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Pressure too high?

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SleepyMommy703 +0 points · over 2 years ago Original Poster Sleep Commentator

So I just had my overnight sleep study at the center to follow up on my home study that showed "significant respiratory disturbances." I haven't seen the doctor yet for my official followup, but the only thing the tech said to me in the morning was that they didn't need to give me as high of a pressure as my machine was giving me at home so he thought that may be my issue. During the study he only gave me a level 7 and at home it's averaging around 9. He also said this could be because of issues with leaks with my current mask. The one he used for the study definitely felt more secure and had far less leakage than my average night of sleep. But he also had me tighten my chin strap to a rather uncomfortable level too. We'll see what the doctor says, but maybe a new mask will be of help.

I'm also wondering if there could be an issue with my machine. I have the Resmed Autosense 10 (I think that's the name?) and I normally leave the ramp setting on Auto without an issue. Last night I put it on and was still awake and watching tv breathing normally. Within 10 minutes it had ramped up to 10.6 and was still climbing. It shouldn't do that if I'm still awake and just breathing normally right? I had 2 faulty machines prior that weren't giving correct pressure with the last model so I hope I'm not having this issue once again.

The reasons for my studies were that despite treatment for months I'm still tired all the time. I do have some improvement and my AHI is usually at or below 1 on the machine. I don't get as many headaches and when I'm off CPAP I notice short term memory issues and a lot more brain fog. But I still feel like I could sleep all day pretty much every day. Could too high of a pressure still make me so tired?

Just wondering if anyone else experienced this. Thanks!

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SleepDent +0 points · over 2 years ago Sleep Commentator

I am a dentist working in dental sleep medicine. OSA patients often underestimate the time that it is going to take to abolish their symptoms, even if they are getting adequate treatment. Remember, your untreated OSA damaged your body in a variety of ways and it takes the body quite a long time to undo that damage. First the damage is repaired and then you start to feel better. Your symptoms will not go away in a straight line. It is more like two steps forward and one step back. You will have your good days and your bad days. But always, there will be slow progress forward. It could take up to six months or longer for your symptoms to fully resolve. This is admittedly on the long side of normal, but it happens. Good luck to you. Arthur B. Luisi, Jr.,D.M.D.

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sleeptech +0 points · over 2 years ago Sleep Enthusiast

9 cmH2O is still a pretty low pressure and I would be very surprised if it was causing problems to that extent, especially given your low AHI. Your chin strap shouldn't need to be uncomfortably tight. You could wear it a little looser and check you leak rate to see if you are mouth leaking. Mask leak could well account for the differences in pressure.

Tiredness is a symptom of about a million things. Persist with your CPAP therapy, it sounds like it is working and, as suggested above, it may simply be a matter of time. If this is not the case you could start looking into other causes of your tiredness.

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SleepyMommy703 +0 points · over 2 years ago Original Poster Sleep Commentator

Thanks! The new mask may be just what I needed. It fits so much better and is registering no leaks now 3 nights in a row. My machine was set to a range of 5-16 and I know went as high as 11/12 at times but 9 was the average I gather. It looks like they now set it so it goes no higher than 7. Is that typical?

Anyhow with a pressure of 7 my AHI is still below 1, so it seems to still be working. I have a tendency towards a lot of annoying side effects from CPAP and from what I'm reading it sounds like if the pressure goes higher than what you need it could be a cause of a lot of these issues. So hopefully this will help both my fatigue and reduce the side effects. Fingers crossed!

We have spent years looking into other possible causes for my fatigue. Vitamin deficiency, thyroid, sugar, etc. have all been looked at many times. I'm now on an SSRI as I do have issues with both anxiety and depression, but I don't think that's the cause of this level of fatigue. One of my sleep doctors suggested I may have trouble cycling from sleep to awake, that my brain gets stuck in sleep mode essentially. And my current doctor suggested that there are some people who literally need 12 hours of sleep to function well and that I may be one of those people. If these latest changes don't help the next step sounds like a daily dose of something like Provigil to help me feel more awake and alert.

Trying to be hopeful for now.

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sleeptech +1 point · over 2 years ago Sleep Enthusiast

A common step for someone with successful CPAP therapy (by which I mean a very low AHI like yours) and who is still tired, with no other clear explanation, is a test for narcolepsy. You may want to discuss this with your doctor.

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SleepyMommy703 +0 points · over 2 years ago Original Poster Sleep Commentator

Thanks. They did do the daytime test for narcolepsy with my first sleep study 12 years ago. While I slept easily all 5 times they asked me to nap, I did not reach REM so they said it wasn't narcolepsy. Although one of the doctors seemed to indicate that there may be a bit of a spectrum for narcolepsy or "narcolepsy-like" disorders. Either way it sounds like the treatment will end up being the same which is a daily dose of something like Provigil to keep me feeling more awake and alert.

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