New user with low AHI still feeling exhausted

I see a lot of posts like this around here but I'm another new user looking for help improving their therapy.

I started using a Resmed Airsense 11 in January 2024 after receiving a pAHI of ~20 using an at home test. The first few weeks I had the machine I was using an F30i mask and found I was generally feeling better. Over the same period of time I had a head cold, and the extra moisture actually seemed to be helping me to breathe better at night. It all started to go down hill after I recovered from that head cold. And since January I've tried multiple masks (F30i, P10, P30i, F20, F30, F30i), chin straps, cervical collars, and pillows of different sizes and configurations.

In March I finally went to a sleep clinic for a full polysomnogram and daytime MSLT. The sleep study found I slept fine using a full face mask (note I do not have the results but I'm working on getting that report) and the MSLT did not indicate another disorder such as narcolepsy. Following that study, my doctor did set my PAP to constant 5cmH2O, as on APAP (5-20cmH2O) he felt it tended to stay towards a low pressure and thought it might help.

The problem is I continue to feel tired most of the time. On days my AHI is below 1 I tend to feel OK, but above 1.5 and I have hypersomnia, brain fog, etc. Looking at my data in OSCAR I see that most of my apneas are central. I've tried disabling EPR both on APAP and CPAP but it hasnt made a difference (EPR currently set to 1 at 5 cmH2O). Below are links to data from the past several nights as well as a closeup of some of my CA events (also attached):

• 4-8 (AHI 0.87)https://imgur.com/oB3fFYD

• 4-9 (AHI 1.9)https://imgur.com/Z4Va26F

• 4-12 (AHI 1.81)https://imgur.com/XOwJrQL

• 4-12 closeuphttps://imgur.com/Kxdk5rH

The other thing I notice is that I have some residual flow limitations, but I dont know if they're significant enough to impact my treatment. I do tend to be congested; I've tried flonase, Xlear - which is pretty good - and breathright strips, which all help but never allow me to breath fully.

This is all to say, I'd welcome help, both in understanding my data and how I might be able to use it to improve my treatment and to help talk through things with my doctor.

Perhaps you are still acclimating... I don't see anything concerning myself.

Monitoring your O2 is a good thing to do... I use O2Ring, they're not cheap at 180USD.

Also, SleepHQ is a good adjunct to Oscar... we can't zoom into your Oscar screenshots but we can zoom into a SHQ link. Here's a recent night of mine, see how you can click and drag to zoom in? R resets the zoom. I'm a paying customer so I get to add my O2Ring graphs, looks like I'm doing good at my new pressures!

https://sleephq.com/public/212480cb-7bf ... e098acf135

Need to work on those leaks though.

vandownbytheriver wrote: ↑

Sun Apr 14, 2024 6:16 pm

Monitoring your O2 is a good thing to do...

I too bought a pulse oximeter (the excellent Wellue SleepU) as an extra aid in trying to understand what was going on when I slept - after all, I thought that's the ultimate problem we are trying to solve....stopping our oxygen level dropping because of the OA, H & CA events.

I expected the oxygen data from the oximeter would correlate well with the events data from the CPAP machine, but that's not what I am finding. I find very little correlation between any of the oxygen data and: (a) the CPAP data, and (b) how well I slept! I do though find that pulse spikes and movement DO correlate well with some of the CPAP data.

Do your findings differ?

I get very few LARGE drops in oxygen (i.e. below 90%), but I do see frequent random drops from my base level of 95-96% to 92-93% - and it stays there often for an hour or more. I am starting to realise that these low-oxygen periods DON'T correlate with CPAP events but they DO seem to correlate with arousals - frequently starting and stopping at the time of an arousal (where the graphs show a sudden broken flow shape PLUS a brief movement followed by a pulse spike - AND I have confirmed this with a camera).

My working theory is that something triggers an arousal (and again, it's generally not clear what) and the resulting slight movement alters my airway - maybe due to a chin tuck - so as to permanently affect SpO2 until another arousal comes along and changes it again.

Don't know what you've tried in the past, but rather than lowering your max pressure, raise the min. by e.g. 2-3 for a wk at a time and see how it goes... its the one that does the work.

BigWing wrote: ↑

Mon Apr 15, 2024 2:46 pm

I get very few LARGE drops in oxygen (i.e. below 90%), but I do see frequent random drops from my base level of 95-96% to 92-93% - and it stays there often for an hour or more. I am starting to realise that these low-oxygen periods DON'T correlate with CPAP events but they DO seem to correlate with arousals - frequently starting and stopping at the time of an arousal (where the graphs show a sudden broken flow shape PLUS a brief movement followed by a pulse spike - AND I have confirmed this with a camera).

My working theory is that something triggers an arousal (and again, it's generally not clear what) and the resulting slight movement alters my airway - maybe due to a chin tuck - so as to permanently affect SpO2 until another arousal comes along and changes it again.

Would be nice to see the graphs... included in SleepHQ or Oscar would be perfect. Since going on bi-level my O2 is ridiculously good... 95% is as low as it gets. It does go down if I get up and pee etc... that's normal.

In the before time, the long-long-ago (6mos), it would go up and down with flow limits and events... here's a representative night, just after I'd gotten the Ring... the pulse is pretty crazy, I've had to tape the Ring on to prevent that. Note the FL's coinciding with the SPO2 desats:

https://sleephq.com/public/dd7e77fa-756 ... 46783cbbd8

This was back when I thought I could get away with lower pressures... only going up 1cm after 12 years and 100lbs? Nope!

Here's a recent night on bi-level:

https://sleephq.com/public/212480cb-7bf ... e098acf135

Must have gone supine about 6am... slept like a log through that anyway. Point is the O2 is great.

vandownbytheriver wrote: ↑

Sun Apr 14, 2024 6:16 pm

Monitoring your O2 is a good thing to do... I use O2Ring, they're not cheap at 180USD.

Ill look into monitoring O2, thanks.

Julie wrote: ↑

Mon Apr 15, 2024 3:08 pm

Don't know what you've tried in the past, but rather than lowering your max pressure, raise the min. by e.g. 2-3 for a wk at a time and see how it goes... its the one that does the work.

Thanks. I had wondered if I was experiencing treatment emergent apneas at higher pressure but the CAs havent gone away so I’ll try raising my minimum incrementally and see how it goes.

For the record, CA's don't respond to C/Apap.