APAP seems to work, but still tired

Thanks to RG I got to see some numbers from my APAPs LCD.
The week medians were:
Pressure 13,00
Leak(L/s) 0,00
AHI 3,90
AI 0,90
HI 3,10

The funny thing is that I'm still tired.
Could it be that sleeping as a trunkface disturbs my sleep structure?
Can I hope for getting used to it and sleep better?

The leak looks suspicious?
Also, no data for last night. Why?

The thing is ResMed Autoset Spirit (I).

Bump...

turbosnore wrote:Thanks to RG I got to see some numbers from my APAPs LCD.
The week medians were:
Pressure 13,00
Leak(L/s) 0,00
AHI 3,90
AI 0,90
HI 3,10

The funny thing is that I'm still tired.
Could it be that sleeping as a trunkface disturbs my sleep structure?
Can I hope for getting used to it and sleep better?

The leak looks suspicious?
Also, no data for last night. Why?

The thing is ResMed Autoset Spirit (I).

The leak rate looks fine to me. The machine takes into consideration the mask's normal leak rate..that is assuming you've got the correct mask type selected. As far as the lack of data for the previous night is concerned, if you don't take the data before 12 noon, it disappears and falls into the weekly category. If you've only been on cpap/auto pap for a little while, it may take some time before you regain your sleep from a deprived state.

Oh yeah, this morning I remembered that the day of the machine begins at noon.

Anyway, the setting was 9-13. I got a datacard from the clinic with the new settings and now the settings are 9-16.
After one night sleep the pressure was 16, ahi was 7.1, AI was 0.3 and HI 6.8.
Whay happened? Maybe, because I have a very mild flu that tends to stuff my nose during the night?
Or could it be that I have some very subborn hypopneas for which no pressure is enough?

I was originally titrated at 11.something.

If you're sick... it could be impacting it.

turbosnore wrote:The funny thing is that I'm still tired.

Even if "cpap" is doing its part of the job fine, there are many other things that can cause a person to feel tired or sleepy... other health issues, sleep hygiene issues, med side effects, hormones...the list could go on and on. At least if a person is using cpap, the "breathing during sleep" issue is taken care of. For some, that's all it takes to feel good again. But for many, there can be other problems still at play that have nothing to do with breathing during sleep. Sometimes we have to be our own detectives or get other possible health problems checked out -- thyroid, GERD, med side effects and med interactions if on meds. Could also be something as simple as needing a better mattress, or a good vitamin/mineral supplement, or making the sleeping environment quieter, darker, cooler, whatever.

turbosnore wrote:Could it be that sleeping as a trunkface disturbs my sleep structure?

Sure could. There's nothing "natural" about trying to sleep with a mask on one's face. Especially in the early months of using "cpap", some people can have so many struggles with finding a comfortable mask and getting used to sleeping in this crazy new way, the equipment itself can cause a lot of sleep disruption. In many ways, it's a tradeoff...trading off the more comfortable way we used to "sleep" (suffocate, actually, even though we were unaware of that) for a safer, better, but less comfortable way to sleep (and actually be able to breathe while we sleep.) We're also trading off the apneas that left us tired, for equipment issues that leave us just as tired, or in many cases, even MORE tired than before.

turbosnore wrote:Can I hope for getting used to it and sleep better?

Yes! You have a much better chance of that happening than most people who are prescribed "cpap" out there in the world at large. You have a great chance of that happening eventually, because you found your way to a message board that offers so many people helping each other to make it work. Just keep reading, keep asking questions, and keep working on making everything about your setup as comfortable as you can. You'll get there.

turbosnore wrote:Oh yeah, this morning I remembered that the day of the machine begins at noon.

Anyway, the setting was 9-13. I got a datacard from the clinic with the new settings and now the settings are 9-16.
After one night sleep the pressure was 16, ahi was 7.1, AI was 0.3 and HI 6.8.
Whay happened? Maybe, because I have a very mild flu that tends to stuff my nose during the night?
Or could it be that I have some very subborn hypopneas for which no pressure is enough?

I was originally titrated at 11.something.

If I were to take a "wild guess", it would be that the pressure changes during the night are disturbing your sleep and leaving you tired.

Den

If I were to take a "wild guess", it would be that the pressure changes during the night are disturbing your sleep and leaving you tired.

I slept worse with CPAP and pressure 12.

When I put the gear on, I get used to the pressure within a minute so that I don't notice the difference.
Also I stop feeling the mask on my face within about the same time.

Anyway, next night: pressure was 15.1, AHI 9.1, AI 2.7 and HI 6.4.
Any ideas why am I getting to the wrong direction?
The upper pressure limit was 13 and the numbers were quite good. Now the upper limit was raised to 16
and the numbers have gotten worse (AHI 3.9 -> 9.1). Why does the machine raise the pressure so high, if lower
pressure gives better numbers? Or could there be something else going on?

Your brand of machine scores Hi's higher than most, try to get the AI as low as possible and control leaks. Jim

turbosnore wrote:

If I were to take a "wild guess", it would be that the pressure changes during the night are disturbing your sleep and leaving you tired.

I slept worse with CPAP and pressure 12.

When I put the gear on, I get used to the pressure within a minute so that I don't notice the difference.
Also I stop feeling the mask on my face within about the same time.

