[CPAP] Returning to CPAP, Is my pressure too low (flow limitation problem)? See chart please

[MarkSleeps]

Hello,
I'm getting back into the CPAP game after a few years away from it - I was diagnosed with moderate OSA (AHI 26) back in 2013.
and made an account back then but only to read posts - too tired to post stuff I guess.
  
Bought a Resmed S9 Elite because of the data capabilities.  I wanted to buy the Autoset model but the doctor... well I digress.

Then I got mixed up by a bunch of sleep doctors - I'm not over weight, but my anatomy is the issue - small jaw, big tongue, possibly underlying UARS but definitely OSA.
So over to the dentist, I went the way of the oral appliance - SomnoMed - got my AHI down to 4 - 4.5.  I thought it was just my big tongue that was causing the problem.  I also lost some extra weight for good measure.

My problem is that I'm still tired.  I did a sleep study back in May with the oral appliance and indeed my apneas seem to be under control - only 2.
However I have 22 Hypopneas, 15 RERAs.  My Flow limitation was around 35% which my dentist said was on the high side.
At that point I was asked to go see another sleep doctor as my Somnomed only deals with my tongue and obviously I have more going on.

So then back to the sleep doctor.  To make a long story short, the sleep doctor offers nothing new and no suggestions.

So I have decided to give CPAP another try.  This time I want to be more active in trying to figure out how to fix my sleep problem using CPAP.  One major thing that I like about CPAP over the oral appliance is all that data.  

CPAP HELP:
My titration was done in the summer of 2013 and I had a horrible night - got very little sleep.  Not sure how the sleep tech came up with a pressure of 6cm. 

So fast foward to present, I've been using CPAP for about a week.  Still very tired.  I'm not confident that my pressure is high enough - should I increase it a little?  My usage is about 6-7 hours each night.  My Flow limitation seems a bit high.  I'm also wondering if my mouth is opening as I use a very minimal mask - P10 nasal pillows.  I might get a chinstrap or use medical tape - one strip going vertical - not to seal it shut but just to keep the mouth closed.  Not sure if the Resmed can detect a leak due to an open mouth?
Any pointers on how I can get started on this?
Thank you for your time!
Mark

Here's my chart from two nights ago:

[quiescence at last]

your flow limitations do not seem horrible, or even extra high.

your machine does not track RERA, but I wonder looking at the one night whether you would even likely register many RERA at this pressure.

are you sleeping on your back?

your leaking may be from mouth drifting open, but unless the leakage is disturbing you, causing you to partially awaken many times a night, this also doesn't seem like anything to be concerned about.

so, there are other things that can influence tiredness besides apnea.

low testosterone, high blood pressure, stress level, hypothyroid, vitamin deficiencies, to name a few.

good luck!

QAL

[MarkSleeps]

Thanks QAL, I appreciate your reply.


I sleep pretty much on my side (sometimes stomach).  Never on my back.
I trained myself not to sleep on my back because of my previous oral appliance therapy.

I normally don't notice my mouth open - only happened once this week so far.
I'll probably get a chin strap just to see if there is any difference but I think its nothing major like you suggest.

Last night, I used the machine for 7 hours, AHI of 0.29 - 0 apneas and only 2 hypopneas - 2 awakenings.
Even if I was at an AHI of 0 I'd still be tired though.

I have been tested for some of those things i.e. vitamin deficiencies, thyroid - all passed.
Used to have high blood pressure but got that under control.  Stress level is an up and down thing for me but usually I try to find ways to chill out before bedtime.
Not sure about low-T, guess I could inquire about that with my doctor since I'm in my 40s.
I do seem to have some nasal congestion so I'm going to find out what I can do about that.  Although CPAP is good at blasting through congestion I suppose.

I have a feeling this could take some time to solve this mystery of feeling refreshed after my nighttime sleep.

[Marillion]

That chart is not bad at all! In fact it looks very good. Anytime your AHI is below 1 you are doing very well. I don't see any real flow limit issues. If you wanted to experiment and go a little higher, like say 6.6 or even 7 or so you could, but where you are at right now may be as good as it gets.

If you are feeling tired, I would suggest trying to get closer to 7-8 hours of sleep a night instead of your usual 6-7. It could just be that you need a bit more quantity of sleep. The amount of 6-7 would be on the low side for most people (including myself.) If I was doing that consistently, I could see myself being quite tired too.

[trish6hundred]

Hi MarkSleeps,
WELCOME BACK! to the forum.!
Better luck to you this time around with CPAP therapy.
Hang in there for more responses to your post.

[ajack]

I think your sleep issues will lay elsewhere. I would google sleep hygiene for an overview of things that could help. you may need to see a sleep doctor. That chart looks fine, you could raise the pressure to 7 and see if it's enough for the flow limit. You are working with a very low pressure, so 7 could be enough, 6 is enough for your apnea.
Have to used EPR function? It lowers the breathing out pressure, some people like it.

[MarkSleeps]

Thank you for your responses.  
Yes, its true that my sleep hygiene is rough, I will admit it.
I should definitely try to increase by sleep quantity to 8 hours and see if that helps.

A sleep doctor said that my CPAP therapy is good but I am in sleep debt and need to catch up.
Is "sleep debt" really a thing?  If I haven't been getting proper sleep for a long time, does that mean I have to catch up on all the hours that I missed?  Or is it more or less just find that right number of hours to sleep per night and stick with it and when you don't get enough sleep on a particular night try to catch up as soon as possible.  Wish I could do siestas!

Yes I need better time management.  Somehow I need to break this cycle.
I drag my butt when its time to get to bed, sometimes following asleep on the couch for an hour or two or three. Then up to bed.
Other nights I just stall to get to my bed - since I have to get a hundred things done before bedtime.
I don't get it, since I know I need extra sleep.  I have to make a bigger effort I guess.

I've just started using the S+ sleep tracker by Resmed - they were clearing them out at Bed Bath and Beyond, I kind of like it since its all about sleep hygiene and also records my sleep patterns - it uses Sonar and seems accurate - it shows the wave pattern of my breathing.  If I move ever so slightly, the wave pattern changes.  It shows me a chart of when I'm in deep/light/REM/awake/interruption.  It coincides with my interruptions on my CPAP charts - seems to play nice with CPAP therapy.  So I'm going to see if this helps.  So far my deep and REM numbers are improving since going back on CPAP!

Now I just have to get more quantity!