[CPAP] Still sleepy and having arousals despite low AHI

[meatheadmd]

Hi all,

I've been using CPAP since last April with my settings a majority of the time being CPAP 9 cmH2O with no EPR or ramp.

Initially, with a full face mask (Resmed F20), I was unknowingly removing my mask in the middle of the night and getting <4 hours on the machine each night but after switching to a nasal mask (Resmed N20 Airfit) with mouth taping I was able to get 7+ hours a night and was feeling somewhat refreshed for maybe about a couple of months or so. Since late summer of last year until now, I am still getting a consistent 7+ hours a night on CPAP but waking up very unrefreshed and sleepy. One thing I noticed that was changed AFTER I started feeling more tired was using a higher pillow which may be causing some chin-tuck/positional apnea for me so I will try to sleep on a flatter pillow; however, I did switch to a higher pillow AFTER i started to feel not refreshed after a night of sleep so I wanted to post some OSCAR screenshots here to see if I may be missing something.

I have tried to uptitrate to 10 and even to 11 cm H2O with no improvement in symptoms and only worsening of aerophagia. I am struggling with aerophagia even on 9 cm H2O especially when sleeping on my side. I tried to downtitrate to 8 cm H2O which does reduce the aerophagia but provides no improvement in treating of my apnea. I have been sleeping at a 45 degree incline for the last couple of nights which solves the aerophagia problem but I am still very tired.

My AHI has been consistently below 1 but my flow rates are never been regular. I will post a smattering of screenshots from various times throughout the last year since I'm not sure what will be helpful but please let me know if I can provide more information.

Thanks in advance!

[staceyburke]

The key is EPR. It will reduce flow limits. I would set it to EPR 3 full time. Also when you post again leave the event chart up.

[meatheadmd]

Would you recommend keeping the pressure at 9 cmH2O with EPR 3 full time? The last time I had EPR on I was taking my mask off unknowingly in the middle of the night likely because the change in pressure was arousing me to take off my mask. If I set it to EPR 3, I worry that when the pressure comes down to 6 cmH2O (and I am trying to inhale) that it will not be treating my apnea. Please let me know if I am thinking about this incorrectly. Thank you!

[staceyburke]

The EPR reduces the min by 0, 1, 2 or 3 or exhale. The inhale WILL BE THE SAME no matter what you set EPR to.

[meatheadmd]

Update:
I started using pressure of 11 cmH2O and EPR 3 full time. Had much less flow limitation last night. Feeling a little tired but may be improved; too early in the day to tell. Still having a few arousals that look like the pictures in the attachments though. Also flow rate doesn't look exactly flat. Any more tips for optimizing therapy based on what my data looks like?