Sudden fatigue after 5 years on CPAP

Hello

My apnea symptoms worsened recently. Since mid-March my daytime fatigue and brain fog increased significantly - checked my CPAP stats on Oscar, AHI increased from usual 6-8 to 16-20, likely to cause fatigue.
Main component is Unclassified - around 10, and CA around 4. Obstructive is low, around 3. Numbers fluctuate, but pattern is similar.
Not sure why this happened - CPAP used at least 4 hours every night for the last 5 years, admittedly mask leakage a bit high, but no fatigue until recently.
In the last few days tried to use CPAP 6-7 hours per night, but still daytime issues - difficult to stay awake, even when driving. 30 min nap helps, but only for couple of hours.
Night sleep - usually ok from 11pm till 2am, after that difficult to fall asleep again.
CPAP is Airsense 10 Autoset, F20 Full face mask, pressure 14 CPAP for the last 2 years. Since fatigue started tried 13-15 Autoset, not much help.
Tried to use nasal pillows mask, this reduces leakage, but not much improvement on AHI and fatigue.
Medical stats :
Blood pressure around 138 - 80, measured daily.
Glucose 6.4 - 6.6
Age 59, male with diabetes
Exercise - 7-9 K steps daily

Thanks

Hate to ask, but have you possibly gained wt recently (more than e.g. 15 lbs)? That'll do it if it happened. Can you post some Oscar charts in this thread?

No weight gain, weight excessive but stable. What does Unclassified Apnea in Oscar mean?

vps wrote: ↑

Wed Apr 20, 2022 1:04 am

What does Unclassified Apnea in Oscar mean?

On an Autoset it means the machine was not able to distinguish whether is is a central apnea or obstructive. This can often occur in association with large leaks. Let's see a couple of Oscar charts - one showing the whole night and another zoomed in on an unclassified apnea.

Here are Oscar charts for 18.04.22. This time CA are higher than Unclassified, leakage is lower than usual. How CAs can be reduced?

Here are Oscar charts for 17.04.22. High leaks unfortunately typical, full face mask is tight, but gets a bit displaced as I move during the night. Sleep mainly on my side. Getting mask any tighter is uncomfortable. Unclassified and CA high, probably fatigue caused by those. Any advice?

First of all please see this thread for examples of which graphs to include in your shared images.

viewtopic/t158560/How-to-post-images-for-review.html
Pay special attention to "hide the calendar" and which graphs we want to see.

You have included unneeded graphs and omitted needed graphs.
You are using the forum attachment feature and we are very near maximum capacity so not so useful reports are filling up the storage. When it gets full no one can post attachments. Please read this.
https://www.cpaptalk.com/viewtopic/t183 ... again.html
Thank you for helping us keep the attachment feature active for everyone. Please remove the above screen shots.

So can you redo your reports...you can get all we need on one screen shot.
Please go and remove the not useful screen shots and replace with more useful screen shots.
One with you in cpap mode and one using apap mode is sufficient at this time.

Reports showing so much excessive large leaks are really pretty much useless except for confirmation of large prolonged excessive leaks. You are seeing UAs/unclassified events because the leaks are so bad the machine only knows something happened it needed to flag but with so much leak it can't tell what it was that happened.
Any leak over 35 L/min is really going to compromise therapy effectiveness as well as reporting.

Until the leaks are better managed we really can't offer any ideas as to how to best deal with your obvious less than ideal OSA therapy.
You are having a lot of obstructive stuff get flagged as well as central stuff. In the face of so many obstructive events the centrals might (stress the might) be related to arousals caused by the Obstructive stuff.
We really can't do much about centrals with this machine....meaning more or less pressure can't really help reduce centrals. Reducing or turning EPR off might (again stress the might) help reduce the centrals but this only helps if EPR is the cause of the centrals. At this point we don't know if EPR is causing the centrals or not. I have my doubts because if EPR was the trigger for the centrals you most likely would have been seeing high central numbers long before now.
But it is worth trying....so reduce or turn off EPR. If you really need EPR for comfort to fall asleep you can use it in ramp only and make use of the ramp feature.

Your mask is horribly leaky...how old is it? Is something tired like the cushion or headgear causing the mask to move around a lot??? When is the last time you got a totally new mask?

Do you have facial hair?

You need to get the leaks under control first so we can see how well your settings do once leaks are removed from the equation.

Auto adjusting mode (apap) might be a better choice for right now. It's really hard to say one way or another based on the above reports which is why I request that you remove them from your storage and replace with reports showing the basics as in the examples thread.

