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

[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.

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.

Are you feeling better with Bi-PAP? The OSCAR shows I had no RERAs with Dreamwear nasal mask, but I did wake up adjusting the mask many times.

I have been lower the AFlex from 3 to 1 for the past two nights, and I felt better last night(but slept 10 hrs, with many hours awake).

[ChinaMan]

............
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 suggested1) 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!

I don't know how to make FR(_120 to 120), FL, TV (with the median reference line). Can you tell me how to adjust the graphic?

Attached are the largest extent I could adjust to the graphic. I was using Amara View full face mask, and my mouth contained a night guard for teeth grinding.

AFlex was lowered to 1 for the past two days. I feel better wake up this morning, but I slept for 10 hrs and spent many time awake. Comments are welcome. What I want to emphasize is that I always feel awesome after short naps with no events.

[mper6794]

... i think you went great on starting up your charts, However,
Sorry, i am afraid neither me or others here would not still be able to go any further with those displays.
Just click on the left side; everything you need to adjust and add are there.
TV maximum no mote than 1.500, in addition.
GL

[WillSleep]

Hi Chinaman, 

Saw your PM.  I will just answer those questions here.  

"So you are using an ASV, and AHI is 0 but you still feel tired?"

Yes, this is correct.  It seems like some folks are done with their quest for better sleep by just getting their AHI numbers low.  For me and some lucky others a lower AHI is only one of  2-5 things to need to be worked out.

1. Check your Oxygen Saturation Levels through the night: Maybe half of the point of getting a low AHI is to improve your cardiac stats.  Did it work?  How will you know if you don't check?  
If your still tired with a low AHI then I believe the first next thing to check is to wear a pulse-oximeter all night and see if your getting any Oxygen desaturations (SPO2) below 92%.  The SPO2 standards vary from 88% - 92% as being the medical lower limit but I sure can feel it the next day if my O2 stays down at even just 92% for 20-30 mins.   

My nightly SPO2 goal is a min of 93-94% and an average of no less than 95-97%.       


"I don't know if anything would change if I switch to bi-pap or ASV."

Yes, for sure things would change.. but which Bi-Pap design would be best?  And are you a good fit for an ASV or will you be prevented by meeting the contraindications for an ASV or maybe your body would just prefer a different design.   

2. Before choosing a different machine more investigation is required so that you get the machine and prescription that will help you most.  

You have a low AHI but are still tired.  This means your Doctor is still responsible to be fully engaged with you to help you find a solution.  Book follow up with your Doc and say Doc, "I need your help.  Lets keep going."


2.a Try a less painful configuration with current DreamStation, AHI may go up but you still might feel better.   I would be exhausted every day if I slept every night with harsh config you are running now.  Min:13 - Max:13.5, A-Flex 1   The higher your Min setting the fewer apnea events but the downside is your lungs take a beating, higher heart rate variability all night and higher your blood pressure.   You want your machine settings to lower your blood pressure overall.   

So a question to ask/to test if you have not yet done so..   "Which settings are healthier for me overall and help me feel more rested?  The current settings or a more common approach of starting with a lower Min and maybe a little higher Max so the Machine has some room to do its job and increase your A-Flex setting so exhale is easier and you push more CO2 out on each breath.   

A more common setting for the DreamStation APAP.  Note: You did not post the results of your sleep study so I will just make some numbers up, adjust to meet what your sleep technician told you     A more common setting on that machine might be Min: 6-8,  Max: 12-15, A-Flex 2 or 

2.b   If you want to do a quick check to see if a Bi-Pap might be better drop your Min to 7 or 8 and turn your A-Flex on to 3.   This is sort of a light pass at what a Bi-Pap will do.   The A-Flex set to 3 gets you something like 3 cmH2O pressure relief at the bottom of your exhale (so maybe really 2.5 cmH20 relief) and is not far from what a Bi-pap will do for you.    For example the Bi-PAP using EPR or C-Flex+ is often set to give 3-5 cmH20 relieft rather than just this 2.5 you get with A-Flex .... but in feels in some ways kind of the same so you can get some ideal of what a Bi-Pap will do for you.    (to others..  FYI..  A-Flex at least on my machine seems to work better after an upgrade to the latest firmware).  

2.c  Good next steps might be less of a mystery if we could see your charts well enough to coach (same as mper6794  said just above).    
         
You are close.  Follow this  tutorial http://www.apneaboard.com/wiki/index.php...ganization  

On your overview of the night chart  http://www.apneaboard.com/forums/attachm...?aid=15800  

The Pressure row could be half as tall
The Flow Rate chart should be three times as tall, wide as it is now.. (this is the most critical chart to review in detail).

Here is an example  ..   http://www.apneaboard.com/forums/attachm...?aid=13801
........  But the AHI row is not needed and high "Flow Rate" row could be twice as big.  

Then second attachments should be zoomed into interesting times of the night.  Here is a good example to follow.  http://www.apneaboard.com/forums/attachm...?aid=15331


3. There a few other good recent threads will discussion on similar issues that might be of value.  Here is one thread. http://www.apneaboard.com/forums/Thread-...till-tired



WillSleep    Off to sleep.. ZZzzzzzzz

[SleepyTexasGirl]

having used CPAP for about 3 months. healthy weight male in my mid 30s. ....

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

You are a little young for a diabetic. Not sure if you’re young for a prediabetic. But I’ve known 4 Type 2 diabetics diagnosed in their 30’s. (2 have Apnea, don’t know about the others) The “healthy weight” is a little concerning. 

Normally the first thing they ask you to do is lose weight. Diabetes in people of normal weight when they are younger is more typical of type 1. 

Just one medication is typical for prediabetics.  If you progress quickly to needing multiple medications, get tested for antibodies to insulin. There was a study that 1/4 of Type 2 diabetics diagnosed before age 35 turned out to be LADA or MODY diabetics, which is a slow onset type 1 diabetes. Sometimes called Type 1.5.