AHI under control, still feel terrible

[JPinkman]

Hey everyone,

Just hopped on here to try and get some insight about my cpap treatment I started. Ive been on it for a little over a month now and like most people have yet to feel a breakthrough in regards to fatigue. About 3 months ago I took a lofta sleep test because I had been feeling so exhausted and had very clean bloodwork. My AHI was 8.0, my RDI was 15, and while my O2 saturation mean was 95, at one point had desaturated to 86 and 62 times had desaturated 4-9%. Minimum pulse rate BPM was 43, mean was 63, maximum was 106. Im not overweight. Im using a Resmed Airsense 10 with a nasal cushion mask, pressure set between 4-20cm. I have tweaked with some of the settings to try and feel well rested so Ive changed the EPR from 1-3 and currently have it at 1. I upped the minimum pressure from 4 up to 6.4 in the last couple of nights. There was a couple of nights where I had significant leaks and had multiple different event spikes, so I've donned the chin strap to limit the leaks. I've attached some data from Oscar of nights where I didn't suffer big leaks, happy to include more if that will help get some insight. Appreciate any and all help.

https://imgur.com/RfK6zIk https://imgur.com/adLWnng

[gurug]

Definitely try to get the leaks under control first since it can really throw the quality of the data.

You may want to work on bumping up your minimum pressure to try to reduce the flow limitations. Bump the pressure 1/2 to 1 cm and sleep a few nights and then review data. Lowering the top end of the range can also help keep the machine from going crazy and waking you up with high pressure for non issues. Higher EPR can also have a positive impact on the flow limitations, but you may need to up your pressure as you add EPR.

Arousals can have a huge impact on your fatigue.

[Pugsy]

Are you experiencing any nasal congestion at night?

Do you take any medications of any kind? If so, what?

Any other physical or mental health issues going on?

How many hours of real sleep (not just laying in bed) are you getting on average?
Are those hours fragmented with very many wake ups?

Are those leaks causing you to wake up?....or do you sleep right through them?

[JPinkman]

Definitely try to get the leaks under control first since it can really throw the quality of the data.

You may want to work on bumping up your minimum pressure to try to reduce the flow limitations. Bump the pressure 1/2 to 1 cm and sleep a few nights and then review data. Lowering the top end of the range can also help keep the machine from going crazy and waking you up with high pressure for non issues. Higher EPR can also have a positive impact on the flow limitations, but you may need to up your pressure as you add EPR.

Arousals can have a huge impact on your fatigue.

What does an arousal look like on the graph?

[JPinkman]

Are you experiencing any nasal congestion at night?

Do you take any medications of any kind? If so, what?

Any other physical or mental health issues going on?

How many hours of real sleep (not just laying in bed) are you getting on average?
Are those hours fragmented with very many wake ups?

Are those leaks causing you to wake up?....or do you sleep right through them?

I’m not experiencing any nasal congestion, and don’t take any medications. Nothing else physically, but I would certainly say mentally it’s a struggle when you feel like you’re running on fumes most days.

Real sleep I would say I get about 7 hours on average give or take a bit. One wake up to pee. I haven’t woken up from a leak but have once taken my mask off unknowingly.

[Janknitz]

It took me a long time to adjust to CPAP, and once I did I craved sleep and felt pretty fatigued. I don't believe it's really possible to "make up a sleep debt" but I just wanted to be back in bed sleeping whenever I had down time for a while. I didn't have one of those "Wow, I feel great" moments, it took a good long while to feel human again.

You might try a recording pulse oximeter and see how your O2 levels are at night.

[JPinkman]

So I raised my pressure a bit up to 7.0, kept the EPR at 1, and taped my mouth shut. Also did not wake up to pee in the middle of the night. Feeling pretty good today for once. Should I continue to raise pressure slowly and tweak the EPR? Here is my Oscar screenshot for the night, what do you guys think?
https://imgur.com/a/IrdzzMB

[zonker]

So I raised my pressure a bit up to 7.0, kept the EPR at 1, and taped my mouth shut. Also did not wake up to pee in the middle of the night. Feeling pretty good today for once. Should I continue to raise pressure slowly and tweak the EPR? Here is my Oscar screenshot for the night, what do you guys think?
https://imgur.com/a/IrdzzMB

in my opinion, you should leave the settings alone for a few days to see if they settle in.

and long term, you may not want to change anything. your ahi is remarkable.

