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Mild Sleep Apnea/UARS - New to CPAP

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tjack900 +0 points · about 1 month ago Original Poster

I am a 22-year-old male living in Indiana. After suffering from two years of daytime sleepiness and brain fog, I was diagnosed this winter with upper airway resistance syndrome/mild sleep apnea. I had an AHI of just 1.2, but my RDI was 11.2 (which combined with my symptoms, led to a diagnosis of sleep apnea/UARS).

My doctor prescribed me CPAP, and I began using a Resmed Airsense 10 two weeks ago. I am using the nasal pillows mask. I have struggled to adapt to the therapy, though I have succeeded in sleeping through the night with CPAP on a few times.

However, I am feeling more tired than usual, with no improvements so far. My morale is quite low, and I wanted to see if anyone on this forum could offer guidance about achieving results with CPAP (as well as what the timeline for that will be).

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4variety +0 points · about 1 month ago

Hey Tjack. I'm a 27 year-old who was diagnosed with mild obstructive sleep apnea. A level-three study that included sleeping on my back showed an AHI of 7.8, and a level-one study that included me sleeping on my back showed an RDI of 4.2, but I wore a MAD. I'm healthy, skinny, and physically active.

I tried wearing CPAP for about three years, and I tinkered with settings (i.e. pressures, ramp, humidity, etc), masks (i.e. nasal vs full-face), my diet, my level/types of exercise, and overall sleep hygiene habits. I tried nasal dilators, CBD oil, sleeping pills, nasal steroids, and even lavender oil. I've also spent countless hours reading clinical literature, reading through sleep forums such as these, and even recording my own personal sleep data to analyse. Throughout the entire trial period of three years, I was still experiencing the same exact level of fatigue when wearing the CPAP by the end. I spoke with Ear-Nose-Throat doctors, respirologist sleep specialists, multiple general practitioners, and my family doctor. No one had any answers to the question of why do I feel fatigued (more tired than usual) when I wear the CPAP?

I hope I haven't pushed you to lose hope, but I just want to be open with you and perhaps help you avoid some of what I've gone through.

The first thing I would like to say is that there is data that indicates that it may take some time to "catch up on sleep" after experiencing untreated sleep apnea, and two weeks of CPAP isn't conclusive. Meaning, you may be playing catch up still, which explains your feelings of fatigue.

Second, when I spoke to my sleep specialist regarding the fatigue I feel after a night of wearing CPAP, he said to me that it's probably because the CPAP is doing more disturbing than helping, as I only have mild sleep apnea. I realize that is vague, but essentially he didn't have an answer (nor does anyone else insofar as I have looked), but he said that it is something he sees in patients from time to time.

Third, there is research demonstrating that CPAP for mild-sleep-apnea patients is often ineffective.

Now, with all that said, there are other options available, and there are small changes to lifestyle/sleep hygiene that can also go a long way in improving your quality of sleep/lowering your AHI/RDI. And, as mentioned before, you're too early on in the CPAP trial to come to any conclusions regarding your compatibility with CPAP as a treatment, so give it some more time and try working with your sleep therapist. The pressure just might be too high or you may be acclimating to the disturbances that CPAP engenders or nasal patency may be poor. There are so many angles to work from, and I'm assuming many of those are still unexplored by you. Sleep-apnea treatment is very individualized. There's no one-size-fits-all treatment plan out there, so start tinkering with the variables, and feel free to post here whenever you're dealing with unanswered questions.

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tjack900 +0 points · about 1 month ago Original Poster

4variety Our stories sound quite similar, so thanks so much for the reply. Have you been able to achieve any improvement at all with your fatigue? If so, what helped you?

Also, are you still using cpap or have you stopped?

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4variety +0 points · about 1 month ago

I have been able to deal with my fatigue, mainly be discontinuing my use of CPAP. About twenty days ago, something dawned on me. I had not tried sleeping without some form of treatment for about three years. That is, for three years I had always either used a CPAP or an MAD. In addition, I started reading a lot about iatrogenics (when treatment causes more harm than benefits), and thinking back to what my sleep specialist asked me during consultation: "how much of this do you think may be in your head?". The importance of that question is to remind you that there is almost always a psychological factor at play in the experience of any given health complication, and OSA is not exempt. So, I started thinking about how I started getting involved with OSA treatment, what led me there and why. It became clear to me in retrospect that there was certainly a lot of anxiety present during the days leading up to me receiving my first mode of treatment. This is all to say that, well, I do have OSA, but perhaps it is more tolerable than I have been telling myself over the past few years, and, importantly, there are other things I have been able to do to help mitigate the severity of my symptoms but also the degree to which OSA manifests itself.

Somethings that have helped me out: 1) One of the first places that your body deposits fat is the base of your tongue, so being even just a few pound overweight can worsen OSA. 2) Avoiding inflammatory foods, particularly closer to bedtime, has proven helpful. 3) Ensuring clear nasal passages to maximize nasal patency. We are supposed to breathe through our noses, except when we need more volume, such as during exercise, so naturally breathing through your mouth typically leads to worse OSA. Pay close attention to your nasal congestion during the next time you eat something say high in sugar or fat or dairy. I think you will find a noticeable difference/response. Identify your allergens and avoid them. 4) Positional therapy. Meaning, OSA is typically less severe when sleeping on your side, and sometimes there is even a better side to sleep on (left vs right), due to the asymmetries in your passages. 5) Exercise in general. Think about OSA for a second, your brain/body doesnt get enough oxygen, so compensatory responses come into play. For example, heart rate increases, respiratory rate increases, mouth opens, etc. Optimizing your resting heart rate and your oxygen-delivery efficiency will benefit you. 6) Buteko breathing method (let me know if you have trouble finding this). Essentially, there are ways to breathe that are ideal for avoiding OSA, and the good thing is they can be trained into you. 7) One happy medium I found was not wearing the CPAP for the first half of the night, and then putting it on for the second half. This helped reduce the feelings of fatigue when using CPAP, making for a decent sleep.

