New member with a couple questions

[mttm]

Hi all - this is my first post here and I had some questions. It might be a little long but I want to give as much detail as I can.

For a little over a year now I’ve been feeling fatigued and had a feeling of brain fog, I’ve seen it described on Reddit before as drunk without the feeling of ecstasy and it feels like I’m not really present ever. It feels like I’m looking through life through a window or there’s bubble wrap around my head, it’s a little hard to describe. I am typically able to fall asleep easily, don’t wake up in the middle of the night, but I never feel well rested when I wake up and feel tired throughout the day and have a consistent fog present in my head.

I’ve went through my PCP to rule things out by taking MRI, EEG, blood test for iron, vitamin B, thyroid conditions, lyme disease etc. but everything comes back normal. I am in my 20s and would say I am pretty healthy in general so my PCP didn’t think sleep Apnea was possible so I took two at home tests through Lofta and Wesper. Lofta showed an AHI of 14.0 and hourly RDI of 34.0 and Wesper gave an AHI of 5.7. I was wondering what people’s thoughts are on these services and if they are very accurate at detecting sleep apnea.

I got an RX through Lofta and ordered a CPAP through Apria with my insurance and was told over the phone that it would be a Resmed Airsense 11 but I got a 3B Luna G3 instead which at the time I thought was fine because I was happy to finally get a CPAP. From what I understand now however, this data is not compatible with the OSCAR software so I can’t interpret the data at all to tweak my settings. Should I call my DME and have them switch it or is this not possible because I’ve started using the Luna G3 already? I don’t think the RX mentioned a specific model and I guess the alternative would be to pay out of pocket for the Resmed which I really would prefer not to do if my insurance can cover it.

As for the results of the CPAP from a little over a week of using it, I have attached them below. So far I have been feeling mostly the same and I understand that the CPAP takes a while to work for most people but I have had one day (9/8) where I woke up feeling great and had energy all day even though I still felt brain fog and not feeling present, I didn’t feel fatigued.

I guess I am wondering a few things at the moment: are at home sleep tests generally reliable or does it depend on other things? Should I try to exchange my device for another one so I can actually interpret the data better? Thank you all for any advice you have, I can provide any other information that's needed

[Miss Emerita]

Welcome!

It's encouraging that you've had one day feeling rested and energetic. It's possible the brain fog will start to lift as you have more days like that one.

Can you think back and identify anything special about the day and night before the good day? Time you went to bed? Temperature of the room? Use of alcohol or screens before bed-time? Exercise or exposure to sunlight the day before? Reduction of stress the day before? -- You get the idea.

You should immediately get in touch with the DME to ask about swapping the Luna for a ResMed Airsense 10 Autoset (or an Airsense 11 Autoset). You'd get much more useful data that way, as you've noted.

The data you have suggest some encouraging things. You aren't having any large leaks; you're spending reasonable amounts of time most nights using the machine; and your AHI is mostly low.

I couldn't quite figure out what your settings are. Could you go into the clinician menu and check? (Turn machine on, then scroll right to the SETTINGS option. Press and hold HOME button and RAMP button (round) together at the same time, for about 5 seconds.) Especially, what are you minimum and maximum pressures? And are you using a feature that lowers your pressure when you exhale and then raises it when you inhale?

If you could scan and post your sleep studies that might be helpful. Be sure to black out your personal information. In general, in-lab sleep tests are regarded as the gold standard, but many of us are diagnosed well enough using home tests. Could you describe the paraphernalia involved with those two tests?

[mttm]

Welcome!

Thanks so much for all of the insights. Nothing about that day jumps out to me in particular, I try to exercise daily and I don't drink. I also sleep at the same time every day, around 10:30pm and don't use screens before bed and I'm generally not stressed about things. I've started to keep track of factors like these on my phone to see if I can find any patterns. One thing I forgot to mention is that I will typically wake up at around 5 or 6 am, I'm not sure if this is because my body has decided it has had enough sleep but that's what I have read online. My guess is probably yes because if I was waking up due to discomfort, I would think I would wake up at random times, not consistently in the morning. The CPAP mask, a nasal one from resmed I believe, has been comfortable for me and I have an easy time falling asleep. I generally sleep on my back but sometimes move around to my side or stomach.

When I ask the DME about swapping, is there a possibility they would say no and what type of reason would I have to provide? I'm new to all of this so I'm not quite sure how it works.

The settings are as follows:
Mode: AutoCPAP
Initial P: 4.0 cm
Min APAP: 4.0 cm
Max APAP: 20.0 cm
SmartA: Off
Sensitivity: 4
Max Ramp time: 0
Reslex: 2
Humidifier: Auto
Heated tubing: Auto

I believe the only changes I made were turning the Reslex on 2 because exhaling was a little difficult and putting the heated tubing on Auto.

