AHI OK but still nervous system overdrive

[Jack the Nipper]

Sleep study:

• AHI: 16
  
• Oxygen level: ?, Did not get
  
• Sleep study did not differentiate between obstructive vs. Central
  

Machine:

• Resmed 10 Autoset
  
• Quattro air FFM
  

Current setting:

• 6-20 cmH2O
  
• EPR 1
  
• 95% pressure hovers around 10 cmH2O
  

The APAP has helped a lot but still having some symptoms and trouble to sleep. Leaks are under control. I'm a heavy mouth breather and always wake up my mouth open. My BMI is 23-24. Probably inherited the sleep apnea from my mother who also has it.

Usually I sleep the first half of the night quite OK, but after the first bathroom visit have trouble falling a sleep again and wake up several times while many times I notice to gasp for air. Even though my AHI looks good, only around 1, the next day I feel the headache like some acid burning my brain causing a heavy brain fog. I feel kind of nervous system overdrive, very exhausted deep down but at the same time impossible to get sleep.

I checked what happens when I wake up gasping for air and there's a Hypopnea type of event in the sleepyhead graph which is not long enough to be registered as AHI but still is enough to wake me up. When looking at the graph I get these kind of events almost the whole night. Mostly they seem to trouble me in the morning time when I wake up several times.

I have tried with EPR 2 ad 3 which was comfortable but felt worse the next day. Seems it was inducing central apneas. I have also tried to adjust the lower pressure up to 10 cmH2O but that seemed not to help (also induced centrals). I have also tried constant pressure 10 cmH2O but no help. For the time being the best setting has been 6-20 cmH2O with EPR 1.

Basically no matter what setting I try, the AHI is always around 1, but the next day feeling might be better or worse depending on the setting.

Any recommendations of what could I try next? Thanks.

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Tried to post some Sleepyhead snapshots but seems need 4 posts in the forum before allowed to do that.

[Hojo]

The AHI is still high and you may want to post your Sleepyhead data so others can review and help (not me, I'm still learning).

[Marillion]

Welcome to the forum Jack. Just do some more replies and make a few postings a few if you need to not saying much at all. You'll get the 4 very easily. Then post some of your Sleepyhead data so that we can give you some advice. Please look in my signature line on how to do that and how to arrange your data.

I will say 6-20 is wide open and you are likely gasping for air since your minimum should be set higher to give you enough air flow and your maximum is probably much higher than it needs to be. The max being set to the highest though is not such a big deal since you don't actually go all the way up there unless needed but the machine algorithm is said to be more efficient if it is optimized.

Hard to say exactly what numbers you should be at until we see your charts though. Don't worry, you'll get plenty of help here and congrats to you for taking the initiative to treat your sleep apnea! Things will get easier, I promise.

[trish6hundred]

Hi Jack the Nipper,
WELCOME! to the forum.!
You might consider raising your minimum pressure to 7 and lowering your maximum pressure to 12.
But hang in there for more suggestions, as two or more heads are better than one.
Good luck with CPAP therapy.

[Jack the Nipper]

Thanks all, I will try to get the Sleepyhead data here.

[Jack the Nipper]

Previously I had a worn out F10 mask with a lot of leaks which woke me up quite often but now with the Quattro Air FFM the situation has gotten better. At least not so much disturbing leaks anymore.

[Jack the Nipper]

Will try to post the graphs.

One thing I noticed. I feel better when I sleep less, around 6 to 7 hours without forcing myself to sleep 8 hours or more. Not so much headache but still feel a bit beaten and tired so I feel I would need the 8 hours quality sleep.

[Jack the Nipper]

Here comes the Sleepyhead data.   
From the overview you can see that I have already tried different tighter pressure ranges for a couple of times but still have felt better with the 6-20. Perhaps that's the best for me after all and just need to give it some more time?

Any other graphs I could present which could help?

*Edit the higher pressure on Aug 8th is from my mother. I let her use my APAP for one night to find out her 95% pressure since she has a CPAP and not much information from the sleep study.

[Sleeprider]

I think you will find your machine responds much better if it starts from a minimum pressure of 9.0. You have a very low event rate, and it appears your pressure rises in response to stronger flow limitations. As you can see on your pressure chart, the pressure rises rapidly and appears to peak at 12 cm. If you were starting at 9.0, it is likely that the rise would not be as disruptive or that the events around those pressure increases would not occur at all. Often we see a higher minimum pressure, prevents the peak pressure increases from occurring. Your leak rate is good and nothing to worry about, and your respiratory statistics are very good with normal respiration rate, timing and tidal volume. Other than minimum pressure, this looks very good.

[Jack the Nipper]

Thanks for the help. I tried with 9-20 last night. It was a bit contradicting, the overall leak rate was even lower than with 6-20 but the leaks disturbed me more since they happened while I was more aware. When I use 6-20 the leaks do not disturb me much since the pressure is higher while I'm in a deep sleep more or less. Anyhow the numbers looked better last night, though it's only one night.

I think I need more time to get used to the higher low pressure level. Perhaps one week lower pressure level at 7, then 8 and so forth.

Here's the last nights' data: