Low AHI Still Feel Like Crap

[mrsub96]

I've been instructed this is my best place to come to get some help as I have been struggling with feeling better with my machine and have reached a standstill on my ability to be able to read and best understand my Oscar data.

I was diagnosed with mild sleep apnea with an AHI of 7 and RDI of 12. I have had all the symptoms you can name including horrible fatigue, brain fog, irritability, crazy loud snoring, etc...

I was given recommendation to leave settings wide open on my machine of 4-20 and to adjust accordingly.

Initially my battle was being able to keep the mask on for the entire night... and when I would, I would feel significantly better the next day, more mental clarity and more energy.

I have now conquered that battle; however, even after wearing the mask all night I am feeling awful the next day and noticing that I am probably waking up anywhere from 5-7 times per night from what I can remember.

From my Oscar charts it looks like I am hitting my maxes on my chart in terms of pressure and am not sure what needs to be done in order to fix it.

My pressures are currently.... PS 5 over 10-18

These have been reached just from trial and error on my end from my basic reading and understanding of my charts.... the PS may be too high for all I know.

I have attached some reports from some nights to show you guys and hopefully someone is able to help me understand where I am going wrong!

   

   

   

[mrsub96]

bumpp

[staceyburke]

Welcome to the board. As you probably know your pressure is driven by flow limits. As your fl increase so does your pressure.

You have PS set to 5, so you are where I would think is a good setting for this but you might try to increase the ps while decreasing the min to see if that helps.

I woyld try ps 5.6 and decrease the min the same amount .6.

[mrsub96]

Hi Stacy thank you for your reply. Been through a lot of trial and error lately and worked with a sleep doctor who was trying to have me work with a PS of 2 and although my AHI was fine (under 2) my flow limitations have gone off the charts. I bought an oura ring to help start monitoring if I am waking up constantly throughout the night and my suspicions are true, I am getting flagged with minimal deep sleep and waking up constantly over the course of the night.

Here are the screenshots of the recommendations that you made for me and the results I had testing those. It seemed to have helped but I still was having issues with feeling like I am waking up throughout the course of the night and not sure why I am having the random breathing flow issues I had as included in the screenshots. 

I seem to be a restless and sensitive sleeper and not sure if the raises in pressure are causing me to wake up or not.

   

   

   

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[SevereApnea]

mrsub96 Greetings

I totally agree with Stacey, not sure why your sleep Doc would want less PS, maybe they have their own reasons. I would like to humbly offer another point of view. (PS Your diagnosed AHI is mild sleep Apnea. Do we know why you are on an AirCurve 10 Vauto?)

Long Story, (apologies in advance)

Thanks for posting some of your charts. 

What I see from your chart of 1 May is your initial setting of Min EPAP of 9.8 could just be a tad too low. Why do I say this:
1. because your achieved Med EPAP is a full 1 cmw higher at 10.96,
2. your achieved 95% EPAP is at 14.92.
3. Your EPAP never came back down to 9.8 during the night.
4. Flow limitations are on the high side: 95% FL is ok at 0.12 but could be better, less than 0.1 is usually what the pros here suggest is better.

On your chart of Jul 3 with PS of 5.6 your FL were much better at 95% FL of 0.0 = zero, which is excellent, and your achieved Med EPAP was the same as your initial EPAP.
(Question to more experienced board members: is this FL too low? Can we ever be overtreated? I often ponder this myself: hypothesis is that a low AHI can either be due to optimal treatment or overtreatment.)

Your chart of May 2nd again shows pressures going higher than you would like, but also show some clustering: using a SCC soft cervical collar helps many here on this board including myself reduce flow limitation and apnea/hypopnea events. Not sure if you are using this.

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optional ramble…
I also use the Vauto but for my part my pressures are much lower than yours, 7 – 11 with PS generally < 2.0. That said, I am pretty much data driven, and my numbers show that both MinEPAP and PS are needed to help to reduce my FLs. See screengrab from spreadsheet with Correlations.
[attachment=44706]
It is interesting that for me there is a moderate negative correlation between Min EPAP and 95FL (correlation coefficient = - 0.36 p value < 0.01): this means that for me, higher Min EPAP alone can help to reduce my flow limitations and therefore limit machine pressures.

More noticeable is that is that there is a stronger negative correlation of PS (pressure support) and 95 FL with a correlation of -0.42). Again, what this means is simply this: more PS >> less flow limitations.

But note that the best negative correlation of -0.65 is between Min Pressure and 95 FL (P-value of 8.77075E-33 LOL all this means is that this is Highly Statistically Significant) The Min set Pressure is made up of Min EPAP plus Pressure Support. So, what that means for me, is that both are needed to get my 95 FL down (usually in the 0.02 - 0.04 range.)
…..end of ramble

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The lower your FL is, the less your machine pressures will rise, potentially reducing pressure induced side effects. However, if you are pressure sensitive, the initial set pressures might be your limiting factor. Only you can work out which is the best middle ground for you based on comfort and how you slept during the night, and the absence of xPAP side effects.

This may not apply to you at your pressure levels, but I thought I would share with in case it helps and adds another topic of discussion. There will be point of balance here for you somewhere in between.

Long story short: Your settings of May 2nd with a SCC might be worth exploring some more.

[Dormeo]

With PS of 5.6, your flow limitations are well treated. You can try inching that back down to see how the FLs respond. Try 5.4 for a few nights to see how it goes.

I suggest an additional experiment, but please do only one experiment at a time so you can clearly see what the results are. The second experiment would be to set your max to your min + PS. This will keep your pressures constant throughout the night. Some people are fairly sensitive to pressure changes, so you could see whether this helps you sleep any better.

Finally, I notice that you go to bed and get up at times that vary a lot from one night to the next. I'd suggest you become as disciplined as you can in following the standard recommendations for improved sleep:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

These guidelines sound kind of vanilla, I know, but following them can really help.