[CPAP] 3 years of low AHI and still tired. Any ideas?

[Lexie]

I have been using a ResMed Airsense 10 Autoset since February 2020 and despite consistently having a low AHI, I still feel like my sleep quality is very poor. I usually wake up feeling tired and have trouble functioning during the day. I am fairly sure something is continuing to interrupt my sleep because other medical causes of tiredness have been ruled out. Also, my level of tiredness varies depending on the day and I am very sensitive to changes in humidity, temperature, and bedding, which makes me think these factors may affect my CPAP therapy, but I haven't been able to identify patterns. I also monitor my heart rate and oxygen saturation during sleep using a FitBit, and although I know the FitBit is not necessarily very accurate, I've noticed that when I feel worse in the morning I often had more erratic heart rate and oxygen saturation measurements during the prior night. 

I've been lurking on here for a while and would love to see if anyone has any idea of additional tweaks I can try as I'm running out of ideas. Things I've tried so far that didn't help much or made me feel more tired are: switching to nasal cushions (felt worse); using a nasal spray regimen of saline spray, Flonase, and Azelastine (seems to be marginally helpful); using a wedge pillow (unclear results); increasing min pressure to 8 (felt worse); and reducing EPR to 2 (felt worse). I haven't been very rigorous with my experimentation, though, so I may need to try stick with some of these things longer before concluding they don't work.

I'm attaching one OSCAR chart from a rare night where I felt well rested (Dec 16) and one night where I felt bad (Dec 20), as well as a zoomed-in shot with an example of a flow rate pattern I often see in my data that looks odd to my untrained eye. This is my first time sharing OSCAR images so please let me know if anything is incorrect or if other charts are needed. 

Thanks in advance for any suggestions! 
           

[Lucid]

Hi, Lexie, and welcome to Apnea Board!

Some people are disturbed by changes in pressure.  A few months ago, I switched from APAP mode to CPAP mode and am using a constant pressure of 11 with EPR 3.  I find this more relaxing, and it evened out my flow rate.

I started at 9, tried 10, and settled on 11.  You're 95th percentile pressure is lower than mine was, though, so a lower pressure might work.

This idea is just based on my own experience and observing some unevenness in flow rate in your charts.  The experienced analysts here may identify something else to work on.  Your numbers look great, though!

[Lexie]

Thanks so much, Lucid! It's great to hear that switching to CPAP mode has helped you. I'd actually been wondering if APAP mode may be causing my problems, too. It seems like I feel worse on nights where my pressures go higher (although I wasn't sure if it wasn't the pressure itself or breathing-related issues leading to higher pressure that are the problem.) I'm going to experiment with this--glad to have something else to try!