Still waking up exausted.

[VegasGMC62]

I posted about  this a few years ago and want to give it another shot in case someone has some new info or insight.
I've been on CPAP since 2017. I quit going to my doctor because I felt worse after using the CPAP machine than I did before and he just wasn't listening to me . Diagnosis  was OSA with AHI at 59. He kept my pressures at 4-20 for 2 and a half years. I saw him multiple times and told him how awful I felt and all he would say is your numbers look good stick with it. There was never any mention of titration or changing pressures or any settings. I found this board and you guys gave me the info I needed to set up the machine my self. Its been going pretty good but I still have 1-3 days a week when I wake up feeling exhausted and like I've been up all night. I use Oscar and I don't see what would be causing this. I'm not snoring and my pulse ox meter says my O2 levels are in the upper 90's all night and I have minimal mask leaks. I have an Airsense 10 with Swift Nano nasal pillow, tape my mouth and wear a chin strap. I video myself sleeping and don't see anything unusual.  The tiredness has gotten so bad my doctor has put me on Modafinil. I'm posting screenshots of a good and bad night. I don't see a difference. Thanks
1st screenshot is bad night. And my AHI has absolutely not relation to how I feel in the morning.

[staceyburke]

My first thought is flow limits are high. Could you post the flow limit chart with the events chart? (Bad night)

[pholynyk]

Your 95%tile flow limits are 0.20 but we think 0.10 or less is a reasonable value to aim for.

I see that you are not using EPR, so I would suggest you start using EPR 3 and Full Time. This will not only reduce the flow limitations you are seeing, it will be more comfortable. Since ResMed bumps the pressure when it detects flow limitations, ith should also lower your maximum pressure to some degree.

[Gideon]

What pholynyk said above.

Set EPR=3, Fulltime, no other changes.

This is, to us, fairly obvious.

[VegasGMC62]

I used to have EPR at 1 but found I felt better with it off. But I'll try 3 and full time tonight. My flow rate varies every night from 40-80 the past 6 months. It used to be consistently in the 30's. I really don't understand what the flow rate is. Larger numbers bad? The past few months I wake up during the night with my mouth blown up with air. Should I reduce pressure with EPR on?  The past 2 years, I would start to wake up tired and found that bumping up the pressure helps. I have to do that about every 3 months.Thanks

[staceyburke]

Do try EPR 3 full time

When you post again put in THE FLOW LIMITS CHART. And make sure the left column in in with the AHI and settings in that column.

[VegasGMC62]

Felt a little better this morning. Is this what you needed? thanks

[Crimson Nape]

Looking good! I would recommend that you update to the new version of OSCAR, version 1.4.0.

- Red

[staceyburke]

EPR 3 seemed to help. Thank you for putting in the flow limits. You don’t need the rest but you should include a few others. The charts that are the most helpful are in a link I’m my signature. 

Just so you know flow limits are apnea, only smaller and not timed. The classification of apnea is in my signature. 

Flow limits stop you from getting into deep sleep and cause pressures to rise to stop them from being larger events. That is why we like to see flow limits chart and pressure chart.

[VegasGMC62]

Sorry it took so long to get back here. Terrible week for work and sleep. EPR is a no go. That first night was a fluke. When it's set at 2 or 3, I struggle to inhale. It feels like the pressure is being cut or the hose it being squeezed. Exhale is normal. I didn't feel that with it set at 1 but still woke up feeling bad. This is screen shots of past 2 nights. Friday I felt ok but tired. The leaks are from me scratching and breaking the mask seal. All these masks and pillows itch. This morning I felt pretty good and actually cycled 12 miles. One screen shot is the last night I used EPR at 2. I don't know what caused the 50min gap. Thanks