AHI less than 2, but still tired when wake up in the morning. Feel good after naps.

[ChinaMan]

having used CPAP for about 3 months. healthy weight male in my mid 30s. Using Amara View full-face mask, elevated the headboard and waking up multiple times every nights finding myself slipping down to the bottom of the bed and the mattress cover was ripped out of the mattress due to I was slipping down the mattress.

After I took naps in the afternoon, I would always feel refreshed, and AHIs for naps were always 0.

My question is whether I am highly sensitive to all sorts of sleep disordered breathing(including FLs and REs); that I will feel not tired in the morning only if the AHI is 0?

Is there anyway to eliminate all sleep disordered breathing?

P.S., I am borderline prediabetic, A1C was 5.8 in early september(>5.7 is considered prediabetic) 

  .

[Dormeo]

Congratulations on starting treatment for your apnea. It’s an important and valuable step for you to take.

You do not have to eliminate all events to get restful sleep. Do you have a sense of why you aren’t rested without a nap? Do you wake up a lot? If so, do you know why?

I’m curious why you elevate the head of your bed, especially because it sounds like it’s disruptive.

I’m also curious why your pressure is set to a very narrow range. Do you know the thinking behind that?

[mesenteria]

Hi.  What you are experiencing is rather typical, or, if you'll excuse the generality, 'normal'.  It isn't universal, not by any means, but it's so common, and so many come here reporting that they wonder if they're really being successfully treated, that you are among a huge throng.  Many report 'fuzzy brain', or 'brain fog', feeling like they're drained, and they don't place any, or much, faith in the efficacy of their machine and its current settings.  However, the data you show is pretty darned solid.  Your AHI, if it has variance of around 0.5 or less, is really very good.

You may take 6 months before things start to clear, or until your regimen becomes sufficiently innocuous and normalized that you just subconsciously accept it for what it is, how it is, and that it is.

If there's anything you can do to prevent onset of diabetes, that's every bit as important as dealing with apnea.  It's bad enough that you have the one; don't shrug off the other...not if you can help it.

And no, there's no way to eliminate all events, whether recorded or not, or whether mild, moderate, or severe.   Well, except that the machine is meant to mitigate all of it. Or, maybe we can say that the machine attempts to predict events to the extent it can and to forestall them.  Some are better than others, though, and we find that the RESMED AS10 series do better than others at 'keeping-up' with you while you sleep instead of being merely reactive after the fact.

Hang in there.  Again, before too long you'll just accept the new you and hopefully it will be better than the you you know at present. 

[WillSleep]

Welcome Chinaman!

I am presently researching why I personally am still no 'not refreshed' when my OSCAR report shows me at 0.0 AHI. 

This has led me to a possible hypothesis that once we are consistently producing nightly AHI of less than 3.0 or 4.0  at least some of us might gain more from monitoring and improving our Pulmonary Function performance than from continuing to try to drill AHI down to Zero.  

Sleeprider posted this in an earlier thread of mine.   "A very simple principle to keep in mind when working with BPAP of any kind.  PEEP (Positive End Expiratory Pressure) controls oxygenation.  An increase in EPAP min should keep oxygen levels higher.  EPAP min is also used to control obstructive apnea, but in ventilation the term is PEEP. Pressure Support increases tidal volume and CO2 blow-off.  These are powerful tools and you can find many references if you search Non-Invasive Ventilation, PEEP, Pressure Support both articles and videos that explain all this.”


Learning some of the underlying fundamentals of Ventilation is great stuff.   The Google link above is good and here a few good additional foundational learning links.    

• EPAP = PEEP,  Positive end-expiratory pressure (PEEP) https://www.ncbi.nlm.nih.gov/books/NBK441904/   
  
• ICU team basic training Ventilation (ASV focused)  Hamilton Adaptive Support Ventilation Presenter: Dr Ian Rechner  Advanced Ventilation Workshop Date of recording: 2016-11-02 https://www.youtube.com/watch?v=4uOFPGkh8vE      
  
• Many good starting "How to" Ventilation inputs at ARDSnet like this Ventilator Treatment Protocol card which I found quit validating of what I took above from the learning links above..  A nice two page keeper to refer back to  Ventilator Protocol card (pdf) 
  

///// comments on your charts

I am NOOB on this topics so my comments below are not worth anything..   Seriously! These are observations and most likely mean NOTHING.  Just points of interest to maybe help learning ventilation more fun.  

Ok so a quick clueless, sophomoric "once over" looking at your Respiratory Rate, Minute Volume, Tidal Volume, Inspiration Times & Expiration Times and I noticed:

Inspiration/Expiration Ratio 

• I have read something like a good default starting point Inspiration/Expiration ratio 1.2 to 1.4 will help ensure you are ejecting enough CO2 to maintain good oxygen saturation (and being heavy on CO2 might make you tired.. ).
  
