AHI under control, still feel terrible

vandownbytheriver wrote: ↑

Sat Feb 17, 2024 5:11 pm

At any rate your machine is set to 4-20 wide open.

No it is NOT set to wide open. You are incorrect. Please see my response above.

Pugsy wrote: ↑

Sat Feb 17, 2024 5:30 pm

vandownbytheriver wrote: ↑

Sat Feb 17, 2024 5:11 pm

At any rate your machine is set to 4-20 wide open.

No it is NOT set to wide open. You are incorrect. Please see my response above.

Thanks for the clarification... I was looking at the initial settings... which *are* 'wide-open' and not something to run with for a while.

Okay friends, so Im back again after a few days with some more charts and insight. Last week I bumped my pressure up a touch and had what so far was some of the best sleep I've gotten yet since this CPAP expedition began. I was on 7.2 cm pressure, and EPR 2. My AHI was .5 max or lower (.2). On the night of the 20th however, I was having difficulty falling asleep with the pressure for some reason and jumped the EPR from 2-3. That night's chart is misleading as in the beginning of the graph I was awake. I further tweaked settings after that night, bumping my pressure up further from 7.2 to 8.0, putting the EPR back down to 2 and instead giving a small ramp Time to comfortably fall asleep. My AHI dropped even further to .13, my lowest since starting CPAP. Naturally you would think I would have felt amazing but for some odd reason I was yawning almost every 20 seconds, almost like my body was thrown off by a completely uneventful night of sleep. I met with my doctor that day to discuss my therapy. He was glad I had began to tweak the settings, and told me that my machines average was around 8.7cm pressure I believe, so that was the goal to raise my minimum too. I also discussed with him how it was that my AHI many nights was sub 2 and that I still was dealing with fatigue, and only woke up feeling refreshed when I was able to get it under 1. He said it appeared in my case that getting the AHI under 1.0 was my magic number. Since then, I've slightly raised the pressure to get towards that 8.6 number, with my EPR staying at 2. Generally speaking I feel like im hovering around the target and just need to find the fine tuning to get where I want to be. In the last week, my 95% pressure was a bit over 9. The dilemma seems to be aligning the correct pressure with the correct EPR, and it seems that raising the EPR is not necessarily better. My understanding is that it lowers the pressure and this can cause some unwanted effects. Is consistently hitting an AHI of sub 1.0 a lofty goal in my case and is there real nuance in how someone might feel between .5 Ahi and low 1s, and what do you guys see as the right direction based on my charts? I'll attach a bunch of charts, any insight is always appreciated.

https://imgur.com/a/1qvW0MO

Your leak charts are misleading - right click on the margin, and chnage the Y-axis from "Automatic" to "Default".
You're changing pressure too frequently - I'd try the "best settings" (min 8.0) for at least a weak before moving on.

You need to get your leaks under control.

I suggest you read this - https://www.apneaboard.com/wiki/index.php/Mask_Primer- It is long, if you want the quick version skip down to this part

https://www.apneaboard.com/wiki/index.p ... erfect Fit

Basically tighter is not always better when it comes to preventing leaks and many people are improperly sized on their masks which causes leaks.

I didn't see where you listed your mask model/brand?

An O2ring is a good way to check if you desaturate at night. Leaks will cause this as well as the apnea events in general. It is NOT a direct indicator of problems, instead it is just another data point.

That said - it took me about 2 months from starting treatment before I actually was sleeping all the way through the night (I was sleeping 10 hours at a stretch vs 4 hrs before ).... and after a few months I was also waking up and thinking 'I feel good'

For an adult male on cpap I would expect a good starting point is - 7 to 15cm, EPR 3, no ramp or a short ramp - then adjust from there. When you have the lower setting below 7 your inhale volumes will be wonky. Most people I have seen use a setting of 8 to 16 or adjust around that depending on what the pressure graphs are telling you.

Big deal here - the numbers are one thing, how you feel is what is important. I have had 0.0 nights where I woke up feeling like death warmed over. I've also had nights with high AHI (for me these days that means over 2) and feel great. My AHI tends to average below 1 and most days I feel between OK and pretty good. So, when I wake and get out of bed the first thing I do is decide how I feel, then I go use Oscar to see how I slept - and I record how I feel in the notes tab each day.

So, Don't chase the numbers, chase the feeling.