Still Drunk Tired with AHI Close to 0.0

[FormerSnoreGremlin]

Hi Everyone,

First I'd like to thank everyone who has helped me here over time. It's made a difference for sure, but I'm still drunk tired much of the time. I clearly need help.

A few details:

* I was diagnosed with OSA, even though my sleep study was all hypopneas and centrals.
* I live at high altitude.
* I'm currently using a Resmed ASV with the settings as recommended here. My current AHI as per OSCAR is typically around 0.3, sometimes being 0.0.
* I was never tested for UARS, but given that I am a thin female who had major orthodontia as a child, I think this is likely.
* For some reason, a nasal strip seems to make a big difference. If I forget to put it on, I feel much worse the next day.
* I have been tested for things like RLS. I don't seem to have any other sleep issues.
* I can breathe well through my nose and don't think I'm having an abnormally high level of leaks.
* I still use the bathroom 2-5x per night (I don't drink water before bed) and often have middle-of-the-night insomnia (CBT-i has been pretty ineffective).


My questions are:

1. Why would nose strips make so much difference? I don't generally have allergies or a stuffy nose.
2. Is there a way I can see if I'm having issues with UARS on OSCAR?
3. Is there a possibility of adjusting my ASV to better address things? I can't figure out what in the world could be going on with my AHI being that low.

I'm happy to post OSCAR data if folks think it would be helpful!

Thank you again for all of your help.

[Crimson Nape]

If you zoom in on your Flow Rate.  If the top of the graph is a flat top and not a peaked shape, then that would indicate possible UARS.

[staceyburke]

Please post Oscar so we can see if there is anything we can see.

[FormerSnoreGremlin]

Thank you. It definitely looks "normal" as far as the curve is concerned, but damn my sleep is so fractured. I just can't figure out why.

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Please post Oscar so we can see if there is anything we can see.

[factor]

If you put your finger over one nostril and breathe in does the other nostril collapse in to the septum? Do both sides.

I assume the nasal strips help because you have small nose and possibly a deviated septum.
Have you seen a ENT doctor?

This might help too.
https://youtu.be/tPz7jxlkb0I

Have you looked at other reasons outside of Apnea? Have you seen an internal medicine doctor? not just a GP or Family doctor.

Have you had a complete metabolic panel, complete blood count, vitamin levels for B and D, and Thyroid.
You would need these to rule out Anemia, Hypothyroid, and Vitamin deficiency. Low vitamin D is very common and under treated can cause tiredness and lack of energy. Anemia is fairly common in females as well.

Do you take good Multivitamin?

Thinking outside the box of apnea.

[staceyburke]

Your flow limits are large ones. They are apnea also. See my signature for how they are classified. We use ps to help those. I raise the ps by one and see if that helps you fell better. You can raise it more if it is helpful.

[FormerSnoreGremlin]

If you put your finger over one nostril and breathe in does the other nostril collapse in to the septum?  Do both sides.

I assume the nasal strips help because you have small nose and possibly a deviated septum.
Have you seen a ENT doctor?

Thank you so much! Yes - I have seen many four ENTs in my life. I don't have a deviated septum, but have been told that I have "freakishly narrow nasal passages".

This might help too.
https://youtu.be/tPz7jxlkb0I

Have you looked at other reasons outside of Apnea?  Have you seen an internal medicine doctor? not just a GP or Family doctor.

Have you had a complete metabolic panel, complete blood count, vitamin levels for B and D, and Thyroid.
You would need these to rule out Anemia, Hypothyroid, and Vitamin deficiency.  Low vitamin D is very common and under treated can cause tiredness and lack of energy. Anemia is fairly common in females as well.

Yes! I'm tested for these things every year to a point that my Drs think I'm a hypocondriac! Nothing is ever unusual.

Do you take good Multivitamin?

Yes I do.

Thinking outside the box of apnea.

Thank you for that. This stuff is so damn confusing and I appreciate any help!!!

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Your flow limits are large ones. They are apnea also. See my signature for how they are classified. We use ps to help those. I raise the ps by one and see if that helps you fell better. You can  raise it more if it is helpful.

So PS from 2 to 3? Thank you for your help!

[factor]

Ok cool.  Just wanted to be sure we didn't miss stuff outside the box.  

Small passages nasal strips help a-lot the video helps explain it.

[FormerSnoreGremlin]

Thank you SO MUCH for the video link. I am really appreciative of quality videos!!

[staceyburke]

ps to 3 and raise it if it seems to help..  You can go up as far as you want.  so you know _ your min pressure is your exhale pressure and your inhale pressure is the min+PS.  Your max is as high as the machine will go to treat apnea.