• I noticed that your ratio in the images you posted above was only 1.05.  IF! you wanted to tune & test your Expiration Time to be shorter to improve this ratio and see what that did to your night long SPO2, AHI and how refreshed you feel you would want to lower pressure during exhale, so might carefully try A-FLEX and increasing 1 level at a time and test.  Given your current Pressure and EPAP you might already be running A-FLEX and uping A-FLEX ups my pressure as well so you might drop your top level pressure by 1 every time you raise A-Flex by 1.  (Just an FYI, I used to hate A-FEX on my Dreamstation APAP, now I run A-FLEX at Level 3 when I ride that machine.) 
  

Respiratory Rate + Tidal Volume 

• I have read that the default desired Respiratory Rate is 12 and 12 - 20 is within normal ranges.  Your Respiratory Rate Mean was 15, which is OK if your Tidal Volume is not too high.  
  
• Your Tidal Volume mean was 420, which is either a little low, just right or too high.  Was'nt that helpful   
  
• Look up your height in this handy dandy pdf from ARDSnet to see what your Tidal Volume should be at a Respiratory Rate of 12.  Use the 8ml if you are in a state of trama and 6ml column for a starting point for a long-term Tidal Volume target.   Once you have your expected Tidal Volume number it is simple algebra to see how your Respiratory Rate, Minute Volume and Tidal Volume all check out.     Predicted Body Weight Calculator (2005-02-02) (pdf)    
  

My Dreamstation APAP beats me silly and leaves my exhausted when I run it at high pressures.  

• On my Dreamstation for me personally, I am less tired at AHI 3.5 running lower pressures than AHI 1.5-2 at high pressures...  actually for me that machine is 'nope cant do this' unbearably harsh at high pressures.   
  
• So it is just a thought that if you could get great AHI at lower pressure that may (or may not) impact how refreshed you feel.
  

WillSleep ... questing for better sleep

[WillSleep]

Oh, and the first thing I would do if you are not is to wear a SPO2 sensor all night to see if your 02 is at the ideals of 94-97% all night or if you are seeing any desaturation issues through the night and a heart rate tracker of some kind as well.  

To those I add a sleep an iphone based sleep tracker & sound recorder each night.  

Being able to correlate from all those data sources helps clarify ambiguities in OSCAR and are learning & monitoring tools in their own right  (E.g. constantly landing a nightly heart rate curve in the shape of a hammock is the goal for a refreshing night sleep).

WillSleep..  Zzzzzzzz

[ChinaMan]

When I used Dreamwear nasal masks, there was no RERAs; but nasal masks usually slipped off my noses during the nights. Should I return to nasal masks, albeit more secure ones?

BTW, it appears that raising my mini pressure from 12.5 to 13 further reduced AHI.

Expert commentary is welcome.

The issue is that whenever I had short naps, my AHIs were always 0 and there was always no events. And I always felt very refreshed after short naps. Hope I can replicate the nap experience into whole night experience.

[ChinaMan]

Welcome Chinaman!

I am presently researching why I personally am still no 'not refreshed' when my OSCAR report shows me at 0.0 AHI. 

This has led me to a possible hypothesis that once we are consistently producing nightly AHI of less than 3.0 or 4.0  at least some of us might gain more from monitoring and improving our Pulmonary Function performance than from continuing to try to drill AHI down to Zero.  

Sleeprider posted this in an earlier thread of mine.   "A very simple principle to keep in mind when working with BPAP of any kind.  PEEP (Positive End Expiratory Pressure) controls oxygenation.  An increase in EPAP min should keep oxygen levels higher.  EPAP min is also used to control obstructive apnea, but in ventilation the term is PEEP. Pressure Support increases tidal volume and CO2 blow-off.  These are powerful tools and you can find many references if you search  both articles and videos that explain all this.”


Learning some of the underlying fundamentals of Ventilation is great stuff.   The Google link above is good and here a few good additional foundational learning links.    

• EPAP = PEEP,  Positive end-expiratory pressure (PEEP) 
  
• ICU team basic training Ventilation (ASV focused)  Hamilton Adaptive Support Ventilation Presenter: Dr Ian Rechner  Advanced Ventilation Workshop Date of recording: 2016-11-02 
  
• Many good starting "How to" Ventilation inputs at ARDSnet like this Ventilator Treatment Protocol card which I found quit validating of what I took above from the learning links above..  A nice two page keeper to refer back to  
  

///// comments on your charts

I am NOOB on this topics so my comments below are not worth anything..   Seriously! These are observations and most likely mean NOTHING.  Just points of interest to maybe help learning ventilation more fun.  

