Low AHI in CPAP I still feel very bad

[sleepywizard]

Hello to everyone. I am sorry for any mistakes, English is not my native language and I don't live in the USA.

After feeling bad for about 15 years I discovered one year ago that I had severe sleep apnea in a lab sleep study. The result was:

- RDI: 123 per hour (in about 3 hours of sleep I had 138 hypopneas, 227 obstructive apneas, 5 central apneas).
- Sleep efficiency: 36%.
- Micro-awakenings: 91 per hour.
- Average oxyhemoglobin: 93%.
- Min oxyhemoglobin: 88%.
- Desaturation Index of oxyhemoglobin: 13/h.

My health insurance gives me a Resmed Airsense 10 CPAP machine and OSCAR says is a "BRICK! ". My doctor prescribed 11 cm-h2o with an EPR of 1 cm-H2O. A year later I am still sick. The doctor told me that I'm very fine because my AHI is under 5 and my leak is under 30 and after talking a lot with him the pressure was changed to 13 for a month and then to 15 which is my actual pressure. I am not weak up randomly in the night and I am a little better but not enough. The health insurance does not want to change the CPAP to an AUTO-CPAP. In any configuration, CPAP has always shown between 1.5 and 3.5 events per hour and leaks between 1 and 10 l/min.

I rented a Resmed Airsense 10 Autoset for a month and set min pressure 9 cm-h20, max pressure 20 cm-h20 and EPR off. The attachment images are the result of my first night (yesterday) in the rented machine and with my mouth taped and sleep on my side. I woke up in the night randomly about 4 or 5 times with a need for breath, fainting feeling and panic (same symptoms that I had with the old CPAP with 11 and 13 cm-h20). Today I am feeling very bad.

Thanks for your help.

[blancobonzo]

Hey. First of all you can change the settings yourself by holding the dial button and home button down. I would turn the EPR up to 2 or 3, which will likely improve your level of comfort with the machine and helps treat flow limitations.

[staceyburke]

Take a look at your flow limits chart. You have a high number of flow limits. Flow limits are apnea just like O and H events  they are smaller but they can cause sleep disturbances and wake you up. 

To help with flow limits we use EPR.  Change your EPR to on full time at 3. You will find it easier to breath and you will sleep better.

[Ratchick]

Hi and welcome to the board - your English is fine.

As the others have said, you can have many events that don't strictly qualify as full-on apneas or hypopneas, and that can still leave you feeling terrible.

Definitely turn on the EPR, and also up the minimum pressure if you're feeling like you can't get enough air.

[sleepywizard]

Thank you all for the recommendations.

I increased the EPR to 3 and have been increasing the minimum pressure from 9 to 13.

Min. pressure 11:
   

Min. pressure 12:
   

Min. pressure 13:
   


I notice improvement at night with higher minimum pressure but I feel just as bad during the day. I notice that if I increase the minimum pressure the obstructive apneas increase. Do I keep increasing the minimum pressure to 14 or 15? I need to find the correct settings on the rented Auto-CPAP and then apply them to my CPAP (not Auto-CPAP).

Thanks for the help

[SarcasticDave94]

The OSCAR data is improving, especially when EPR 3 was added. The flow limits have certainly reduced, that's the right direction.

I don't know if you can get your doctor to listen, but you need to tell them you're doing better on the rented APAP, even if you're not feeling it yet. Maybe share some of your OSCAR charts if they would look at them. Tell them what we're telling you about the therapy, flow limits, and all that.

Your therapy needs are looking and sounding better for using the AutoSet. Hopefully you make the case that it is giving better therapy.

I'm only guessing right now, but I wonder if part of your continued unrest is due to the many years of poor sleep with Apnea and flow limits. It may take more time with good working therapy to get to where you feel better for therapy.

[factor]

Dont increase the Minimum pressure to high as you see it cause issues.

Min of 9 seemed ok for you before.

I would go back to 9 or 10.

Min Pressure 9
Max Pressure 16
EPR 3 
Ramp Off if its on.

Leave this set for a few days and come back with a Screen Shot.

Dont just change settings to change stuff.  We want to go slow.  Your not going to feel better immediately it going to take getting the setting correct.  Then after that its going to be a few months.  You were sick for 15 years...  Got to give it some time.

A CPAP only machine cant do a range like 9 -16. It can only do one number. it can do EPR though.

[Marillion]

You've been getting some good advice above. I agree with the numbers Brent suggested above, those were going to be my suggestions also. As always SarcasticDave made some great points too I would act on. I just wanted to reinforce what they said and make sure you post an updated screenshot after a few days. You have to let your body get used to the new settings for a bit.