CPAP possibly ineffective?

[Jake31B]

I'm a 24 yo male who was diagnosed with Sleep apnea at 22 with an AHI of 19. I am very physically fit I run around 30 miles per week and eat a healthy diet, I'm 5'11'' 170 lbs and I use my CPAP religiously all hours I sleep. I average 8-9 hours of usage daily. I'm having an issue where I am still chronically exhausted and wanted to rule out sleep apnea is the cause, my machine tells me my AHI is routinely lower than 1 AHI. When I wake up however I feel like I have swallowed large amounts of air and my blood pressure is high usually at 140/90. I feel as though the treatment may not be effective and could be contributing to my issues. I've included OSCAR data from last night.

[StevesSp]

My personal experience with CPAP (ten yrs or so) suggests that chasing really low AHI isn't necessarily the best goal, especially if you have to run high pressures to achieve that.

The first thing that should be trialed is using your machine in APAP mode rather than fixed pressure. The PAP boffins in here will doubtless suggest initial settings for you.

What I hope will happen is you will spend far less time at max pressure. This should reduce your aerophagia (swallowed air).

[Gideon]

Two things
Read up on sleep hygiene, as not all issues are caused by apnea and everyone can benefit from this

Remember these settings, fixed 14 EPR=3 full time. They represent a safe place should any changes radically disagree with you.

Change to auto mode with the goal to minimize your pressures on average.
Min pressure =7, the lowest that will allow EPR to fully work.

Set Max pressure to 12, with the intent to slowly increase if needed based on obstructive events.

Again the intent is to eliminate the aerophagia for comfort then to very slowly increase to avoid aerophagia

[StevesSp]

One of the other benefits of running in APAP (auto) mode is that the machine will determine what pressure is needed to deal with obstructive events and this will be reported in Oscar, allowing for a much more effective therapy based on YOUR physiology. APAP mode also provides for flexibility when required, such as when you gain or lose weight, have a few drinks in the evening, change your meds, etc.

Be prepared for some disruption to your sleep initially though. You're used to fixed pressure and may be disturbed when the machine ramps up pressure to head off an event. This should pass as you adjust to the new regime. You might also need to use a higher start pressure than advised above, because 7cm is half what you're used to. This can feel like your starved of air. If that happens, I would suggest trying a minimum of 10cm for a few nights, then gradually lower the min pressure in increments till you establish an effective (therapeutic) minimum that's comfortable.

Oscar will guide you!

[Jake31B]

Thank you for the suggestions I plan on trying this tonight and I’ll update once I see how it effects me!