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+--- Thread: low ahi but still very tired (/Thread-low-ahi-but-still-very-tired)
low ahi but still very tired - CpapGee - 11-05-2024
Hi,
Could someone review my oscar chart, My AHI is low but still very tired and have tried multiple things to help remediate leaks like mouth taping, Chin Strap, Nasal or FFM masks varying types.
I am always awake around the times between 0030 - 0200 and still continue the therapy but do not feel refreshed in the mornings. My original sleep study at home showed AHI of 16 and saturation at 32.
Many Thanks
RE: low ahi but still very tired - PeaceLoveAndPizza - 11-05-2024
With your machine being CPAP fixed pressure only, all you have to work with is pressure and pressure support.
I assume you have tried lower pressures and ended up at a fixed pressure of 16. There are quite a few flow limitations that are the likely culprit, so a few things to try come to mind...
1. Try a lower pressure to see if that affects them. Maybe start with a fixed pressure of 12 and work from there.
2. See if a flatter pillow helps lowering the FL's. Sometimes a higher pillow will kink the neck or cause nasal drainage issues.
3. Possibly try a full-face mask if you have one to see if things change.
In the end if your fixed pressure machine will not handle things, you should be considered a candidate for a bi-level. If insurance will not cover it you can find them on the used market at reasonable prices in the States, but not sure about Albion. Worth a go to find out what may be available.
RE: low ahi but still very tired - CpapGee - 11-05-2024
Thanks for the reply
I started at pressure of 11 and have been increasing slowly to try reduce the number of flow limitations. I have also been trying different nasal and ffm masks, one issue is leaking which was happening when I drift into REM and my lower jaw was causing the mask to leak. Tried taping with kinesiology tape and chin strap but flows were still there.
I’m in the UK and it’s really difficult to explain to the techs that I need a bi level machine. Maybe I’m articulating it wrong for them to understand.
They tend to think the AHI is below 5 your treated which is frustrating
How would you explain that bi level would help instead of the fixed support machine?
Thank you
RE: low ahi but still very tired - PeaceLoveAndPizza - 11-05-2024
Ta, it is difficult at times to convince them there is a problem when they do not see it themselves. I would point out the arousals breaths, align them with flow limitations, and talk about how using a bi-level with more pressure support should help reducing flow limitations. It would also allow you to use lower pressure overall which should increase comfort.
If they want numbers, the left-hand table tells the story. Sometimes all they care about is the AHI, which is a good directional indicator but is not the entire story. The flow rate tells a far different story in the ebbs and flows of your breathing. You can clearly see the reduction in the flow rate as flow limitations impact it, which is something worth pointing out to them as they may not have the same data as you.
Having an APAP or bi-level would be a better choice as it would allow the machine to respond to flow limitations and adjust pressure accordingly. A bi-level would be the best choice as you get the most options to fine-tune settings.