3 months of APAP and still fatigued daily - OSCAR results

Hey guys,

I am really in need of some advice, as I cannot function anymore.
OSA is really taking over my life, I suspect I have UARS actually.

In May 2022 I was diagnosed with mild to moderate OSA at a sleep lab.

Since late May I have been using a ResMed Airsense 10 Auto machine + F20 mask and have had several troubles that I have partially been able to successfully address.

My issue is that the way I feel after sleeping seems to be luck of the draw. Regardless of how I use the machine. Most of the time I am waking up absolutely wrecked, like a Zombie. It’s not that I am necessarily overly sleepy. It’s more the general feeling of utter exhaustion.

Brain fog, headaches, stingy red eyes, and the feeling of a heavy head like I have been partying for 3 days in a row are my main symptoms. This comes with mood swings, concentration / memory issues and zero energy, also very low libido which is affecting my relationship too.

This happens nearly every single day.

My first issue is that I am a mouth breather, not just at night but in everyday life – This now makes sense as it has always been the case since early childhood memories. I had my tonsils removed and my polyps made smaller around the age of 13. Still, every day I feel like I have trouble always breathing through my nose, more like it does not come naturally, so my mouth is open the whole day.

Using nasal spray that numbs my blood vessels helps tremendously and IU do feel a real difference mostly the next day with most symptoms gone, however I am not supposed to use it more than 3 days in a row. Now I have an appointment in 1 month with an ENT to check my nasal passages and see if I can get an operation done, I am guessing that might help.

When I started using the machine, I had severe problems with dry mouth issues which I have been able to address mostly successfully by cranking up the humidity to the max setting and setting it to 29C (84.2F) and 2 x using Xylimelts tablets nightly, otherwise I wake up from dry mouth.

In terms of how long I have been able to use the machine, I have had a little more success. Usually manage around 5-8 hours per night now, but often still feel wrecked the next morning as stated above.

It’s worth mentioning that I have had blood tests done, everything seems to be fine, though my Testo and Iron levels are on the lower side, but apparently within range.

Below are my results from the sleep lab:


DOB (dd/mm/1985): Height (cm): 177 Weight (kg): 82 BMI (kg/m2): 26.2

Summary Sleep Architecture
Time available for sleep (min) = 467.0 Sleep latency (min) = 75.0 Total sleep time (min) = 257.5 REM latency (min) = 77.0 Wake after sleep onset (min) = 134.5 NREM sleep (min) = 172.0 Sleep efficiency (%) = 55.1 REM sleep (min) = 85.5

Respiratory*, Movement and arousal events Total RDI (events/hr) = 7.0 Minimum SpO2 (%) = 91 Total AHI (events/hr) RERA index = 6.8 = 0.2 ODI (desat/hr) = 3.0 RDI in NREM (events/hr) RDI in REM (events/hr) = 2.1 = 16.8
Limb Movement (Movement/hr)= 0.0
Total arousal index (arousals/hr)= 21.9 Limb arousal index (arousals/hr)= 0.0



So, these are my issues, and my questions and worries are:

Am I going anywhere with this?
Do I just need to give it more time, months, years?
Or am I even doing something wrong like keeping my EPR settings on or other settings like ramp on AUTO?

What more can I do to feel rested and normal again in life?



TL;DR: Using CPAP for months, still no improvement and don’t know what else to do. Losing my life.

And here some results from OSCAR:

https://imgur.com/a/AxiyAD7

So on the report you shared from Aug 9 you got about 6 1/4 hours on the machine but we can tell that you weren't asleep the entire 6 plus hours.
I can see at least 3 breaks in therapy where the machine was turned off. Two in the middle of the night and looks like one right at the end of the night where you may have tried to fall asleep again and then just got up.

Any idea why the fragmented sleep?
Is this typical of your night? Always have 2 or 3 wake ups during the night where you turn the machine off?
Do you have very many wake ups where you DON'T turn the machine off as well?

Which is it for an overall average of hours of machine usage...5 or 8?

Can you get me an image from the Overview page from OSCAR....the Usage graph along with Session times graph?
Also a screenshot of the Statistics page in OSCAR.

Couple of other standard questions.
Do you take any medications of any kind (even OTC) and if so, what?
Do you have any other physical or mental health issues going on that might impact sleep or how you feel?

Pugsy wrote: ↑

Thu Aug 11, 2022 5:38 am

So on the report you shared from Aug 9 you got about 6 1/4 hours on the machine but we can tell that you weren't asleep the entire 6 plus hours.
I can see at least 3 breaks in therapy where the machine was turned off. Two in the middle of the night and looks like one right at the end of the night where you may have tried to fall asleep again and then just got up.