I've attached my tests below. The Lofta test is a one night test that uses the WatchPat One device which I believe has a pulse oximeter and wristband for heartrate. The Wesper test was two nights with a pulse oximeter and two patches that go on the chest and stomach which I believe measure breathing, heartrate, and sleeping position.

Thank you again so much for the helpful response

[Miss Emerita]

Can you look at your Rx to see whether the make and model of the prescribed machine is specified? If it isn't, I'd suggest you tell the DME that (a) you were told you'd get an Airsense 11 Autoset and (b) although you are compliant with the Luna, you remain tired with brain fog during the day and want to see whether the Airsense 11 (or 10, preferably) algorithm would benefit you.

Another thought: can you go back to whatever company issued your prescription and ask that it be revised to specify the Airsense 10 or 11 Autoset?

Your second sleep study showed a pretty high RDI (respiratory disturbance index). This measures arousals that are related to respiration. For some people, a high level of "flow limitations" corresponds to a high RDI.

Flow limitations are limitations to the flow of air within the airway. They can originate in the nose or further down. If they originate in the nose, a PAP machine can't do much of anything about them, but if they originate further down, a PAP machine can help. It can help via its pressure settings and also via settings that produce a differential between exhalation pressure (lower) and inhalation pressure (higher). For your machine, that's Reslex.

Let me know whether you have a stuffy nose or structural issues inside your nose, but in the meantime, I'd suggest raising your minimum pressure to 7 and setting your Rexlex to 3. I'd also suggest turning off your ramp, unless you need it to fall asleep.

[mttm]

Can you look at your Rx to see whether the make and model of the prescribed machine is specified? If it isn't, I'd suggest you tell the DME that (a) you were told you'd get an Airsense 11 Autoset and (b) although you are compliant with the Luna, you remain tired with brain fog during the day and want to see whether the Airsense 11 (or 10, preferably) algorithm would benefit you.

So in my Rx the make and model of machine isn't specified and I was able to call the DME today and let them know I wanted to see if I could switch machines, waiting on that right now.

I can also try reaching out to original company which gave me the prescription, Lofta in this case, and get the Rx changed for the Airsense model.

Yes, I've been dealing with some congestion issues that vary throughout the day and sometimes I can't breathe out of one nostril. I'm not really sure when it began but it might have coincided with when I started having symptoms of fatigue/fuzziness/brain fog. I am seeing my ENT about it but they said there is nothing structurally wrong with my nose/tongue/tonsils and I also took a blood test that tested negative for allergies. Regularly using a Nettipot and I need to start Flonase which they also recommended so I'll probably start that today.

I'll try those settings you suggested tonight, thank you for all the helpful advice

[Miss Emerita]

Just so you know, it can take a week or two for Flonase to kick in, so be patient.

Keep us posted!

[mttm]

So a bit of an update: my DME agreed to provide me with the Airsense 11 so that will be delivered today. I was wondering what pressure settings I should be using on that because the low of 7 and high of 20 with reslex 3 was not waking me up at all on my Luna G3 and was comfortable. Should I bring these settings over to the Airsense 11 for tonight's use or use the default and tweak them when I see the data?

I have not felt too different in my condition with daily use of the Luna G3 and flonase but I am recording every night's conditions and if any variables are consistent with feeling slightly better or worse. I'm hoping that the data of the Airsense 11 will help with that too. Anything else I should know about the Airsense 11 would also be greatly appreciated thank you

[ozij]

Use what you slept well with.

[Miss Emerita]

Good job getting a different machine! You might want to sign up for a free SleepHQ account so you can share a link to your charts with people here.

So set your min = 7, your max = 20, and your EPR = 3. Once you have some data with these settings, there may be some fine-tuning that would be useful.

[mttm]

I was able to get the Airsense 11 setup with no issues but I did wake up again around 4:30am after going to bed at around 10:30pm. I wasn't sure if I should attempt to go back to sleep because as I said before I've heard some people say that the body needs less sleep when you're getting quality sleep. Other than this I did not wake up at all during the night and I ended up staying up after 4:30am.

I thought I wasn't feeling tired upon waking up and went for a walk right after but throughout the day I started to feel exhausted. Is it generally recommended to go back to sleep if something like this happens or does it depend?

I also didn't realize that the Airsense 11 requires an SD card so I'll be adding that today to record a night's data so I'm able to share it.

One last thing I was wondering about was using mouthtape as I've tried it with the Luna G3 a few times because I've sometimes woken up drooling (not sure if I was woken up because of this directly or not) but I found that mouthtape left me very lightheaded the next morning. Should I hold off on this or not bother with it and just focus on getting actual data first?

[Pugsy]

I found that mouthtape left me very lightheaded the next morning. Should I hold off on this or not bother with it and just focus on getting actual data first?

I would wait until I could see the actual leak data and just how "bad" it might be before I started to try to fix the problem.
15 minutes of mouth breathing leak isn't the end of the world but half the night in large leak is a different story.

