New to ACPAP/UARS

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Seb-Sanfilippo
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New to ACPAP/UARS

Post by Seb-Sanfilippo » Mon Jan 16, 2023 2:02 am

Hi,
I haven't got the result of my sleep study yet but I suspect UARS because I have all the usual symptoms.
Already tried ACPAP (6-15, EPR 3) for 3 nights with very little success.
Can you tell me what you see in my data because I cannot make sense of it.
Thanks

Seb.
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Miss Emerita
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Re: New to ACPAP/UARS

Post by Miss Emerita » Mon Jan 16, 2023 12:05 pm

Welcome, Seb! If you told me you were feeling rested, I would think that made total sense, since your chart is unremarkable. But you're not feeling rested, and so that means focusing on some things that might not be an issue for other people.

First, I would suggest you turn off the ramp or raise your ramp pressure to 6 or 7. A pressure of 4 leaves many people feeling air-starved.

Second, you do have some flow limitations. These are just what they sound like: restrictions within your airway that don't amount to hypopneas or apneas but do, for some people, disturb sound sleep. If the restrictions originate within your nose, there's not much the machine can do about them, but if they originate farther down in your airway, in your pharynx, some EPR might help.

For that reason, I would suggest using an EPR of 2. This will lower your pressure by 2 each time you exhale; by the same token, it will raise your pressure by 2 when you inhale, and this little boost may help overcome the FLs. If this is comfortable for you, you can then set the EPR at 3. (That's the most you can get from this machine.)

Your leaks are well within the acceptable range as far as the functioning of the machine. But do they wake you up? If so, maybe we can make some suggestions about how to control them. But if they don't wake you up, I wouldn't worry about them.

Finally, you've used PAP only for a few days. A lucky few people feel great right away, but for most of the rest of us, there's a period of adjustment to the new sensations. Everyone is different, but you some patience while your body and mind get comfortable with the new experience.

And a P.S. If your sleep study shows that you do indeed have UARS, some experts would recommend you use a machine that can deliver more EPR (actually called pressure support on those machines). An excellent machine of that type is the ResMed Aircure 10 VAuto.
Oscar software is available at https://www.sleepfiles.com/OSCAR/

Seb-Sanfilippo
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Re: New to ACPAP/UARS

Post by Seb-Sanfilippo » Mon Jan 16, 2023 12:32 pm

Thanks Miss Emerita

I definitely do not feel rested, the fatigue is so severe I am unable to function at all

Thanks for your suggestion about ramp but isn't ramp only the pressure when you're awake?

The ENT told me I had a slightly deviated septum but I rarely wake up with a stuffy nose. Not sure what to make of that.

The EPR on my CPAP is set at 3 already and it feels fine.

I did read somewhere that BiLevel is recommended for UARS

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robysue1
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Re: New to ACPAP/UARS

Post by robysue1 » Mon Jan 16, 2023 12:48 pm

Seb-Sanfilippo wrote:
Mon Jan 16, 2023 2:02 am
Hi,
I haven't got the result of my sleep study yet but I suspect UARS because I have all the usual symptoms.
What symptoms of UARS/OSA do you have?

You need to get the results of your sleep study. If it doesn't show UARS or OSA, then xPAP won't help resolve your symptoms of daytime tiredness/sleepiness.
Already tried ACPAP (6-15, EPR 3) for 3 nights with very little success.
If you do have UARS/OSA, you need to understand: For most of us xPAP is not an instant success. What I mean by that is that for many people with UARS/OSA, it takes several weeks to several months of xPAP therapy before they start feeling noticeably better. In my case, I actually crashed and burned at the start of xPAP and for the first 4 months I felt far worse using xPAP than I did before my OSA was diagnosed. But I had a really awful time learning how to sleep well with the machine. About 6 months into therapy I started noticing very subtle improvements in how I felt mainly because I was keeping a sleep log for fighting insomnia at the time. Now? I look back on how I used to wake up (pre-xPAP) and wonder both why I tolerated it for so long and why it took me so long to adjust to therapy. But I'm sure glad I didn't just give up when the going got really, really tough. (The folks here at cpaptalk were a critical part of why I kept going.)
Can you tell me what you see in my data because I cannot make sense of it.
IF you said you felt like you had a really good night's sleep, then this data would be easy to interpret: The AHI is close to 0, you used the machine for over 8 hours, and while the leaks are not great, they are also "acceptable"---if they aren't waking you up all the time.

