Low AHI but very tired and fatigued

[ppk8]

[attachment=5924][attachment=5924]Hi,

I was able to bring my AHI down to 3-4 level by using a fixed pressure of 8. But I kept feeling fatigued in the morning and throughout the day. So I tried to increase the pressure by 0.5 and my AHI remained similar and I felt similarly tired. I then increased it and tried 9 and 9.5 pressures and over both times AHI increased to around 6-7 level and the fatigue continued. 

I had previously tried variable pressure between 8-14 but whenever the pressure would go beyond 10, my CA would increase dramatically. Should I potentially try a variable pressure between 8-9.5 for example?

I am not too sure what to do and it would be great to get any and all advice. I have attached all the relevant charts.

Thank you very much in advance!
PPk

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...few more screenshots

[Sleeprider]

Can you zoom in on the flow rate in a 2-minute section so we can see the actual respiratory flow wave form? Something I notice is that as pressure increases, your expiration time becomes shorter. That might be a key to understanding why higher pressure is not working for you.

What has been your experience with Flex?

[tedvpap]

The medical community would conclude that your treatment is fine so you are properly treated.
So by definition you are trying to fine tune your treatment.
I agree that you should continue to try to improve your treatment as I would not be satisfied.
I like your idea of keeping auto off so that it is easier to interpret results.
I like the idea of turning FLEX on so that it is more natural. Set it to 1.
Pick a pressure and try it for a week. See how your results vary day to day.
Have you tried 6 yet?

[ppk8]

hi sleeprider,

thank you for your response. please see the two minute flow guides.

the flex seemed to be ok at low pressure levels but increased the CA events when pressure moved higher.

thank you for your help.
pppk

[Sleeprider]

By 2-minutes, I mean something more like this where the respiratory wave form can be analyzed:

[ppk8]

hi sleep rider,

please see attached. I also turned on flex last night and it took my AHI levels higher with Hypopneas increase, i have put a screenshot of this herein also.

Look forward to hearing from you.
pppk

[Sleeprider]

I think it's arguable that there is any difference with the use of Flex; it seems to neither hurt nor help. Your treated AHI ranges from acceptable to borderline, and I can't really discern a cause. The mixture of predominately hypopnea and CA, and the fact pressures over 10 significantly increased CA makes me think that relatively little of this is obstructive apnea. The fixed pressure at 8.5 produced your lowest OAI, but hypopnea was prevalent. There is no consistency in your results vs pressure.

I don't have a good answer to this. It seems higher pressure or lower pressure does not make much difference or may make things worse. ASV would work to treat centrals and hypopnea, but it's expensive. Unfortunately, I just don't have an idea of how to optimize CPAP to improve your results. You might try a counter-intuitive approach of trying even lower pressure, like in the range of 6.5 to 8.5 and see what that brings. I suspect it may reduce CAI but do nothing for hypopnea. With CPAP treatment, you may just find a pressure that produces the best and most comfortable results, and have to accept the fact your AHI is going to be in the 2.5 to 5.0 range.

[ppk8]

Hi sleep rider

Thank you for your reply. Seem to be spot on and if I am ok with the costs, would you recommend an ASV machine as a next step? Also any recommendations on which one?

I am also having another sleep test done this week and will post the results after

Thanks
Ppk

[Sleeprider]

I'm certain ASV would resolve the issue, and both Philips and Resmed produce the leading technology, however the Resmed Aircurve 10 ASV and Resmed S9 VPAP Adapt are considered the most comfortable and easiest to use. If your sleep study involves the use of bilevel pressures, they will quickly discover a high rate of central apnea. The fall-back should not be to try CPAP which in my mind is already a failure, but to move to a bilevel with backup rate like the ASV. If your sleep study can be arranged to evaluate bilevel and bilevel ASV that would be ideal. Anything else will just leave you where you are.