Low AHI but still choking

[oskar97kx]

Hello, I'm 29 years old and I was diagnosed with mild sleep apnea 3 years ago (AHI 5 and brain oxygen levels went down to 88% during sleep study) and I started using a CPAP 2 years ago.

I also had a blood clot in the lungs 3 years ago which made me lose 1/3 of lung function however I'm still able to do hard workouts so the lung function has either returned to normal or it's not affecting me much throughout the day.

The improvement in sleep quality was massive in the first months, however I ended up gaining 50 pounds with the first 15 pounds being in the first week of using the CPAP. 

Somehow, getting on the CPAP increased my appetite a lot and despite working out 2 hours per day the weight just kept piling on (both muscle and fat but mostly fat). After gaining the weight, my sleep quality deteriorated despite always having AHIs between 0.5-1.5.

In any case, I lost almost all the weight the last 6 months and my AHI is consistently below 1, but I still wake up feeling unrefreshed and my wife sometimes catches me choking at night. I just wanted to check here if there's possibly something wrong with my sleep / CPAP therapy? I'll attach data from 3 nights of sleeping and if you happen to see something that is off, I'd really appreciate if you let me know. 

Best regards,
Oskar

[staceyburke]

Your flow limits are not showing so I'm taking a little guess that it is flow limits that are the problem.  We use EPR to help with FL.  You have set your EPR to the mac of 3 but your min is at 6 making your EPR really at 2.  EPR is exhale pressure relief.   The exhale pressure is the min - EPR but your min is at 6 and subtract 3 would give you an exhale of 3 which the machine can not do.  The absolute min a pap machine can go is 4.

I would suggest that you set the min to 8 and see how that feels and if it helps with the tiredness.

[OpalRose]

I don't see anything in your data that might affect sleep quality except... you're not getting much benefit from using EPR with a low minimum pressure.  If you're using a minimum pressure of 5 with EPR 3, the machine can only go as low as 4.  (5-3=2)
You don't see a benefit of pressure relief until you reach a pressure of 7.

You might want to try bumping your minimum pressure to 7cm and turn off the ramp if using.  Keep EPR set to 3.

Note:  I'm only suggesting this change to help with your comfort level.  Your numbers are good otherwise.

One important thing to consider is sleep hygiene.

Read through these articles and see if there is anything to improve on. Good Luck!

https://www.sleepfoundation.org/articles/sleep-hygiene

http://healthysleep.med.harvard.edu/heal...oming/tips

[mper6794]

_ Hi,

-as someone said Flow Limitation may be the culprit
- and humble, with no arrogance, and really curious about,  based on my experience successively with brick CPAP (lost time) + APAP (lost time, quickly realized it did not work) + BiPAp (this, the only I know is able to battle flow limitation), does anybody ever succeded on battle Flow Limitation with pressure support < 4.0 ? 

see this Resmed protocol S-mode titration protocol; Initial Pressure Support is indicated as 4.0, which looks confirmed in this Forum for so many people.

all the best and good luck

[mper6794]

https://document.resmed.com/en-us/docume...er_eng.pdf

[SarcasticDave94]

It would be helpful to see a more standard OSCAR screenshot. Typically this is pressing the F12 key on your computer keyboard. Again, typically we need to see these charts unless more detail is necessary: Events, Flow Rate, Pressure, Leaks, Flow Limits.

[oskar97kx]

Thanks for the advice, I just tried upping my min pressure to 8. I slept almost 10H without any awakenings, I'll try it for a week and see if it helps sleep quality. After that, I'll try removing ramp too and see if it makes a difference.

Sleep hygiene: Been on it for about 3-4 years. Sleeping before 10:30 PM every night in a pitch black, cool and quiet room and using blue light glasses after 8-9 PM.

OSCAR screenshots: I tried pressing F12 however it doesn't work on my mac so I used the second recommended method in the guide where I went into view > take screenshot. In any case, I got a second screenshot of each night showing the flow limit, leak rate and snore, I attached them here. If there's a better way to take the screenshots, please let me know.

[staceyburke]

All 3 show min 6. Not 8.

[oskar97kx]

I wanted to wait a few nights before posting the ones with the new settings. 

Here are the ones with min pressure 8 from last night (I used the F12/take screenshot method in OSCAR but needed 5 screenshots to get all the graphs so I'll post the last 2 in the next reply)

---

And here are the last 2 screenshots with graphs

[Jeff8356]

oskar97kx,

The screenshots on your Mac can either be done with view > take screenshot or by pressing fn + F12 (the fn key is usually on the bottom left of the keyboard).

You can also change the graphs into the preferred order for posting by view > reset graphs > standard
and you can reset the height of the graphs using view > reset graph heights

That should put things in a better view for posting...