

Yes I often wake up one or two times per night. Without fail one time around 1am. Don’t know why.

Max pressure I tried was 12 fixed. But central apnea became worrying.

It's normal to wake up after a REM sleep stage is completed so an occasional wake up is actually normal and to be expected.
Hopefully you turn over and go right back to sleep.

Your zoomed screenshot for the CAs/centrals at 01:23 points to both of those flagged events being arousal/awake related false positives. The big breaths immediately prior to the flags points to an arousal/awakening. You may or may not remember being awake but you were.
I wouldn't be surprised if the bulk of your other central flags aren't also arousal related.
If you aren't asleep nothing flagged is a real asleep apnea event.

Google melatonin side effects....one of the side effects is drowsiness or fatigue the next day.
Same thing for your diazepam.
Anything a person takes to help them sleep will usually have similar side effects. They all come with baggage like that.

I doubt that your centrals are pressure related or even real centrals. I would suggest giving Palerider's idea a try...see what happens. Sometimes arousal centrals can be caused because an airway related issue can cause an arousal (may or may not remember the arousal) and better preventing potential airway issues can also end up reducing arousal centrals as well.
Can't guarantee it but worth trying.

Do you drink alcohol within 2 hours of bedtime?
Recreational drug use?

Pugsy wrote: ↑

Thu Sep 23, 2021 2:40 pm

otterley wrote: ↑

Thu Sep 23, 2021 2:17 pm

Yes I often wake up one or two times per night. Without fail one time around 1am. Don’t know why.

Max pressure I tried was 12 fixed. But central apnea became worrying.

It's normal to wake up after a REM sleep stage is completed so an occasional wake up is actually normal and to be expected.
Hopefully you turn over and go right back to sleep.

Your zoomed screenshot for the CAs/centrals at 01:23 points to both of those flagged events being arousal/awake related false positives. The big breaths immediately prior to the flags points to an arousal/awakening. You may or may not remember being awake but you were.
I wouldn't be surprised if the bulk of your other central flags aren't also arousal related.
If you aren't asleep nothing flagged is a real asleep apnea event.

Google melatonin side effects....one of the side effects is drowsiness or fatigue the next day.
Same thing for your diazepam.
Anything a person takes to help them sleep will usually have similar side effects. They all come with baggage like that.

I doubt that your centrals are pressure related or even real centrals. I would suggest giving Palerider's idea a try...see what happens. Sometimes arousal centrals can be caused because an airway related issue can cause an arousal (may or may not remember the arousal) and better preventing potential airway issues can also end up reducing arousal centrals as well.
Can't guarantee it but worth trying.

Do you drink alcohol within 2 hours of bedtime?
Recreational drug use?

No recreation drug nor Alcohol ... Zolpidem (3,5mg) to fall asleep, it works but I wake up two hours after taking it.

So last night I used setting 11, EPR 1, max 20 as you recommend.
It dit not work, so sad to say : I feel like a crap.

I am going to send you all details during the day.

Thanks

Hi here are the Oscar screens from last night with settings you recommend

And the last one

I check my sleep every morning with the Autosleep on my Apple Watch. It used to be very accurate.
For last night, it said quality sleep 4h and deep sleep 44 min.
The night before it was quality 5h and deep 1h20...

I try last night a new app on my Iphone : SleepScore -> it said I waked up 8 times !! I only remember one or two.
I had 48min REM.

I wonder why I sleep so bad. Maybe it is not apnea but depression after all ???
Or Sertraline side effet...

Thanks for your help.

Sertraline side effects....well known to mess with sleep and make a person a walking zombie during the day.

Unfortunately so are the symptoms it is designed to treat.

I don't see tweaking the settings being the solution to your complaints as I think there is a huge chance that medication side effects or the problem the meds are supposed to help are a big factor.

CPAP machines can only fix problems related to the airway collapsing. They can't fix medication side effect problems or other physical or mental health problems no matter how much we want them to.

Google SSRIs and effects on sleep....well known to mess with sleep in general.

Talk to your doctor about reducing or going off the meds and see how you feel.

Ok but I can't stop using the CPAP anyway.

So you think the best is to keep settings Auto around 7-12 with EPR 1 ?

You see no evidence of a problem in Oscar reports ?

I don't think that changing the pressures is likely going to be a miracle fix for you. The bulk of your AHI is central apneas and we don't fix them with more or less pressure.

But a couple of weeks at the settings palerider suggested won't hurt and they might help.
You can't dismiss a change just based on one night though. It takes a while for the body to adjust.

Anything is fair game to try to improve our sleep as long as trying it doesn't cause problems but you have to give a change a fair trial.

Pretty much all the zoomed in flagged events above are all arousal/awake related events. You weren't asleep and if not asleep they don't count other than point to crappy sleep. They don't/can't tell us what caused the arousal though,
Looks more like spontaneous arousals to me which means we don't know the cause but we know it wasn't airway related.

Palerider gave an idea to try based on if the arousals were airway related....and some might be but some aren't.
Will his idea help??? Dunno but you really have nothing to lose to try it.
But you have to give it more than 1 night trial....this stuff takes a lot of time when changes like that are made.

My thoughts personally...I would look at medication side effects very closely but I would want to make sure that something as simple as a pressure change was at least tried and ruled in or out.

The fact that last night pressure has not been higher than 12.16 does not mean that higher pressure is useless ?
Just I question.

And I wonder whether arousal cannot be caused by two much pressure. It's a fear.

Do you have any idea why my doctor told me to use fix pressure only ??

otterley wrote: ↑

Fri Sep 24, 2021 1:23 pm

Do you have any idea why my doctor told me to use fix pressure only ??

No. Lots of doctors prefer fixed pressures for any number of reasons. Even here in the US we have doctors who don't understand how auto adjusting pressures work so they persist in staying in the dark ages and refuse to embrace auto adjusting pressures.

otterley wrote: ↑

Fri Sep 24, 2021 1:23 pm

And I wonder whether arousal cannot be caused by two much pressure. It's a fear.

Too much pressure from where???
Get past that fear...it's unfounded. The worst that might happen is higher pressures might trigger central apneas and I don't see that happening with you. Not enough centrals to worry about.

otterley wrote: ↑

Fri Sep 24, 2021 1:23 pm

The fact that last night pressure has not been higher than 12.16 does not mean that higher pressure is useless ?

You need to understand max pressure setting...doesn't matter what the actual mask pressure setting is if the machine doesn't go there. It's a moot point. If the machine could be set to 100 cm and we set it at that and the highest it ever goes is 14 cm...doesn't matter that the max was 100. Just because it can go there doesn't mean it will go there.
The minimum pressure is the most critical setting to make. It does the bulk of the job of holding the airway open and preventing collapse. It needs to be high enough to hold the airway open the bulk of the time and the with the max at a higher number it can go up for anything that happens out of the ordinary to cause the airway to try to collapse....like maybe REM stage sleep or supine sleeping which both can cause OSA to worsen and need more pressure.