AHI low, what else could be making me sleepy?

[fsc321]

Hello everyone, I'm new to the forum.  I'm 37 and I've been using a DreamStation for about a year but took close to 2 months off after getting septoplasty and turbinate reduction.  The procedures made breathing out of my nose MUCH easier and I thought it might help my sleep, but I used a snore score app a week ago and found that my snoring was actually worse than before.  Go figure.  So, I'm back on the CPAP and have had some interesting results.  I'm posing because you guys know so much more than I do about all of this and I'm hoping you can point me in some directions for further investigation.

I started my first couple of days back with a full face mask but thought I might give the nasal mask a try since I can now breathe out of my nose.  I also was seeing my VS2 score which seemed high, and I wondered if using the nasal mask would reduce the snoring.  Since starting back up the first two days were with the full mask and the last three days were with the nasal mask.  After switching to the nasal mask I looked at sleepyhead and raised my pressure from 7.5 to 8.5 which seemed to substantially reduce my AHI the last two nights.

I'm looking for my sleep study.  I recall my apnea was largely positional, 15 events on my back less than 5 on my side.

I'm a day wearing the full mask where I felt good, a night wearing the nasal mask where I felt good, and a night wearing the nasal mask where I feel tired.  For my untrained eye, the one thing I do notice is that I feel better when I get 8.5-9 hours of sleep, but it seems odd to me that getting 8 hours alone would make me feel so much worse than an extra 30 minutes.  My off days I wake up feeling tired, my resting heart rate is higher, and I just generally feel more lethargic.

[staceyburke]

The way you have the charts set up we can not see some important info. At thew top of the left side click on view and select reset charts and chose standard. take the screen shot and post....

[fsc321]

Thank you, doing that now.

[fsc321]

Charts updated to Oscar, standard view.

[staceyburke]

I'm sorry but the chart I needed to see is the flow limits, I think it is high but cant see it.  One thing you can turn off is the VS2 it is not needed and just clutters up the chart.  

Other than the flow limits, the only thing is the snore chart which shows quite a few events.  To try to limit that raise the min number by 1 min=9.5

[fsc321]

I looked around and couldn't find a way to add that chart, but after looking at http://www.apneaboard.com/wiki/index.php..._your_Post it seems like with my CPAP that flow limitations will only show in events.

[fsc321]

It is interesting, going back and looking at data before the surgery my snore frequency was much lower than it has been this last week. 

[staceyburke]

Check other areas like you did with the flow limit.  and see if the breathing pattern is different.  This graph shows mouth breathing and that would go along with the snoring.  If the breath pattern is flat on the top (these were) it shows mouth breathing and rounded tops show normal breath.

[fsc321]

My breathing around snoring phases does look different.  

If I am mouth breathing would going back to the full mask and raising the pressure be the better option or sticking with the nasal mask and raising the pressure?  

I've seen quite a few videos of sleep techs and doctors talking about mouth taping, velcro, etc. to keep the mouth shut, is that fairly common with mouth breathers?

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Also, thank you so much for taking a look at this!  I feel lost and my sleep center doesn't do much other than send new masks and say "everything looks okay" when they check my data.

[Sleeprider]

Nearly every time someone starts a thread and says they still feel tired, I know the answer lies in flow limitation. Take a look at the wiki which explains a lot http://www.apneaboard.com/wiki/index.php...imitations I will bet if you zoom in closely on your flow rate, you are going to see the characteristic flat tops on the flow wave. The real solution is "pressure support", or a difference in pressure between inhale and exhale, which your Philips Dreamstation does not really provide, but a Resmed Autoset does as EPR (exhale pressure relief), as well as any bilevel / BiPAP. Your Philips has "Flex" which is a flow-based pressure reduction, but unlike the Resmed, it is not an effective bilevel pressure. With Philips I usually suggest not exceeding a setting of 2 for Flex, and while increased minimum pressure may relieve some flow limitation, it is not nearly as effective as the Resmed.

Flow limitation is generally caused by upper airway restriction or resistance, and causes you to use more effort during inhale. This increased respiratory effort frequently results in arousals termed respiratory effort related arousals (RERA) and even hypopnea. The only option without pressure support, which assists the inspiratory effort, is to use higher minimum pressure with the hope of decreasing resistance in the airway.