Anyway, next night: pressure was 15.1, AHI 9.1, AI 2.7 and HI 6.4.
Any ideas why am I getting to the wrong direction?
The upper pressure limit was 13 and the numbers were quite good. Now the upper limit was raised to 16
and the numbers have gotten worse (AHI 3.9 -> 9.1). Why does the machine raise the pressure so high, if lower
pressure gives better numbers? Or could there be something else going on?

How long did you try it there?

What are your pressure settings on the machine?

Why are you raising the maximum pressure when the numbers get worse?

Are you aware of the limitations of the A10 algorithm in the ResMed machines? It's been discussed here many times.

If you don't have the software to download and SEE what's going on during the night (only using the numbers from the LCD), you're just "stabbing in the dark" by changing pressure settings with no justification for doing so.

Den

I have had mornings with low numbers on APAP, yet very tired...so I'm surprised to see flat leak line and low AI/HI. When I catch these days on software, I see that I had my sometimes only apnea of the night for 10 seconds or so, JUST BEFORE I WAKE UP FOR THE DAY!! No wonder.....I'm starting the day with an o2 deficit!!

I don't know yet how I can address these...and will be discussing in less than a month with my great sleep doc. I'll let you know what he says.

Wishing you good nights and better days,
J

To wulfman:
I was on CPAP 12cm for 3 weeks, (the machine - Escape - didn't collect data), then a about a week on APAP with pressure 9 - 13 cm.
the numbers from the week were:
Pressure 13,00
Leak(L/s) 0,00
AHI 3,90
AI 0,90
HI 3,10
After getting the numbers I changed the settings (got a datacard from the clinic) to 9 - 16 cm.
and now, the third morning , numbers are:
Pressure 15,80
Leak(L/s) 0,00
AHI 6,80
AI 0,80
HI 6,00
The numbers of the two other mornings are in previous postings.

What i don't get is why does the machine raise the pressure even if AHI gets worse.
The upper limit was changed, because the pressure was always up to the max.

I don't have the SW, and the DMEs in finland don't even sell it to individuals, but to medical staff only.
The machine is also lent me for free (long term) from the clinic, and may change, so buying the SW is not a good idea,
until the situation is stabilised and I can trust that the machine is not going to be changed soon.
Actually, even using the clinical menu is a bit "illegal".

To JayC:
Typically the pressure is lower in the morning, like today it was 11.something.

To Goofproof:
I guess my leaks are pretty much under control: 0.0.
I was a bit suspicious about this, but I was explained, that the machine nows the expected leak rate for
the mask, and the number gives excessive leak.

The "pressure" number on the screen in the pressure you spent most of you your time "at or below".

When I (with software) saw the early morning apnea event that I wrote about, it was my only apnea for that night. The pressure listed on the screen in the morning did not reflect the pressure the machine briefly increased to in addressing that apnea. And according to the software, I had AHI under 2, ZERO apnea (which statistically was correct) and zero leaks. The summary said it was a good night.

And I felt like total crap.

My awakening experience was of probably low oxygen stats, and the apnea probably roused me before I was actually ready to awaken, but I was "rested" enough to not be able to go back to sleep, especially given that it was near time for me to get up to get to an appointment.

I guess my point is that the screen data is better to have than not..... but it doesn't tell you some thimgs you need to know IF you are still feeling unrested or poorly.

J

turbosnore wrote:To wulfman:
I was on CPAP 12cm for 3 weeks, (the machine - Escape - didn't collect data), then a about a week on APAP with pressure 9 - 13 cm.
the numbers from the week were:
Pressure 13,00
Leak(L/s) 0,00
AHI 3,90
AI 0,90
HI 3,10
After getting the numbers I changed the settings (got a datacard from the clinic) to 9 - 16 cm.
and now, the third morning , numbers are:
Pressure 15,80
Leak(L/s) 0,00
AHI 6,80
AI 0,80
HI 6,00
The numbers of the two other mornings are in previous postings.

What i don't get is why does the machine raise the pressure even if AHI gets worse.
The upper limit was changed, because the pressure was always up to the max.

I don't have the SW, and the DMEs in finland don't even sell it to individuals, but to medical staff only.
The machine is also lent me for free (long term) from the clinic, and may change, so buying the SW is not a good idea,
until the situation is stabilised and I can trust that the machine is not going to be changed soon.
Actually, even using the clinical menu is a bit "illegal".

To JayC:
Typically the pressure is lower in the morning, like today it was 11.something.

To Goofproof:
I guess my leaks are pretty much under control: 0.0.
I was a bit suspicious about this, but I was explained, that the machine nows the expected leak rate for
the mask, and the number gives excessive leak.

First of all, I think it would be in your best interests to at least SEE what kind of data you will get from a CPAP setting of 12 since you didn't have a data-capable machine to begin with.

My guess would be that the reason your machine is always going to the maximum pressure is that it's chasing Snores, and Flow Limitations (leaks don't appear to be an issue in your case). The ResMed machines will only pursue Apneas above the pressure of 10 cm. if they are preceded by snores or flow limitations. And, since ResMeds count flow limitations (partial hypopneas) in the AHI, it's super-sensitive to variations in breathing changes. If the pressure changes are having an adverse affect on your breathing pattern (and in essence causing additional flow limitations), then it may be creating a self-perpetuating condition.

Den

Is it possible the apneas at the higher pressure are centrals? I had some centrals in the lab when they tried higher pressures and if I set my upper limit too high on the Autoset it chases snores and then goes high enough to create central events--my guess as to why my apneas rise when upper pressure is increased.

I leave it at 7-12 and it's smooth sailing with AI of 0.0 or 0.2 many nights.