But you haven't indicated how you think about this night's sleep. Do you remember a lot of tossing and turning? Did it take you a long time to get to sleep? Do you remember multiple wakes in the night to fiddle with the mask? Or did you slap the mask on, fall asleep, and stay asleep until you woke up in the morning?

Just looking at the Flow Rate graph at this scale, it looks to me like you probably took about 15 minutes to fall asleep. But there also a bunch of places that look like you may have been very restless and/or awake and tossing and turning. Some of them are:
  • 0:30-0:45
  • 1:15-1:30
  • 2:30-3:00
  • 3:45-4:15
  • 5:00-5:30
  • 6:30-7:00
So if you were very restless and/or awake and tossing and turning during one or more of these periods, that may explain why you still feel sleepy or tired during the day time.

Do you have any history of bad insomnia? If so, how would you describe your insomnia?

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Pugsy
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Re: New to ACPAP/UARS

Post by Pugsy » Mon Jan 16, 2023 12:55 pm

EPR is set to "ramp only"...so once ramp ends there is no EPR.

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Seb-Sanfilippo
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Re: New to ACPAP/UARS

Post by Seb-Sanfilippo » Mon Jan 16, 2023 1:25 pm

Thanks robysue1
My symptoms are unrestful sleep, morning headache, dry nose and throat, neck stiffness, daytime fatigue
Over the month the fatigue got worse and I started developing anxiety, a general depressive mood, palpitations and acid reflux
I now often wake up during the night but I often get back to sleep easily
This lead to a few cases of insomnia but nothing major

Thanks Bugsy
I changed the setting to have EPR on through the night

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Pugsy
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Re: New to ACPAP/UARS

Post by Pugsy » Mon Jan 16, 2023 1:29 pm

Do you take any medications (even OTC) and if you do....what are they?

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Seb-Sanfilippo
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Re: New to ACPAP/UARS

Post by Seb-Sanfilippo » Mon Jan 16, 2023 1:38 pm

I take Trazodone, it's an antidepressant. Not sure what it's called in the US
Don't know what is OTC

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Pugsy
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Re: New to ACPAP/UARS

Post by Pugsy » Mon Jan 16, 2023 1:52 pm

Seb-Sanfilippo wrote:
Mon Jan 16, 2023 1:38 pm
Don't know what is OTC
Over the counter....medications/supplements that don't require a prescription.

How long have you been on the Trazadone and what is the dosage?

Where are you located?

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Seb-Sanfilippo
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Re: New to ACPAP/UARS

Post by Seb-Sanfilippo » Mon Jan 16, 2023 1:59 pm

The only OTC I take are VitaminD and an anti-inflammatory nasal spray recommended by the ENT
Took Trazodone for 3 weeks now at 100mg
I am in Brussels, Belgium

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Pugsy
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Re: New to ACPAP/UARS

Post by Pugsy » Mon Jan 16, 2023 2:08 pm

I assume you were given the trazadone to take at bedtime to help you either fall asleep or stay asleep. Is this correct?

You might want to take a serious look at the potential side effects as well as the half life for this medication.
It stays in your system for several hours (like 24 to 48 hours) before it is well out of your system and no chance of it causing the usual side effect of which drowsiness and fatigue are but just a couple of the known side effects (there are many others) that could also be impacting how you feel during the day.

It's going to be hard to evaluate cpap therapy effectiveness with the medication being in your system.

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Seb-Sanfilippo
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Re: New to ACPAP/UARS

Post by Seb-Sanfilippo » Mon Jan 16, 2023 2:17 pm

That's a fair point I hadn't thought about
It was prescribed to help me with sleep and also because the sleep doctor first thought that my complaints were mood related
I'll ask the doctor next week if and when I should wane off the drugs

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robysue1
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Re: New to ACPAP/UARS

Post by robysue1 » Mon Jan 16, 2023 2:25 pm

Seb-Sanfilippo wrote:
Mon Jan 16, 2023 2:17 pm
That's a fair point I hadn't thought about
It was prescribed to help me with sleep and also because the sleep doctor first thought that my complaints were mood related
I'll ask the doctor next week if and when I should wane off the drugs
Did you take the Trazodone on the night you had the sleep study done?

Until you actually see the results of the sleep test and know whether you have UARS or OSA and just how bad your untreated UARS/OSA actually is, I would hesitate to stop the Trazodone.

