Low AHI but still have daytime sleepiness and fatigue.

[FindingCourage]

Hi guys. Making a new thread to get your attention. Desperately looking for help.
Previous thread

I currently use resmed airsense 10.
I got my CPAP 3 months back but I am finally getting used to it after finding out my masks/settings.  Following is the routine:
- Pressure 8-12
- EPR 3
- Intake nasal strip
- Flonase spray
- Neilmed nasal rinse
- Mouthtape
- Nasal pillow mask
- Humidity setting 6
- Hosemask
- Hose Temperature 86 , Room temperature 72
- Neck collar



I adding in my yesterday OSCAR chart.
   

-  Despite getting 8 hours in it and 0.5 AHi, I felt very fatigued and slept for 2 more hours in the afternoon. 
- Ignore the initial large leaks as it was me messing with the mask before falling asleep. 
- I woke up once during 5am which also coincides with the large leak in the graph. But i am not sure why i woke up.
- Is this flow rate graph fine? There are some spikes and doesn't have a overall flatness
- I have added zoomed photos where there seems to be few flatness in flow rate (which are not flagged) Is this normal?
- How to find right humidity settings. Currently it is on 6 and I want to move on to 7 but I get rain outs and water droplets in my nose even with 6. I have added the image o f my cpap setup. I am using a holder to avoid rain outs. what else can i do?
   

Can anyone suggest what should be my next step. I don't even feel bit improved. Is my pressure/EPR too high?

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[Phaleronic]

EPR causes more issues than it helps, so please turn it down or off, but please try it tonight before bed for 30 to 45 minutes.

Lower min pressure to 6cm too once you turn it off, and set max pressure to 11cm.

This narrower band of pressure without using EPR will help your REM and Delta sleep.

[FindingCourage]

Hey Phaleronic, can you please explain why i need to reduce my minimum pressure?
It was initially at 4-12 but i increased based on input from people here. Also what should I expect from turning off the epr? I don't know what to expect since i have it on from the beginning. By trying for 30 minutes do you mean just using the machine while awake?


I am just trying to understand your reasoning behind it so that i can aware too. Thank you!

[FindingCourage]

   
   

Today's chart. I don't even know whether I improved or not. Please help me out. TIA

[Deborah K.]

Were you more comfortable? If not I'd raise your start pressure to 7 and turn EPR back on set at 3. I think you'd feel better.

[FindingCourage]

Waking up i couldn't feel a difference. But i didn't feel sleepy during the day today. So i don't know what to make out of it.

Side question. Can anyone help me with the rainout. I still got water droplets in my mask with humidity 6. Will another hose cover over it help?

[AshSF]

The pressure changes during the night might be causing microarousals and messing with your sleep architecture. That would make you feel fatigued during the day even though your AHI < 1.

Your EPAP 95%ile is 7.x. Since this pressure is pretty low, you can try CPAP mode with either:
pressure = 8cm and EPR =0
OR
pressure = 10cm and EPR = 2 or 3.

Use these settings for a week and see if it changes how your energy levels are during the day. And if you wake up thinking you slept like a baby (this will happen when you titrate to the ideal setting finally).

[FindingCourage]

My 95% epap is 10.3 in yesterday chart. it was 7 x when the epr was at 3. which to take consideration then?

[AshSF]

Take the reading that is most common over the last 30 days. APAP algos are such that there may be significant variations on a daily basis due to conditions like stuff nose, upper respiratory infections etc.

I would go with 8cm with 0 EPR for now. And then evaluate after 5 days.