[split] gadgetmaniah - Low AHI, but still tired

[factor]

Read this to improve your screen shots.
http://www.apneaboard.com/wiki/index.php...creen_Shot

So we can really see the things we need to see to help you.

[gadgetmaniah]

Hello,

Thanks very much for the reply! I hope the screenshots attached here are better.

I think it would be useful to give a brief background to my therapy and what exactly I am trying to improve.

I started CPAP therapy about a couple of months ago and I have not had a sleep study. I started and optimized my therapy through help on another CPAP related forum. If I set my minimum pressure to 4, my average pressure tends to stay around 6. However, I have noticed that at that pressure my breaths look quite flow limited, and I think that that is reflected a bit in the flow limit chart of the OSCAR screenshot below in which my minimum pressure is at 4.

CPAP has helped me a lot and I definitely feel a major difference by using it. Before starting to use it I had the typical symptoms of sleep apnea: extreme tiredness after waking up, vague headaches, brain fog, and drowsiness. I felt that I didn't have enough sleep no matter how much I slept (this is about the only symptom that now persists, though at a lesser severity), which led to being on bed for 10-12 hours. I do have nasal breathing issues since childhood due to enlarged adenoids, which perhaps have contributed to my issue.

Before mid July I had used the Philips Dreamstation for about a month, and before that I used the REMStar Auto that I had rented for about three weeks. After much experimentation, in late June I felt that a minimum pressure of 9 suits me best. I think that is also reflected in the graphs below; in the screenshot where my minimum pressure is 9, my flow limitation charts looks cleaner than in the other screenshots. 

After I received my Resmed Autoset in mid July, I made experiments about what minimum pressure to keep, since I had read that due to the stronger algorithm of Resmed, I could keep a lower minimum pressure. In hindsight I should probably have just set it at 9 too. 

Anyways, my CPAP experience has mostly been good. Until about last week, whenever I used the CPAP I felt that my sleep was about 60-70% better than without a CPAP. The only symptom bothering me was a persistent feeling of not having had enough sleep, even with good amount of sleep. There is this lingering sleepiness that remains. I was thinking that perhaps it could have something to do with flow limitations, or maybe that I am just not getting enough deep sleep. 

The good news is that since the past two nights I can feel the good sleep that I would have on the CPAP returning. Before this, for about 7-8 days, I was waking up feeling very tired like I would without a CPAP. I don't what the problem was. 

Anyways, what I am looking to improve now is the remaining about 30% improvement that I think I still need in my sleep. Though sleep is much better, I never have had a night yet where I felt that I had complete sleep. I always wake up with some amount of lingering sleepiness - it's a weird feeling because I can't actually sleep anymore. It just lingers throughout most of the day. 

Perhaps it would disappear gradually but I think it would be useful to see if I can improve anything in my sleep. 

The main problem that I see in my OSCAR flow rate graph right now: I see a number of arousals that last about 5-10 seconds. Sometimes there is a breath that looks an arousal and it is followed by an obstructive apnea or clear airway. Most of the time, however, it causes mini apneas of around 5 seconds. I don't know if this is significant though. I seem to have about five of these an hour, on average. I was thinking that they might be being caused by flow limitation that the machine isn't detecting, but now I am not so sure. When I have my minimum pressure at 9, my breaths don't look nearly as flow limited as they do when I have my minimum pressure at a lower pressure like 6. I still have the arousals though, and I wonder if they are being caused by flow limitation.

My current settings: Minimum Pressure: 9. Maximum Pressure: 11. EPR: 3. I have tried various pressures and I subjectively feel the best at this pressure. However, I have only been on it for a couple of days now on the Resmed (I used to be on this pressure for about a week on the Dreamstation too and felt better than at other pressures). I would like to continue on this pressure for some days to see how my sleep is like. Also, I previously had the response mode of the machine to soft but I have now changed it to standard.

Sorry for such a long post!

[gadgetmaniah]

I wonder if the breaths like the one in the picture below show anything abnormal? Or are they just irregular breaths that I shouldn't be concerned about? 

They happen sometimes in my sleep and end with a brief arousal (see second picture), after which the flow curves look more normal.

[ubersteiny]

I wonder if the breaths like the one in the picture below show anything abnormal? Or are they just irregular breaths that I shouldn't be concerned about? 

They happen sometimes in my sleep and end with a brief arousal (see second picture), after which the flow curves look more normal.

You're going to want to follow this link: http://www.apneaboard.com/wiki/index.php...ganization to organize your charts to better see the data. The first and easiest thing to do is hide the calendar. That way the statistics (median, 95%, max) will show for each measurement. That data is critical, along with the graphs noted in the link above, to get a better picture of the nights data.

[gadgetmaniah]

Ok, here are a few screenshots of today's sleep. I think there is some flow limitation going on but not as much to be concerned about. The sleep was better today and the feeling of incomplete sleep was less. I can see that the machine increases the pressure in the periods of flow limitation.

Also, this is all the information I could fit into the screenshots since my laptop screen is quite small. I had to squeeze in the important graphs to be able to capture them all, so that's why they might look smaller than usual.