Sleep study proved CPAP is working, so why am I still so tired?

DankShroud · Post by **DankShroud** » Wed Mar 14, 2018 8:03 am

ChicagoGranny wrote: ↑
Wed Mar 14, 2018 7:39 am
#1
DankShroud wrote: ↑
Tue Mar 13, 2018 11:48 pm
What's unusual to me is that my hypnogram - the "sleep stage" chart - is peppered with dense, periodic awakenings where I move rapidly from a lower sleep stage to full wakefulness.
#2
DankShroud wrote: ↑
Mon Mar 12, 2018 9:25 pm
I was tested for other sleep disorders that night and the next day during a nap test and came out clean.

There is a big contradiction between #1 and #2. #1 can certainly make you feel bad. What did your doctor say about #1?

He wrote off the arousals as me "sleeping in a new place"

DankShroud · Post by **DankShroud** » Wed Mar 14, 2018 8:11 am

Mikebear wrote: ↑
Wed Mar 14, 2018 6:17 am
Look up the term "sleep debt", and relax a bit more. You need to find out how long your body REALLY needs you to be asleep, and build up to that amount every night.

I don't know about that. My sleep architecture feels interrupted; I still wake up randomly at night and have overly vivid dreams that I shouldn't remember if my sleep was good.

ChicagoGranny · Post by **ChicagoGranny** » Wed Mar 14, 2018 8:16 am

DankShroud wrote: ↑
Wed Mar 14, 2018 8:03 am
He wrote off the arousals as me "sleeping in a new place"

DankShroud wrote: ↑
Wed Mar 14, 2018 8:11 am
My sleep architecture feels interrupted; I still wake up randomly at night and have overly vivid dreams that I shouldn't remember if my sleep was good.

How about asking the doctor to revisit this issue? Arousals/awakenings seem to be a significant problem.

DankShroud · Post by **DankShroud** » Wed Mar 14, 2018 8:22 am

Pugsy wrote: ↑
Wed Mar 14, 2018 7:32 am

DankShroud wrote: ↑
Tue Mar 13, 2018 11:48 pm
Would it be worthwhile for me to share sleepyhead readouts from my CPAP?
Please post a typical night detailed report.
See here for what and how.
viewtopic/t158560/How-to-post-images-for-review.html
Maybe there's some little something there that might could be improved upon that might help you feel better.
Worth looking.

DankShroud wrote: ↑
Tue Mar 13, 2018 11:48 pm
What's weird is that these arousals don't correspond with any apnea/hypopnea events. I could post a picture if that would be helpful. Should I suspect UARS,
Something worth considering for sure. If that is the case then the detailed software reports may not help much because these machines don't really measure those low level obstructions that seem to go along with UARS all that much and we really don't have much to measure and instead have to rely on how we feel which is much harder to evaluate.
There is a way to change SleepyHead though to see if you are having many low level air flow reductions and have SleepyHead flag stuff it wouldn't normally flag.
More on that if you want to try it.

My CPAP usually reports an AHI of 3-5. My doctor told me that these "artifact" events are unrelated to me real AHI of 1. Could this be my CPAP reacting to UARS events?

Pugsy · Post by **Pugsy** » Wed Mar 14, 2018 8:27 am

DankShroud wrote: ↑
Wed Mar 14, 2018 8:22 am
My CPAP usually reports an AHI of 3-5. My doctor told me that these "artifact" events are unrelated to me real AHI of 1. Could this be my CPAP reacting to UARS events?

Dunno.

These machines react to air flow/reductions or the signs of sleep apnea....flow limitations, snores, OAs and hyponeas that make it past the defenses. If you have UARS and the flow reductions or limitations are so small they fall below the set algorithm parameters then the machine won't do a darn thing about them. Don't ask me what those parameters are because I don't know.

Your doctor may be thinking that "artifact" means awake breathing flagging. Awake flagging doesn't count.

DankShroud · Post by **DankShroud** » Wed Mar 14, 2018 10:30 am

Pugsy wrote: ↑
Wed Mar 14, 2018 8:27 am

DankShroud wrote: ↑
Wed Mar 14, 2018 8:22 am
My CPAP usually reports an AHI of 3-5. My doctor told me that these "artifact" events are unrelated to me real AHI of 1. Could this be my CPAP reacting to UARS events?
Dunno.

These machines react to air flow/reductions or the signs of sleep apnea....flow limitations, snores, OAs and hyponeas that make it past the defenses. If you have UARS and the flow reductions or limitations are so small they fall below the set algorithm parameters then the machine won't do a darn thing about them. Don't ask me what those parameters are because I don't know.

Your doctor may be thinking that "artifact" means awake breathing flagging. Awake flagging doesn't count.

So there's nothing to be done about UARS? The only solution I can think of is getting a mandibular advancement device and hoping it handles what the CPAP can't. Is there any pressure adjustment that could possibly take care of my apneas as well as these events?

Pugsy · Post by **Pugsy** » Wed Mar 14, 2018 10:39 am

DankShroud wrote: ↑
Wed Mar 14, 2018 10:30 am
So there's nothing to be done about UARS?

No, I didn't say that. What I said was you won't be able to gauge things IF (big IF) you have UARS from the data available from the machine.

CPAP is still the go to treatment for UARS but people have to rely more on subjective how they feel than the data available from the machine in an attempt verify effectiveness of treatment.
It's hard for people to wrap their head around measuring "how they feel"...they want numbers to verify something and when UARS is involved the numbers available aren't that much help.

