Need help analyzing results. Low AHI but still sleepy

[boromt]

Hi,

I've been diagnosed with OSA, ~20 AHI and have been using CPAP for around 10 months. For the first few months, I've already got pretty good results (AHI < 2), and even better results at the moment (AHI < 1). However, I've a problem waking up many times (>5 times) in the early morning everyday, and feeling very sleepy and tired in the afternoon. I'm not sure if the CPAP affects my REM sleep in the early morning and wake me up. Please help with your opinion and suggestion.

Thank you in advance

   
   
   

[Deborah K.]

Your leaks are very high.  They are high enough to interfere with your therapy and leave you feeling lousy.  You may need to work on mask fitting or try a different mask or a different type of mask.  Generally, full-face masks leak the most, nasal masks leak less, and nasal pillows masks leak the least.

You also have high flow limits.  You can control this by using the Philips version of EPR, I think it is called flex.  Turn it up as high as it will go.  Flow limits are short-term, unreported apneas, and we want to get them as low as possible.

[boromt]

Thank you very much for your advice, Deborah. I'm currently using Resmed P10 nasals pillow mask. I'm not sure if using Resmed mask with Philips CPAP is the reason why the leak is high, but I'll try different settings to see if the leak is lower.

As for the high flow limits, I've already used FLEX 3 (highest) on my CPAP. Is there any other ways to reduce the number of flow limits?

Thank you.

[Deborah K.]

No setting can help with mask leaks.  You are using nasal pillows, which is good.  Might you be mouth leaking?  Lots of us have mouth leaks. For me, I solved it by using good mouth tape.  I don't know what is available in Thailand, but Hypafix and Cover Roll Stretch tape are good choices.  I prefer Theraband Kinesiology tape, as it is more comfortable and contours better to my face.  Also, I need 2-inch wide tape cut to about 5-1/2 inches long.  Any narrower or shorter and I still leak.  Also, using a different brand mask than your machine brand is not a problem, and does not cause leaks.

As to flow limits, some people find that raising their pressure settings can help.  I suggest that you change your starting pressure setting to 7, as your 3 flex setting won't work well with your low starting pressure.  Also, most adults are more comfortable with a starting pressure of at least 7.  Give it a try.

[boromt]

Thank you very much, Deborah. I've not had any dry mouth in the morning, so I assumed I didn't have mouth leaking. But I'll try to get the mouth tape and see if it helps.

I tried to increase the starting pressure to 7, but I was still not used to it and had problems falling sleep. I'll report back again when I got use to the pressure.

[SeePak]

Hi boromt

There is actually something you could try for mask leaks and comfort/rest...

Nasal pillows have the greatest differential pressure across them.

And as you correctly point out, there could be a difference using one manufacturers mask and/or machine with the other's equipment.
That would be differential pressure!

It has been suggested by an industry specialist to use the FULL FACE MASK setting in the pap machine while using the nasal pillows.
Also, adjust pressure up +1 cm .

Not sure how the algorithm/etc for leaks is affected by this.

But you may/could/will feel more comfortable with the pressure changes during the night which could lead to more restful sleep.

Others on this website have used this 'Trick' with positive results.

[boromt]

Thank you very much, SeePak. I will try the full face mask setting with high min pressure tonight.

I notice that the P10 nasal pillow mask often blocked my nostril when I wear it tightly. Because of that, I tend to wear the mask quite loosely to prevent the blockage, but still tight enough to prevent the leak. I tried different mask sizes but it either too small or too big. Is it okay to cut the P10 nostril hole bigger to prevent the blockage?

Thank you for all the suggestion.

[SeePak]

off the top of my head, NO do not cut.

Just makes sense.

Play with the adjustments, light but firm then put on your pressure and see how it feels, try to keep that same feeling, light but firm.

[SeePak]

Boromt

You are using a Phillips pap, that may not apply, the suggestion i gave about full face mask! sorry

Here's the thread/post 
https://www.apneaboard.com/forums/Thread...#pid530841

The instruction is for a Resmed, full face mask, NO EPR , and +1 cm pressure

If indeed it could work with your machine, You would have to turn Flex OFF, full face mask and add +1 cm pressure, which would take you to 6.5 min.

I agree with deborah that you need higher min. pressure.

And i think it needs to go as high as 7cm keeping your FLEX3 and without changing to mask setting.

Just having the higher pressure  will reduce  the hypopnea you are getting, and i would think your flow limits will improve as well.

Also, with your Oscar charts, it would be good if you selected the Standard Chart from the menu

Also, leave out the month calendar by de-selecting that off the menu, or use the UP arrow by the date at top left .

Also, in your Leak Rate graph, there are 2 lines being drawn, one appears to be above the limit and other much lower, anyone know what this is?
Also, your stats on left hand side show very modest leakage, so that left side matches to the lower line in your Leak Rate, i think?

[SeePak]

Leak Rate if low, lines up with no dry mouth.

Hard to believe the leak rate in the graph is that high all night, but others have more experience than me on that for sure.

Anyone?

Also, a very mild adjustment was made to this cpap pressure, from 5 to 5.5 between 2 of the dates, sept 14 to 23 for min press, and it seems to have had a large effect lowering hypopnea from the other 2 dates
This top one is the latest. Sept 23

I see a lot of similarities to my personal experience.
I am low pressure, and sometimes i can go to 5cm, and i did recently, and have no events, then all of a sudden i have a batch of CA events and need 7 cm
My sleep study prescription says 6 to 7 cm
Anything above 6 cm i had no obstructive apnea ( yeah, i know, one night, etc. etc. ) but it bears out with my charts

I see some big ranges in stats for people, and i wonder if they are showing the control limits as opposed to range for OA control ( which i believe is how we do it here in Ontario )