Low AHI, Comfortable w/ APAP but Still Sleepy

[SJGD7]

Hi,

It's nice to meet everyone and I appreciate any help you can offer.

A little bit about me: I'm 33 yo male, normal BMI (15in neck circumference), anxious and diagnosed cyclothymic. I've always been told I snore and move a lot in bed, and I've experienced headaches, brain fog, nocturia, cold hands and feet. I had an O2 monitor in 2017 and it showed my O2 stats would sometimes dip into the mid-to-high 80s. Sleeping on my side and taping my mouth shut did a lot to improve my sleep, so I felt better, but not perfect.  My sleep deteriorated in the past two years probably because of COVID etc, so I tried CBT-I and it worked well. Something was always missing though. I had nights where I slept perfectly (incredibly refreshing), but the frequent headache or fatigue never went away, so I decided to try a sleep test from Lofta.

The test showed an pRDI of 17 and an O2 nadir of 92. The suggested treatment was APAP 4-20 cm H2O. I originally purchased the Resmed Aircurve but given supply issues switched to the Airsense 11 to get it sooner. I have three months to return it if I don't like it.

I began therapy last week. The first night was a little weird for obvious reasons, but honestly I think I've adapted quite well and my Oscar figures look pretty good to my eye. I'm still pretty fatigued though. (No morning/day headaches though and I don't have "hungover" brain fog.)

I have been reading other users' results that have low AHI, good reports, etc. It seems like the most common advice is to up the pressure a little, increase EPR, improve positioning, etc.

I'm very new to this, but I think I could up the pressure at the beginning of the night? My breathing looks a little off. My EPR is 1, so I might be able to change that. I think most of my issues come in the latter half of sleep though during REM. I've tried a chin strap but honestly I hate it. I taped just the center front of my lips and that helps. I use a flatter pillow since the cervical pillows can be an issue I guess. I also realize it's really early in my journey, so it could just take time. I have some central apneas but have read that's a result of getting more O2 / having less CO2.

I'm fairly certain I entered my machine, etc, but I use a Resmed Airsense 11 Auto, Resmed N20 mask, heated tube, and OSCAR. I tried the Bleep airports, but had a lot of leakage. I may give them another go, but I don't mind the N20 mask; I'd prefer to avoid the marks on my nose and face long-term though.

I'm sure I missed a few things, so I'd be happy to clarify.

Thank you,
Sam

[staceyburke]

Welcome to the board....  Your numbers are very good and you should try a couple things to you feel better.  So with that in mind let me give you a little information and a suggestion.

First the absolute lowest any machine can go is 4.  These machines are made so children as well as adults use them and 4 is is for a child not a grown adult.  Yours is set to 4-20 so you are inhaling at 4Cm which is to low for most adults.

Next EPR is Exhale Pressure Relief.  What it does is subtract from the min the EPR setting from the min to make the exhale easier.   Your min again is 4 so you can not use EPR.  The min needs raised. 

Last Flow limits are not counted in the AHI but are smaller apnea and can cause a person not to be able to get into deep sleep or they can wake you up.  Flow limits are controlled using EPR.

So my suggestion is to raise the min and the EPR to take advantage of EPR.  

I would change your settings to Min 7 EPR 3.

Again, the reason if to help you feel better your apnea is well controlled without any changes.  Give this try for a day or two and post back.

Last comment is that you have probably had apnea and sometimes it takes a while to start feeling better...

[SJGD7]

Thank you so much for taking a look quickly. I’ll try it out and report back.

[gainerfull]

Your leaks suggest the pressure is blowing your mouth open at night and these leak spikes will cause arousals that fragment your sleep. Have you considered mouth taping, a chin strap or a full face mask?