So for now....turn off or reduce EPR...make use of the ramp feature if you just have to use EPR.
This will effectively raise your overall pressure which should help the obstructive stuff that needs more pressure and it might help with the centrals. At this point we don't know if the centrals are related to arousals caused by the obstructive events disturbing your sleep causing arousal related centrals...or if they are centrals triggered by using EPR (which I really doubt is the case but need to at least check it out)

And for now....figure out some way to improve the leak management if you can.
If your mask is old...get a new one.

Thank you for removing those unneeded screen shots from your attachment storage. It may help you in the future or someone else who comes along and needs/wants to use the attachment feature here.
This is something you have to do....I have moderator privileges but they don't include going into your account and deleting those attachments. Only you can do that.

thanks, Pugsy. here are new charts

Hi Pugsy, thanks for advice, deleted charts, posted new. Mask leakage - yes, I have facial hair as shaving causes skin irritation. I know for full face mask facial hair not a good idea.

Headgear is 4 month old, cushion a year or so.
Can buy new mask but not sure full face or pillows? Any thoughts?
Tried pillows with pressure 13.6, after 2 hours becomes annoying, will try again. Leaks are low with pillows.

Even with new full face mask leakage was high - maybe moving during night causes leaks.
Do you think pillows would be better?
Thanks

Thanks. Next time you post a screen shot replace the mask pressure graph with just the linear pressure graph...especially if you use auto/apap mode. No need to redo these recent images.

Facial hair and full face masks just don't play nice sometimes in terms of leak management. I know some people do successfully get it done and I don't know what they do differently but it may have something to do with the type of facial hair as in soft or coarse kind of thing.

I am female...no facial hair and I have never ever really used a full face mask because I just don't really like them and I haven't needed to so I am zero help with hints for hints in getting and keeping a good seal with FFM. Sorry.

Now I can maybe help with the nasal pillow fitting and comfort thing.
Which nasal pillow mask do you have? What was going on when you woke up after a couple of hours and had to ditch them?

Airfit P10, bought those couple of years but never used until now.
Feel fine for 2 hours or so, after that start to feel strong air flow, nostrils get irritated, need to remove pillows for a while.
Pressure was 13.6, maybe too high for pillows?

There are people who use the P10 at pressures over 20 cm....so there isn't a "too high with pillows" pressure thing but it may have just felt uncomfortable or something. I personally have seen pressures of 18 when I used to be using the P10. Slept right through it.

The P10 will be much easier to keep sealed so let's try to make them work.
Also if using auto adjusting pressures we might be able to use a little less pressure with them.
No guarantees though...just try and lets see what happens.

Thanks Pugsy! Tried to use P10 last night. Started with FFM for first 2.5 hrs, then switched to P10. With P10 leaks are low but still a lot of CAs during this time. Also P10 make nose very dry inside, despite humidifier. Any thought how CAs can be reduced? Fatigue is bad, probably CAs cause it? Also sleep very interrupted, waking up a lot.

Your fatigue issues are caused by crappy sleep for sure. CAs/centrals are a part of it but you are also having a lot of obstructive stuff as well. You just HAVE to get the leak situation fixed.
The first part of the night.....massive, massive large leaks. Tons of UAs and we don't know if they are central apneas or obstructive (OA & hyponea) in nature. Doesn't matter ....both central and obstructive are major sleep disrupters.

The only potential central reducer you could try is turning EPR off or just using it in ramp. I don't know if it will help or not though. You can try it but with this amount of large leak I have no idea if the machine can even sense events properly.
EPR can trigger centrals in some people and turning EPR off will only help IF (big if) EPR is the trigger. I am not so sure that EPR is the trigger in your situation. It wouldn't be impossible for the centrals to be caused by the arousals from all the obstructive stuff going on because of the leak. Meaning the crappy sleep is causing the centrals....not the centrals is causing the crappy sleep. For sure the obstructive stuff (allowed by the massive leaks) is causing the crappy sleep.
Crappy sleep will for sure cause daytime fatigue....no matter what the cause.

The full face mask is essentially useless right now. You are no where in control of the leaks with it.
Did you say the cushion was a year old? Certainly time for a new cushion but with facial hair it's going to be a real challenge.

Your pressures....impossible to know for sure if you need more pressure or not because the leaks are so massive that the machine probably can't sense correctly and/or respond correctly.

You absolutely have to get the leaks under control before we can accurately evaluate pressure needs.

We can see when you switch to the P10...leaks were better managed but still having some spiking.
Did you put the full face mask back on at around 3 AM? Leaks went to hell after that.

Thanks Pugsy! yes sleep is crappy, taking melatonin, no blue light after 8pm, go to bed and wake up at the same time but not much of improvement. Yes switched masks last night, large leak is FFM, low leak P10. Will buy new mask - do you think P10 more suitable for me than FFM? tomorrow will see Apnea Consultant