Need help, Low AHI but still feel so tired.

[Jarlo]

Hello Apneaboard,


I have now been through a long process with my doctors in Denmark trying to solve my sleep apnea problems, but they are not very keen on providing specialized help for me.

I have transitioned from a CPAP to an ASVauto machine (Resmed Aircurve 10 CS Pacewave).
It has helped a bit with my fatigue and my AHI, which averages around 2~.

The problem is that I still feel very tired when I wake up in the morning. I am physically active, exercise 5-6 times a week, eat properly, have no vitamin deficiencies that doctors could find, and on paper, I am healthy. I am only 29 years old and sleep an average of over 8 hours per night.

I have lurked a lot here on Apneaboard to find answers to my questions, but now I am writing myself. I'm not certain where my problem lies, since i have found a comfortable Mask, and setup at my bed with my machine, and i've have been used to using the machine, if somebody can help me what is wrong and what to change i would really appreciate it, since i've seen how many you have helped in here!

TLDR: Despite my low AHI, I am very tired even though I have slept for around 8.5 hours per night. I don't know if I can do anything about my machine settings?
Please help me!


ps... Sorry for bad english as it isnt my strongest point

I'll post some random Oscar Charts from some of my latest nights.

[Jarlo]

Bump, i really hope anyone have some insight in this!

[Jay51]

Thanks for posting those charts Jarlo.  2 things come to mind from my experience using ASV.   1.  Leaks.  The leaks could be coming from the high pressure (which I suspect since your IPAP gets up to 23 and 25 max), or possibly not.  Here are some tips for mask leaks.  Mask Primer

2.  Some of your pressure increases may be due to positional apnea.  But since your EPAP doesn't get too terribly high, this is a long shot.  Possibly wearing a soft cervical collar my reduce your pressure a little bit and make for better sleep.  I commend you for being able to sleep with pressure that goes up to 25.   

It might take some time to feel better also.  Think of how long you have had untreated sleep apnea.  Now think how long you have been using therapy.  It can take some time.

There is also the possibility you have some other health problem unrelated to sleep apnea that is contributing to your fatigue also.  I don't suspect any, but it is a possibility.  Is there anything at all that you can think of in your medical history that may be contributing to your fatigue?

[Jarlo]

Hi Jay51

I appreciate the response!

I dont feel like i have big leaks, but maybe my pressure can go a bit too high, which wakes me up! which setting do i have to turn down so my top pressure arent too high?

I have tried sleeping with a collar, which didnt do much for me unfortunately   also in 2 different sizes..

i have a appointment with my doctor about the last thing ur stating about other health related issues, but i've been pretty much cleared out from other dieases, and i look "healthy"

[SarcasticDave94]

You likely have similar settings as the US ASV. Pressure settings will be EPAP Min and Max along with PS Min and Max. IPAP is the sum of the EPAP plus PS and isn't user adjustable directly.

PS Max of 20 is probably one that can be lowered. At least on our US ASV the mechanical highest IPAP max is 25. Yours appears to act like this as well.

I would likely add a small increase to EPAP Min from 4 to 5 and lower PS Max to 15. I'm not sure, but you might lower EPAP Max to 12 or 13.

Then the leaks... Unless I got it backwards, spikey leaks are mask blows, and wide somewhat flat leaks are mouth.

When I used the ASV, EPAP worked on obstructive apnea and PS affected centrals.

[Jarlo]

You likely have similar settings as the US ASV. Pressure settings will be EPAP Min and Max along with PS Min and Max. IPAP is the sum of the EPAP plus PS and isn't user adjustable directly.

PS Max of 20 is probably one that can be lowered. At least on our US ASV the mechanical highest IPAP max is 25. Yours appears to act like this as well.

I would likely add a small increase to EPAP Min from 4 to 5 and lower PS Max to 15. I'm not sure, but you might lower EPAP Max to 12 or 13.

Then the leaks... Unless I got it backwards, spikey leaks are mask blows, and wide somewhat flat leaks are mouth.

When I used the ASV, EPAP worked on obstructive apnea and PS affected centrals.

Hi Dave!

Thanks for the Input ill try that, what would that be like in settings?

Min Epap = 5.0
Max EPAP =15.0
min PS = 3.6
MAX PS = 15

[SarcasticDave94]

Welcome.

You could try that as you list, or if you wish, EPAP Min could be about 13.0.

PS min could be anywhere between 3 and 4, you should be OK.

A good standard protocol for editing pressures is try it a night, asking self in the morning was it better or worse, and how was it so. State those in a post with an overnight OSCAR. Combined, it'll help guide in settings, helping to determine whether to leave as is and try another nights worth or edit further.