Any idea why the fragmented sleep?
Is this typical of your night? Always have 2 or 3 wake ups during the night where you turn the machine off?
Do you have very many wake ups where you DON'T turn the machine off as well?

Which is it for an overall average of hours of machine usage...5 or 8?

Can you get me an image from the Overview page from OSCAR....the Usage graph along with Session times graph?
Also a screenshot of the Statistics page in OSCAR.

Couple of other standard questions.
Do you take any medications of any kind (even OTC) and if so, what?
Do you have any other physical or mental health issues going on that might impact sleep or how you feel?

Firstly, thank you so much for taking your time! To answer your questions:

I can see at least 3 breaks in therapy where the machine was turned off. Two in the middle of the night and looks like one right at the end of the night where you may have tried to fall asleep again and then just got up.

Any idea why the fragmented sleep?

I thought this was normal?

Before I was diagnosed, I would pee like 5 or more times a night and thought something else was wrong with me. Got it all checked out though, blood tests, Urologist and what not. All good thank god.
My gf is saying, since I started with CPAP I am "only" going maybe 2 or max 3 times per night. So the reason you see these fragmented sleep patterns, is because I am waking up with the urge to pee, so I need to disconnect the mask to go. This causes me to turn the machine off intermittently.
I always turn the machine off because I don't want to wake up my partner when I go. I do NOT recall waking up and leaving the machine on and falling back asleep.

BTW, 09/08 was an extremely bad day, the next day 10/08 was extremely good, however I thought that might have to do with me taking half a Valium and also having a better mask seal that night. If I myself compare the leakage rate from both nights in comparison, the latter has as good as no leakage.

Which is it for an overall average of hours of machine usage...5 or 8?

I would say this is getting a lot better and I am going towards 7,8 hrs now. On average see the attached ResMed chart please:
https://imgur.com/a/Dd3W1Nl

Can you get me an image from the Overview page from OSCAR....the Usage graph along with Session times graph?
Also a screenshot of the Statistics page in OSCAR.

https://imgur.com/a/VvJ2AlP

Couple of other standard questions.
Do you take any medications of any kind (even OTC) and if so, what?
Do you have any other physical or mental health issues going on that might impact sleep or how you feel?

Well, I use nasal spray sometimes, but very occasionally Otravin and also Flixonose. But as said just occasionally. I do have to say I have had better nights even good night when I use Otravin as I
can finally breath properly through my nose for a few hours.

In the past I did have depression and a bit of a traumatic childhood. But have done a lot of therapy and feel mostly well now, I am actually a happy man

Let me know if you need anything else, keen to see what my ENT says on Monday too.

How old are you?
Male or female?
Any chance you are male and of an age where nocturia could be possibly related to the prostate?
Waking up to pee even reduced to 2 or 3 times a night from 5ish is still not "normal".
Nocturia is a common side effect of sleep apnea and the fact that you have cut down the pee breaks by 50% points to at least the therapy is working but maybe there is something else also being a factor in the nocturia.

So number one your sleep is fragmented with wake ups to go pee and that canmess with overall sleep quality for one thing.
You may not be getting the optimal amount of sleep in each sleep stage because of the fragmented sleep.

And from the usage hours you really didn't start getting enough hours consistently until the last of July. So maybe you need more consistent quantity of hours.

Your Sept 9 detailed report isn't all that horrible and if that is a "bad" night then I would suspect the "good" night to be really unremarkable. I don't see anything there that is just screaming "fix me".
The only thing I can see is the fragmented sleep which can mess with how we feel during the day...
and the fact that you really didn't start using the machine consistently long enough until the later part of July.
It was hit or miss until then.
Definitely not enough hours or zero hours some nights of using the cpap or even sufficient quantity of sleep in general.

Thanks mate!

I am 37 male. I did have a recent colonoscopy done and also an Endoscopy. Im not sure if they look at prostate issues, but also had a doc do "the check" and he couldn't feel anything unusual.
Im very sure it has to do with fragmented sleep as you say. When I did take a valium( I know not optimal solution), I wake up refreshed, I guess cause my body is staying asleep mostly and not causing me to go and pee all the time.

Yes, the usage gap you see is me giving the rented machine back and buying one outright. As you can see I am getting better at consistency.

Hoping that continuous usage will help me get used to everything. Also, do feel my lungs hurting slightly mornings, nothing major - I guess just the machine working my lungs.

Any input on UARS in general with me?

I guess we should see my results in 2-3 months from now?

Koalamanx wrote: ↑

Thu Aug 11, 2022 6:45 pm

do feel my lungs hurting slightly mornings, nothing major - I guess just the machine working my lungs.