Historically from what I have seen ...people with UARS tend to need more pressure than what the machine is reporting is dealing with the OSA side of things before they actually notice improvement.
Example...maybe someone only needs 10 cm pressure for the machine to report that the data it gathers is showing quite decent OSA prevention but maybe they might need 13 cm before they start actually feeling the good numbers.
I don't know that is what is going on with you...but only that it is possible.
UARS is a difficult diagnosis to make unless someone gets the sleep study done with the Pes device. Most of the time UARS diagnosis is made more from a rule out stand point.

D.H. · Post by **D.H.** » Wed Mar 14, 2018 10:43 am

In general, you should cap the high end of an AutoPAP lower than the machine max only if one of the following reasons:

1) You are experiencing Central Apneas under higher pressures that you did not experience under lower pressures.
2) You are experiencing discomfort (dry mouth, leaks, nasal discomfort, general discomfort), due to the higher pressures.

DankShroud · Post by **DankShroud** » Wed Mar 14, 2018 11:46 am

D.H. wrote: ↑
Wed Mar 14, 2018 10:43 am
In general, you should cap the high end of an AutoPAP lower than the machine max only if one of the following reasons:

1) You are experiencing Central Apneas under higher pressures that you did not experience under lower pressures.
2) You are experiencing discomfort (dry mouth, leaks, nasal discomfort, general discomfort), due to the higher pressures.

Good stuff. My current pressure is 11-20. I start at 11 because that's the pressure demonstrated by my sleep study to be effective. Unless I do have UARS, this is the ideal pressure, no? Also, is a CPAP with autoset features the same as an AutoPAP?

DankShroud · Post by **DankShroud** » Wed Mar 14, 2018 11:57 am

Pugsy wrote: ↑
Wed Mar 14, 2018 10:39 am

DankShroud wrote: ↑
Wed Mar 14, 2018 10:30 am
So there's nothing to be done about UARS?
No, I didn't say that. What I said was you won't be able to gauge things IF (big IF) you have UARS from the data available from the machine.

CPAP is still the go to treatment for UARS but people have to rely more on subjective how they feel than the data available from the machine in an attempt verify effectiveness of treatment.
It's hard for people to wrap their head around measuring "how they feel"...they want numbers to verify something and when UARS is involved the numbers available aren't that much help.

Historically from what I have seen ...people with UARS tend to need more pressure than what the machine is reporting is dealing with the OSA side of things before they actually notice improvement.
Example...maybe someone only needs 10 cm pressure for the machine to report that the data it gathers is showing quite decent OSA prevention but maybe they might need 13 cm before they start actually feeling the good numbers.
I don't know that is what is going on with you...but only that it is possible.
UARS is a difficult diagnosis to make unless someone gets the sleep study done with the Pes device. Most of the time UARS diagnosis is made more from a rule out stand point.

Dandy. So I could raise the minimum pressure one centimeter every night until I take care of these undetectable UARS events and feel relief. I don't see why this wouldn't work if UARS is really involved.

Pugsy · Post by **Pugsy** » Wed Mar 14, 2018 12:06 pm

DankShroud wrote: ↑
Wed Mar 14, 2018 11:57 am
Dandy. So I could raise the minimum pressure one centimeter every night until I take care of these undetectable UARS events and feel relief. I don't see why this wouldn't work if UARS is really involved.

I wouldn't be changing it every night if it were me.
People with UARS are usually what we call very sensitive...sensitive to a lot of things and most likely sensitive to changes in pressure.
Even more important for a person to "give it time" and let the body adjust.

You can try setting custom user flags in SleepyHead if you wish just to see if there are some flow restrictions that aren't enough to earn a hyponea or OA flag per your machine.
SleepyHead...Preferences/CPAP tab...lower left corner.
It will likely requite a rebuild of the data step to get them to show up. Rebuild is in SH under "data" top menu.

DankShroud · Post by **DankShroud** » Wed Mar 14, 2018 1:11 pm

Looking over my polysomnograph, it's likely that all those unaccounted-for arousals are RERAs. Since my study didn't measure/look for RERAs that didn't qualify as apneas or hypopneas, they just appear as random spikes in wakefulness on the hypnogram. Sigh. I'll call and ask the doctor to reexamine it.

Sleep study proved CPAP is working, so why am I still so tired?

Re: Sleep study proved CPAP is working, so why am I still so tired?

Re: Sleep study proved CPAP is working, so why am I still so tired?

Re: Sleep study proved CPAP is working, so why am I still so tired?

Re: Sleep study proved CPAP is working, so why am I still so tired?

Re: Sleep study proved CPAP is working, so why am I still so tired?

Re: Sleep study proved CPAP is working, so why am I still so tired?

Re: Sleep study proved CPAP is working, so why am I still so tired?

Re: Sleep study proved CPAP is working, so why am I still so tired?

Re: Sleep study proved CPAP is working, so why am I still so tired?

Re: Sleep study proved CPAP is working, so why am I still so tired?

Re: Sleep study proved CPAP is working, so why am I still so tired?

Re: Sleep study proved CPAP is working, so why am I still so tired?

Machine	Mask

Additional Comments: Pressure of 17-20, soft cervical collar, chin strap

Machine	Mask

Additional Comments: Auto PAP; 13.5 cmH2O min - 20 cmH2O max