Here's the thing: CPAP fixes sleep disordered breathing issues. But it doesn't fix any other issues that can disturb your sleep and lead to daytime symptoms of extreme fatigue and non-restful sleep.

If you think the Trazodone is helping you get to sleep and stay asleep, it may not be worth trying to wean off of it.

On the nights that you have used the CPAP how much sleep do you think you actually got? The data you posted shows that you used the CPAP for 8 hours, but how much of that time were you actually asleep?

It can take a while for a body to get used to sleeping with a CPAP. And for some people, when they start CPAP there's a lot of tossing and turning caused by dealing with leaks or trying to learn how to turn over without getting caught in the hose. Until you are sleeping well with the CPAP and until any other sleep issues have been dealt with, you might not see as much improvement from sing CPAP as you were hoping to see immediately.

_________________
Machine: DreamStation BiPAP® Auto Machine
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: Also use a P10 mask
Joined as robysue on 9/18/10. Forgot my password & the email I used was on a machine that has long since died & gone to computer heaven.

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robysue1
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Re: New to ACPAP/UARS

Post by robysue1 » Mon Jan 16, 2023 2:45 pm

Seb-Sanfilippo wrote:
Mon Jan 16, 2023 1:25 pm
Thanks robysue1
My symptoms are unrestful sleep, morning headache, dry nose and throat, neck stiffness, daytime fatigue
I would suggest keeping a short sleep log where you track these things with a simple to use scale each day:
  • Sleep quality: 0 = very restful, 5 = awful
  • Morning headache: 0 = none, 5 = awful
  • Dry nose and/or throat: 0 = none, 5 = awful
  • Neck stiffness: 0 = none, 5 = awful
  • Daytime fatigue: 0 = plenty of energy, 5 = zombie all day long
Everything except daytime fatigue ought to be recorded when you first get up in the morning; the daily fatigue rating should be done at the end of the day. The goal is to see if over the next several weeks if you start recording fewer 4's and 5's and more 1, 2, and 3's. Don't expect to record a lot of 0's as least for a while, and really celebrate any 0 that you do get to record.

My guess is that if untreated UARS/OSA is the cause of the morning headache and neck stiffness, you may see some relief on those issues before the unrestful sleep and daytime fatigue starts to get better. The dry nose and throat issues may be related to something other than sleep disordered breathing, but in any case CPAP itself can aggravate them. If you think the CPAP is making the dry nose and throat worse, there are things that we can tell you to try to minimize the CPAP therapy's affect on them.
Over the month the fatigue got worse and I started developing anxiety, a general depressive mood, palpitations and acid reflux
I now often wake up during the night but I often get back to sleep easily
This lead to a few cases of insomnia but nothing major
You may also want to investigate sleep hygiene and do what you can to keep the insomnia beast from getting worse as you are trying to learn how to sleep with the CPAP. The night you posted the data for has some evidence in the flow rate graph of periods of restlessness and/or wake at several points during the night. How well would you say that you slept on that night in terms of your insomnia?

_________________
Machine: DreamStation BiPAP® Auto Machine
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: Also use a P10 mask
Joined as robysue on 9/18/10. Forgot my password & the email I used was on a machine that has long since died & gone to computer heaven.

Correct number of posts is 7250 as robysue + what I have as robysue1

Profile pic: Frozen Niagara Falls

Seb-Sanfilippo
Posts: 24
Joined: Mon Jan 16, 2023 1:49 am

Re: New to ACPAP/UARS

Post by Seb-Sanfilippo » Mon Jan 16, 2023 2:48 pm

Did you take the Trazodone on the night you had the sleep study done?
Yes
If you think the Trazodone is helping you get to sleep and stay asleep, it may not be worth trying to wean off of it.
I am not really sure I need it to fall asleep, I was always a fast sleeper. It certainly doesn't prevent me from waking up multiple times per night.
I'll wait before I wean off but Bugsy had a point about side effects like fatigue, which I read is one of the most common
On the nights that you have used the CPAP how much sleep do you think you actually got?
I sleep through the whole night but I wake up a lot. Usually fall back to sleep very quickly
And for some people, when they start CPAP there's a lot of tossing and turning
I also suffer from light arthritis of the hips and sometimes I need to turn around the ease the pain
First I thought that arthritis might be the cause of my fatigue but I recorded my breathing at night and it sounded like I am making huge efforts to breath in and/or out