[Treatment] Low AHI and still tired

[ripnationstates]

Hello, I was diagnosed with having OSA almost a year ago now, and have been on CPAP since. I was thrilled with this, since it explained the daytime fatigue I have experienced for as long as I remember (the kind that builds up when I am out of the house doing something and becomes overwhelming without taking a nap). I was in Japan at the time, where the health insurance covers a basic CPAP that you couldn't change the settings of. My Dr told me that the CPAP therapy brought my AHI down from around 30 to under 1- the only problem being that none of this was helping me to feel any better. I never had any issues sleeping with the machine on; I wear it for the full 8.5 hours I sleep every night with no discomfort. Even after 8 months of wearing it every night, I was still not experiencing any relief from my tiredness, and my Dr just said that he had done his job and there was nothing else he could do to help.

I am now back in the UK, waiting for an appointment with the NHS, having purchased a Resmed airsense 10 to keep up with my treatment. The last couple of weeks I have finally began to explore the settings and begin altering the pressures from the default (after looking at my data in OSCAR). I have set the machine to a constant pressure that balances controlling apneas with limiting mouth leak, settling at around 7cmH2O with EPR2. I have not noticed much of an improvement in symptoms, but the data in OSCAR looks slightly improved. One thing that I notice from my data is that my breathing is quite choppy throughout the night, so I am interested in any tips for how I could flatten it out a bit, or what pressure adjustments could help me out.
Data from default settings (4-20 EPR off): https://imgur.com/a/FSoyAEF
Data from CPAP 7cmH2O with EPR2: https://imgur.com/a/ltVisiE

Finally, I am just searching for any ideas for why I could be continuing to experience daytime fatigue despite my perfect CPAP compliance and low AHI. I am 27 and fairly fit, but my fatigue has continued to become more overwhelming, causing me to leave my job as a teacher to take some time to work on my health. In my year of CPAP usage, I would go so far as to say I feel worse than I did before treatment (albeit I do manage to sleep about 1 hour less per night).

Thank you to the members that take time out of their day to moderate these boards and offer guidance to me and others in this post. Please let me know if I have missed any information here that I can include in a reply.

[staceyburke]

We really need to see the data.  We get data from the OSCAR daily page with the graphs I have put a link to in my signature.  Please post a nights daily page and you will get some suggestions.

[ripnationstates]

Is it suitable to share the data through imgur? Here is a link for that: https://imgur.com/a/Npk8Opt

[OpalRose]

Welcome to Apnea Board!

Imgur is ok, but it's much easier for us to see data from OSCAR if that's possible.

I did not see a chart with 7-20 pressure settings. They were all at 4-20 and one at a fixed pressure of 7cm.

I believe your data could be a bit better with a narrower pressure range.
Set the minimum pressure to 8cm and maximum to 15cm. Use EPR - 3.
If you feel that 8cm is too big a jump for you, then try 7cm with EPR 2.

Using EPR will help out with exhale breathing, and hopefully lower the flow limitation and Hypopnea. It may raise the CA's a bit, but we can address that when you repost.

As far as you not feeling better for almost a year now, I honestly have to say that it could be something outside of Cpap use. When was the last time you had a complete physical and labs done? You should start by having a discussion with your doctor. Talk to him about your fatigue. Get some blood work done.

[ripnationstates]

Thank you for your reply. Sorry if my initial post was not clear- my CPAP was originally on the factory setting of 4-20 and I have recently set it to a fixed pressure of 7. I have not noticed much improvement from this change however (other than the mouth leak data and flow limit look better).

I have recently had my blood work done on multiple occasions to try to get to the bottom of my fatigue but there was nothing particularly abnormal. I have been on a waiting list for the last few months in the UK after doing a second sleep test here, I will see what shows up there, I am just getting frustrated waiting so trying to do more about it myself.