So, where am I at? Well, I'm waiting to see a second ENT to hear their opinion on me receiving a less-invasive surgery, such as trimming some of my soft tissues. Also, there is a model of a MAD that I would like to try out that I've created a post about in this forum. It's call Oventus. In the meantime, I'm continuing to exercise to reduce my weight. I've been sleeping very well, though a few bumpy nights here and there.

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Sierra +0 points · about 1 month ago Sleep Patron

A few points. First it does take some time to get used to sleeping with a CPAP. It probably took me months along with a number of mask changes to settle on what was best for me. Until you get comfortable with wearing the machine the net benefit may not be high, especially when you start with such a low level of apnea.

It is also possible that your machine is not set up as well as it can be. Do you know what is preventing you from sleeping as well as you could? Mask fit? Leaks? Do you know what pressures are being used? What is your AHI when using the machine?

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tjack900 +0 points · about 1 month ago Original Poster

@Sierra, my mask fit has been pretty decent so far. My pressure settings are 5-18 with auto-titration (I think), and it mostly stays around 5. According to the myair app, my AHI has been rather low (0-0.5) for the last few nights. However, as mentioned above, my RDI was quite high on my original sleep test, and so I'm not sure if that has improved with cpap.

I still wake up a few times each night with CPAP - I have yet to sleep all the way through the night.

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Sierra +0 points · about 1 month ago Sleep Patron

It may be possible to set up your machine for more comfort. Here is what I suggest for the ResMed AirSense 10. To make these changes you need to get into the Clinical Menu. To get into the Clinical Menu just hold the Home key and round set key down at the same time for about 5 seconds. You navigate in this menu the same way as in the User Menu. If you need help see this Technical Manual for the AirSense 10. With your pressure settings I would set the machine this way for maximum comfort and effectiveness.

  • Ramp Time: Auto - This will hold the initial ramp start pressure until the machine decides you are asleep
  • Start Pressure - I would set this to 7 cm. This will ensure you are getting enough air to not get a suffocating feeling while going to sleep. You normally want the start pressure to be high enough that it feels easy to breath. If this seems like too much then set it lower. The start pressure cannot be higher than your minimum pressure, so to do this you would need to adjust your minimum pressure up to match your start pressure.
  • EPR: On
  • EPR Type: Ramp Only. This will cut the pressure back on exhale only while you are awake. After you go to sleep it will stop the cutback and make the pressure more effective. Since you need so little pressure you could also try it with the EPR on full time.
  • EPR Level: 3 cm. This will drop the pressure 3 cm on exhale until you go to sleep. This makes it easier and more comfortable to get to sleep. If you switch the Type to full time, then it will do this all night.

Hope that helps some,

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bthompson +0 points · about 1 month ago

Thanks for the info. I went back to the supplier this morning and the settings that you are suggesting are already set on my machine. I got fitted for a new mask and I felt more comfortable with it then the one I have been using.

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Sherry +0 points · about 1 month ago Sleep Commentator

tjack, I think the auto setting as Sierra is suggesting will be a game changer. I understand what it is like to fight a CPAP Mask/Machine. However, even if you are able to use it some of the night, it will help you feel better in the long run. I wondered if you had considered any alternatives to CPAP such as Positional Therapy (Phillips Respironics), Provent (Nasal Patches), or a Dental Device? The Buteko breathing method that 4variety spoke about is also very helpful.

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ht538 +0 points · about 1 month ago

I too am a new user, slender 45yo woman non smoker and don’t snore. I had no apnea and no desaturations (90% was my lowest O2). I have low BP and my cholesterol is perfect. My only issue is fatigue. My AHI during non-REM was 7 and it jumped to 18 during REM which I understand is a frequent occurrence. So my overall AHI was 8, but sleep doc said OSAS is always worse at home. I’ve also found, post studies) that my breathing. Is like 800 times easier if I use breathe right strips, so I am wondering if that is causing the hypopneas. I have had my mask a few days and yet to fall asleep with it on. I only slept for 22min during my titration study in about one minute chunks. I abandon the mask about halfway thru the night so I can function the next day. I am a working mom with 3 school age kids. All the success stories I see are from those with moderate or severe apnea and snoring issues that cause complaints with their partners. Anyone here with more mild apnea have any success with cpap. I am really struggling to see any benefit to this treatment if it leaves me more tired that before. In addition to me adjusting, this is a big adjustment for my bf. His formerly silent sleeping beauty now comes to bed with hoses and masks and noise. A lot of the success stories are also from those who were driving their partner nuts with the snoring.

I this will improve my health, I am all for it....I just haven’t found anything that speaks to health benefits for those of us with no other health issues and no desaturations robbing our brains of o2.

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Sierra +0 points · about 1 month ago Sleep Patron

One thing to consider is that mild apnea (AHI 5-15) is not treated by the National Health Service in the UK. It is normally treated in North America however. So, there is no guarantee that you will see a benefit, especially in the early use of a CPAP. My observation is that many CPAP machines are not set up well for comfort, as provided by the sleep clinic. Many times the minimum pressure and ramp start pressure is set too low. My tips on how to best set it up for comfort are given above.

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