[robysue1]

Other than this I did not wake up at all during the night and I ended up staying up after 4:30am.

I thought I wasn't feeling tired upon waking up and went for a walk right after but throughout the day I started to feel exhausted.

If you get up at 4:30am, you're going to start feeling tired sooner than someone who slept well but didn't get up until 8:00 AM.

Is it generally recommended to go back to sleep if something like this happens or does it depend?

Short answer is: It depends.

It's always a bad idea to lie in bed not sleeping and worrying about the fact that you're not sleeping and feeling like you are fighting to get back to sleep. It's another thing to lie in bed for 10-15 minutes while relaxed enough to allow the body to fall back asleep if it wants to.

In other words, if you still feel sleepy and relaxed, it is worth giving yourself a reasonable amount of time to get back to sleep. But if can't seem to get back to sleep in what feels like about 10-15 minutes OR if you start worrying about sleep or anything else that's going on in your life, you need to accept that your brain and/or body is just not capable of falling asleep at that point. And get up out of bed and leave the bedroom and do something else. If you wind up getting out of bed several hours before your normal wake-up time and you start getting genuinely sleepy 30-60 minutes after getting up, you can always go back to bed and get a bit more sleep once the body and brain agree that they both want sleep and are capable of getting back to sleep reasonably quickly.

My husband often wakes up sometime between 3:00 and 5:00 and knows that he's not going to be able to quickly get back to sleep. He gets up and does things that he enjoys. If he wakes up between 3:00 and 4:00, he'll often come back to bed in about an hour (when he starts to feel sleepy again) and sleep for another full sleep cycle or two before he gets up for the day. If that wake is closer to 5:00, he usually just stays up for the day and then goes to bed a bit early that evening. It works for him.

One last thing I was wondering about was using mouthtape as I've tried it with the Luna G3 a few times because I've sometimes woken up drooling (not sure if I was woken up because of this directly or not) but I found that mouthtape left me very lightheaded the next morning. Should I hold off on this or not bother with it and just focus on getting actual data first?

I'm with Pugsy: I'd not worry about taping until looking at the data. As she says: 15 minutes of mouth breathing during the night is not something to worry about. Long stretches of mouth breathing all night long is something that needs some troubleshooting.

As for the drooling: Some people drool in their sleep even if they have totally normal sleep patterns---as in they're not using a CPAP and they don't have sleep apnea. And it's possible to drool while not mouth breathing. And if you're a drooler, taping probably isn't going to fix that problem, especially if you're not doing any mouth breathing.

[mttm]

Hi all, thanks for all of the helpful advice in response to my most recent comment, I appreciate it. Last night was the second night I used the Airsense 11 and I slept well until I woke up at around 4:45am but I decided to go back to sleep and was able to. I think that the data is about an hour behind because I slept at around 9:15pm and stopped the machine at about 6am.

I feel somewhat tired as the day goes on today but definitely not as bad as yesterday. I recorded last night's data and I have added it below because I'm not quite sure how to interpret it but I'm working on learning to understand it. I followed the Oscar guide on this forum for getting screen looking right for the screenshot but if there's anything wrong or that I should fix please let me know. I also signed up for SleepHQ so here is the shareable account link for that: https://sleephq.com/public/teams/share_ ... afa709fe65
I will continue to record data but at this point I am looking for a little help interpreting this data if possible.

Is one night's data enough to determine if I do/don't have sleep apnea? Are there any settings I should change for tonight? Is there anything else on the chart I should be aware of? Thank you in advance for any help

[Miss Emerita]

It’s good to hear you had a better day. Thanks for the well-formatted Oscar chart and for the SleepHQ link.

I would stick with your current settings for another few nights t see how it goes. You may at that point want to raise your minimum a little if you continue to see about this same OA index.

Your leaks are well within the machine’s ability to compensate, so if they don’t wake you up, don’t worry about them.

I suspect the CAs will subside as your body adapts to your use of the machine, so I think you can just ignore them at this point.

Fingers crossed you have another good night tonight.

[mttm]

I've recorded two more nights and add them to SleepHQ here: https://sleephq.com/public/teams/share_ ... afa709fe65. I raised the minimum pressure to 8 on the most recent night and didn't have any trouble falling/staying asleep. I've typically been waking up at around 5 am after starting to sleep at 9pm but I'll usually go back to sleep for a couple more hours without the mask. I think I've been less tired and foggy overall but it's a little difficult to tell with the brain fog itself making it difficult to gauge how I feel day to day.

I guess my questions about my data remain somewhat similar as before: I was wondering, are these charts enough to tell I have sleep apnea because I was also wondering if my symptoms of brain fog and fatigue could be from long covid (I don't remember having covid during this time but I guess it is a possibility)? Should I make any changes to my settings at this point or leave them as is? Thanks!