This is quite common and it is sort of the machine working the lungs but not exactly. General chest wall soreness or tenderness happens because of the extra "work" that the chest muscles do exhaling against the pressure.
It's a different kind of exercise that your chest wall muscles are doing from what they are used to doing.
It's no different than going to the gym and doing a new work out and exercising new muscles in a different manner and you wake up with sore muscles. With time as those muscles get used to the new workout the soreness fades away.
This will happen to your chest wall muscles as well. 2 to 4 weeks and the soreness should be almost gone.
The cause of the soreness isn't from the air going into the lungs but instead your muscles are having to work harder during the exhale part of the therapy.

Koalamanx wrote: ↑

Thu Aug 11, 2022 6:45 pm

I am 37 male.

Way too young to think prostate issues IMHO and if the doctor did the old finger probe thing...and didn't mention anything then it is doubtful the nocturia is related to enlarged prostate.

Noctoria is a very common symptom associated with untreated sleep apnea. It's a bit of a complicated thing but the short version is that when the body experiences the stress of stopping breathing, O2 drops, etc the heart secretes a stress hormone call ANP or Atrial natriuretic peptide
https://pubmed.ncbi.nlm.nih.gov/31968025/
This stress hormone goes into the blood stream and makes its way to the kidneys and when the kidneys see it then the kidneys kick into overdrive and we all know what happens when kidneys work hard....lots of urine gets produced and we wake up with a full bladder and have to go pee.
I had this symptom myself and I am female...I was waking up about every hour on the hour with a painfully full bladder each time. It was one of the very first unwanted symptoms I had go away with cpap therapy. It is extremely rare if I have to get up in the middle of night even one time now and when I do it is usually because I drank something I shouldn't too close to bedtime. Caffeine is my bad thing....caffeine is a dieuretic and also makes the kidneys work harder.

There is also this thing called over active bladder that is independent of sleep apnea or the prostate and can happen to both men and women.
I don't know that is your problem but if after being on cpap consistently for a month and you are still having to get up and pee 2 or 3 times a night and with a painfully full bladder....talk to your doctor about the situation.
Also make sure not to drink large quantities of fluids right at bedtime and for sure look for any fluid/food that might have dieuretic properties....
At 37 you shouldn't be needing to get up and pee 2 or 3 times a night and just the wake ups and fragmented sleep could mess with your sleep quality/architecture.

There's a good explanation of why we don't want fragmented sleep and why each sleep stage and in the desired % amounts
to our overall sleep needs for the restorative powers of sleep to work their magic.
The article itself is about alcohol and sleep but when you read it just substitute the word "anything" every time you see alcohol. You are looking for the explanation of why sleep and stages are important and not so much alcohol itself.
It can be anything in life that is messing with our sleep.
https://www.sleepfoundation.org/nutriti ... -and-sleep

Koalamanx wrote: ↑

Thu Aug 11, 2022 6:45 pm

Any input on UARS in general with me?

Unfortunately these machines are designed to respond to and record sleep apnea related stuff and not UARS stuff.
Auto adjusting mode won't really be much help. Typically it responds to snores, flow limitations, OAs, and hyponeas.
It was never designed for the very subtle changes that can occur in the airway which can cause arousals and disturb sleep.
Plus you say you sleep fairly soundly except for the peeing thing. Usually people with UARS report highly fragmented sleep with LOTS of arousals.

UARS is a difficult diagnosis to make and even harder to have any sort of standard out of the box treatment.
Lots of trial and error and lots of your having to rely on subjective feelings much more so than what you see the machine reporting.

RERAs Respiratory Event Related Arousals is something your machine will flag IF you had any but at this point you aren't having any. With UARS we would expect to see some RERAs if you were still having some.
On your sleep study that would be the RDI and yours isn't all that high.
I have my doubts as to UARS being your problem. No RERAs and flow limitation graph isn't all that exciting either.

At any rate you need a lot more time with consistent usage and try to do whatever is necessary to reduce the pee breaks and then see how you are doing.
Perhaps the brain is just telling you that "you are awake might as well go pee" out of habit more than a full bladder "I am going to bust a gut if I don't go pee".

Koalamanx wrote: ↑

Thu Aug 11, 2022 6:45 pm

When I did take a valium( I know not optimal solution), I wake up refreshed, I guess cause my body is staying asleep mostly and not causing me to go and pee all the time.

You are probably sleeping better, more soundly, in general with the aid of the medication.
When you sleep better you will feel better. There's a time and place for meds like Valium as long as it is short term but maybe you could try something over the counter that could help and not be such a potential problem as Valium?????
Something to have a chat with your doctor about maybe????