Ok so a quick clueless, sophomoric "once over" looking at your Respiratory Rate, Minute Volume, Tidal Volume, Inspiration Times & Expiration Times and I noticed:

Inspiration/Expiration Ratio 

• I have read something like a good default starting point Inspiration/Expiration ratio 1.2 to 1.4 will help ensure you are ejecting enough CO2 to maintain good oxygen saturation (and being heavy on CO2 might make you tired.. ).
  
• I noticed that your ratio in the images you posted above was only 1.05.  IF! you wanted to tune & test your Expiration Time to be shorter to improve this ratio and see what that did to your night long SPO2, AHI and how refreshed you feel you would want to lower pressure during exhale, so might carefully try A-FLEX and increasing 1 level at a time and test.  Given your current Pressure and EPAP you might already be running A-FLEX and uping A-FLEX ups my pressure as well so you might drop your top level pressure by 1 every time you raise A-Flex by 1.  (Just an FYI, I used to hate A-FEX on my Dreamstation APAP, now I run A-FLEX at Level 3 when I ride that machine.) 
  

Respiratory Rate + Tidal Volume 

• I have read that the default desired Respiratory Rate is 12 and 12 - 20 is within normal ranges.  Your Respiratory Rate Mean was 15, which is OK if your Tidal Volume is not too high.  
  
• Your Tidal Volume mean was 420, which is either a little low, just right or too high.  Was'nt that helpful   
  
• Look up your height in this handy dandy pdf from ARDSnet to see what your Tidal Volume should be at a Respiratory Rate of 12.  Use the 8ml if you are in a state of trama and 6ml column for a starting point for a long-term Tidal Volume target.   Once you have your expected Tidal Volume number it is simple algebra to see how your Respiratory Rate, Minute Volume and Tidal Volume all check out.     
  

My Dreamstation APAP beats me silly and leaves my exhausted when I run it at high pressures.  

• On my Dreamstation for me personally, I am less tired at AHI 3.5 running lower pressures than AHI 1.5-2 at high pressures...  actually for me that machine is 'nope cant do this' unbearably harsh at high pressures.   
  
• So it is just a thought that if you could get great AHI at lower pressure that may (or may not) impact how refreshed you feel.
  

WillSleep ... questing for better sleep

Last night I had some alcohol before I went to sleep. And I lowered the AFlex to 1. It appears that I felt a little better but still not ideal. And as usual, I woke up multiple times during the night. My question is that why I can't feel refreshed after a night's sleep just like after naps?

Any suggestions for me? You meant lowered the minimum pressure although AHI will go up but I might feel better?

Are you saying that your AHI is 0 now, but still feel tired in the morning? What's your RDI number?

[mper6794]

............
Is there anyway to eliminate all sleep disordered breathing?

P.S., I am borderline prediabetic, A1C was 5.8 in early september(>5.7 is considered prediabetic) 

  .

Hi, there
It looks your case would be one more in this Forum, in which ahi ok and HYF (How you feel) is poor, that is, you would have just touch the tip of the iceberg.
Absolute majority  of such cases, If not all of them, would be associated with unresolved  UARSand/or PLM's. Prediabetic Could be already a consequence of UARS/PLM's (see this Steven Park' book: sleep interrupted).
First Steps suggested:(1) try to confirm diagnostic, posting yours chart, top downward, as like this: pressure, FR (_120 to 120), FL, TV (with the median reference line), RR, and leak; (2) start thinking on the tailored machine for you: the BPAP.
Good luck!

[slowriter]

When I used Dreamwear nasal masks, there was no RERAs; but nasal masks usually slipped off my noses during the nights.  Should I return to nasal masks, albeit more secure ones?

BTW, it appears that raising my mini pressure from 12.5 to 13 further reduced AHI.

Expert commentary is welcome.

The issue is that whenever I had short naps, my AHIs were always 0 and there was always no events. And I always felt very refreshed after short naps. Hope I can replicate the nap experience into whole night experience.

If you read my thread, you might get some ideas.

On my resmed autoset, it was consistently reporting 0 RERAs. When I went to a followup titration study, I had a ton (25/hour), and the only way to resolve them was a bilevel with a fairly high pressure support of 6.

As in, eliminating the RERAs required a relatively high inspiratory pressure (in my case 12), and low expiratory (6); something you can't achieve with CPAP.

That may be a path you'll need to consider.

[ChinaMan]

Oh, and the first thing I would do if you are not is to wear a SPO2 sensor all night to see if your 02 is at the ideals of 94-97% all night or if you are seeing any desaturation issues through the night and a heart rate tracker of some kind as well.  

To those I add a sleep an iphone based sleep tracker & sound recorder each night.  

Being able to correlate from all those data sources helps clarify ambiguities in OSCAR and are learning & monitoring tools in their own right  (E.g. constantly landing a nightly heart rate curve in the shape of a hammock is the goal for a refreshing night sleep).

WillSleep..  Zzzzzzzz

Are you feeling better with the Bi-PAP?