After 6 years of APAP, any ways to improve quality of life?

[gingerkitty]

I've been using my APAP successfully for about 6 years now and am 35 years old currently. I still have some residual daytime sleepiness and some inability to concentrate, so my doctor put me on a 50-100 mg dose of provigil about 1-2 years into treatment. This medication is only really used Monday through Friday, and most days are 50 mg, but busier days 100 mg.

My concern is that I don't really like taking provigil, but I wish there was something else I could work on to reduce this need. My OSCAR screenshots with last night and last week's data, and charting from last night, are attached. I use Resmed's Airsense 10 in APAP mode with 8-12 cm H2O pressure settings and EPR of 1 cm H2O. My mask is the Resmed P10 nasal pillows, which are also comfortable.

At diagnosis, my AHI was in the 5-10 range, but some symptoms would be considered much more severe than the medical classification of mild. This makes me think that despite a mild AHI, my body for whatever reason, has less energy.

I would appreciate any ideas others might have. Some questions from me are:

1. Is there a benefit from oximetry data? If it found anything, would supplementing with oxygen make sense? If worth pursuing, how do I get a reliable enough of a reading for a doctor to use - or do I need a sleep study of some sort with my device?

2. Are there any other treatment options that I should consider? Would BiPAP or any other devices potentially have a benefit? I doubt this, but still wanted to ask.

3. Are there any other standard lists of things to check for that can cause these issues? I do normal annual bloodwork with my PCP and have those things under control, but is there any aspect I should pay more attention to, or tests I should inquire about?

Thanks in advance.

[Julie]

No Oscars... the forum can't accommodate more Sshots right now, so post on Imgur.com and leave that link in this thread. When experts see your results, they will likely suggest any adjustments they might feel are needed.

[gingerkitty]

Thanks for the reminder Julie.

The screenshots are here now: https://imgur.com/a/HvIVd49

[pisco21]

I'm not an expert on interpreting the charts, however your charts look very similar to mine. Flow limitations occur, with the expected reaction of pressure increase, but usually ends up in a hypopnea or apnea. I just met with my sleep doctor, and she increased my min pressure to just under the 95% level (your body seems to want it that high anyway), and increased the max pressure to the point where its still comfortable (so the pressure doesn't wake me, she'd rather have me remain asleep). I only changed it a few days ago, but so far it seems good.

We started down this path because my watch noticed my O2 dropped significantly during the night. OSCAR and SleepHQ helped to correlate the drops with the flow limitations and events. So, reduce those and you increase your O2 sats. And as I said, it's only a few days so time will tell, but O2 drops dropped quite a bit, and only spending a minute or 2 below 92% over the course of the night...

Others will likely offer better interpretation, but the patterns looked similar to mine, so I thought I would comment.

[Julie]

Hi again and thx for chart. Just curious as to why your max setting is only 12, rather than the more usual 20 - it almost looks as if it could be keeping the min. 'capped' when it might want to go higher. If there is no current reason for it (at 12) could you try e.g. even 15 for a couple of nights to see if it makes any difference?

As far as your other Q's go, I'm not a tech expert at all and others should respond soon.

[palerider]

Thanks for the reminder Julie.

The screenshots are here now: https://imgur.com/a/HvIVd49

Set your min pressure to 10, smooth out that pressure roller coaster.

[Miss Emerita]

Many of your pressure changes are being driven by changes in your flow limitations. You might sleep better with fewer pressure changes, so raising your minimum to 10 sounds like a good experiment.

After you've done that for maybe a week, evaluate how it went. Was it reasonably comfortable? Did you see a change in your AHI or FLs in one direction or another?

If all seems well at that point, I would recommend that you increase your EPR, which may decrease your FLs. Try increasing it to 2, raising your minimum pressure to 11 to make sure you're still getting a pressure of 9 when you exhale. If that all goes well, then you could try EPR of 3, with a minimum of 12.

On the home page of Oscar, you'll see a list of oximeters whose data you can export to Oscar. You might give one of them a try, or see whether your doctor's office can provide you with a recording oximeter for a week or so. It doesn't sound as if there's a lot of reason, from what you've told us, to suspect you need supplemental O2, but why not take the steps to put your mind at ease on that score!

Finally, about tests beyond a basic blood panel. Here are the ones that occur to me: thyroid function, iron/anemia (several different tests in this category), B-12 levels, B-9, vitamin D, testosterone if you're male, markers of connective tissue diseases (a family of autoimmune diseases), Lyme disease, diabetes, liver function.

You've probably already been through this with your doctor, but it can help to describe your experiences as clearly as possible. One important distinction is between sleepiness and fatigue. You mention sleepiness; is your experience that you want to nap during the day? That's definitely sleepiness. Or is it more that you have no energy or feel worn out? That's probably best described as fatigue. Giving examples to illustrate what you mean by brain fog can be helpful to the doctor, e.g., in my work I need to be able to review a spreadsheet and figure out what it's telling me, but I just stare at the numbers and can't really analyze them. Or I couldn't think of the word "windshield" and had to use the work-around "window on the front of the car". (That was one of mine!) Or I speak more slowly than I used to because I'm thinking more slowly. Or I can't follow a long train of argument from beginning to end.

I encourage you to pursue your issues further with your doctor. People can have the combination of apnea plus some other condition that leaves them without the ability to function normally during the day.

[gingerkitty]

Miss Emerita, Julie, and Palerider - All three of you gave great responses. I can and will try raising the pressure ranges and changes in the EPR level too. Great ideas.

Miss Emerita - thank you for going through each concern. I seriously felt like you were a doctor by the bedside. Thanks for your help.

I will post back after some time with an update. Thanks again guys and gals.