[JPinkman]

So I raised my pressure a bit up to 7.0, kept the EPR at 1, and taped my mouth shut. Also did not wake up to pee in the middle of the night. Feeling pretty good today for once. Should I continue to raise pressure slowly and tweak the EPR? Here is my Oscar screenshot for the night, what do you guys think?
https://imgur.com/a/IrdzzMB

in my opinion, you should leave the settings alone for a few days to see if they settle in.

and long term, you may not want to change anything. your ahi is remarkable.

Thanks for the insight. The reason I have tweaked the settings is that through a month of using the machine my AHI has been under 4, yet I have largely felt the same if not worse at times.

[zonker]

Thanks for the insight. The reason I have tweaked the settings is that through a month of using the machine my AHI has been under 4, yet I have largely felt the same if not worse at times.

come back in a few days and tell us how you're doing, won't you?

[ozij]

Thanks for the insight. The reason I have tweaked the settings is that through a month of using the machine my AHI has been under 4, yet I have largely felt the same if not worse at times.

So I raised my pressure a bit up to 7.0, kept the EPR at 1, and taped my mouth shut. Also did not wake up to pee in the middle of the night. Feeling pretty good today for once. Should I continue to raise pressure slowly and tweak the EPR? Here is my Oscar screenshot for the night, what do you guys think?

The way you feel, and your results mean the change was needed. Stick to it for a week, keep track of how you feel - and come back to tell us how things are going.

[hey, zonker, I agree with you!}

Most of us, who came here for advice and stuck around have discovered that the formal "less than 5" doesn't really cut it. We're in 2024, our machines and OSCAR let us understand the relationship between our breathing at night the way we feel.
I have no idea how the medical profession arrived at "less than 5", but it's from the days when the majority of CPAP users - and their doctors - had no idea what was going on night by night when people slept using their CPAP's at home.

[zonker]

[hey, zonker, I agree with you!}

i think your "smarts" are starting to rub off on me!

[JPinkman]

So I kept the settings the same last night. Had to get up to pee and didn't feel like I was able to sleep well past that point. Machine went down to 4 again because of the ramp setting, and for some reason my mouth would fill up with air at times even though I had it taped up. AHI went up a bit and while my leaks seemed really minimal my flow rate looked much different than last nights. Here's some screenshots including a zoomed in one of my flow rate.

https://imgur.com/PGRobIw
https://imgur.com/ogfIy9V

[vandownbytheriver]

So I kept the settings the same last night. Had to get up to pee and didn't feel like I was able to sleep well past that point. Machine went down to 4 again because of the ramp setting, and for some reason my mouth would fill up with air at times even though I had it taped up. AHI went up a bit and while my leaks seemed really minimal my flow rate looked much different than last nights. Here's some screenshots including a zoomed in one of my flow rate.

Not seeing your O2 graphs... using an O2Ring would help a lot. You can use Movement from an O2Ring as kind of a hillbilly EEG... when I arouse I always flip sides... this gives movement, or Movement, on my wellue data, which I can correlate with my Flow since I'm holding my breath when I roll over (there is always clock skew between Oscar and Wellue). When you get an arousal, shake your ring hand and you'll see it in your graphs and know it. O2 desaturation is the main cause of health problems from sleep apnea... anything else is just snoring. If you don't know you don't know.

At any rate your machine is set to 4-20 wide open... you should not be on this setting more than a couple of weeks, the graphs plainly show that your airway wants 7-8cm. This is a sign of neglect from your clinician IMO... you should have been titrated for a pressure and have that in your machine. Let's head that way, slowly.

[Pugsy]

Your machine is NOT set wide open. The settings are minimum pressure is 7 cm and the max is 20 cm but it never seems to go near 20 so that's a moot point.

That 4 cm you see is the ramp set to auto ramp and it will increase to the minimum of 7 cm either after the machine thinks you are asleep or after 30 minutes or whichever comes first.

Do you need that ramp????

During the ramp period the machine doesn't record or respond to apnea events that might be going on. I doubt that you are missing events though.

You might try increasing the EPR a bit more and see what happens.

You are going to have "good" nights and "bad" nights so don't expect the sleep quality to never vary because it will vary.