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[CPAP] Low AHI but feel unrested
#1
Surprised 
Hi All

I'm a newbie to the forum but not to sleep apnea or CPAP. I had been diagnosed with OSA in 2004 and have been using a CPAP every night (12 cm flat) since then. For the first few years, it had been a life saver. But due to insurance and job changes, things went on cruise control for the last 3-4 years. Slowly, my sleep had been trending worse and of late, I had been feeling as tired and un-rested as I used to feel before 2004. I hadn't been changing my mask/nasal pillows regularly as well.

Additionally, over the years I was diagnosed with ADHD and Depression and have been taking Vyvanse and Cymbalta for those, respectively. For sleep, I had been taking Ambien 10 mg and Melatonin at bed time.

In the last month, I decided to get a new CPAP device (Airsense 10) and thanks to this wonderful site, I have been able to gather some useful nightly sleep data and analyze it using the SleepyHead software.

The bad news is that I still have difficulty staying asleep most nights and pretty much feel groggy and hard to wake up in the morning. Due to school starting again, I need to wake up at 6 AM to get my kids ready.

I have about 15 days of data and my AHI has been ~2 nightly, with 7 to 9 hours of sleep each night. Leak rate has been less than 15.

What else could be going on? Any hints? Thanks

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#2
RERA?? Sounds like it is time to consult with your friendly MD preferably one specializing in sleep medicine.
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#3
Some people don't do well on variable pressure settings. I am one of them. I was on variable APAP with AHI less than 1 but feeling like crap in the morning. After I changed my settings to fixed pressure, all is well.

There is a paper on pubmed that says that 18% of subjects studied had microarousals on APAP. A microarousal knocks you out of a deeper sleep stage to a shallower sleep stage. Consequently, your AHi still looks good in the morning but you feel like crap due to less amount of REM and SWS sleep.

You may want to set your A10 in a straight pressure mode of 12cm and evaluate the results for 7-10 days. If needed you can always move the pressure setting. Also, feel free to use EPR.

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#4
Its likely not the pap treatment the meds your taking. Especially the Cymbalta.
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#5
I have been on my CPAP a month now and I am kind of in the same boat. I did a lot of tweaking of what some call the comfort settings and am making progress. The apnea's are only one part of using CPAP and if the other settings make you uncomfortable then you will not get high quality sleep even if the apnea is under control. For me I am sensitive to air temperature, humidity, and exhale pressure. I like cold air, no added humidity (not even passive, I use a dray tank), and set the EPR to 3. I am investigating a BPAP because I and the Med community think that when my machine pressure goes up and my exhale pressure tracks that increase, I wake up. I thought I liked humidity and started off increasing it only to find out that now I do not like it.
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#6
Thank you. Are there any threads or links you can point me to that explain how to choose an EPR setting?
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#7
The method is to try it. Try the different settings and see which one you like best. Keep track of your data to make sure nothing is getting worse (not very likely). Try each setting for 3 or 4 days and then decide which you liked best.
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#8
(08-20-2015, 10:45 AM)Ghost1958 Wrote: Its likely not the pap treatment the meds your taking. Especially the Cymbalta.

Thanks. Any more color on this? How is Cymbalta known to impact sleep?
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#9
Hi mk7579,
WELCOME! to the forum.!
EPR is a comfort feature so try each setting for a few days and see which one works the best for you.
Hang in there for more suggestions and much success to you as you continue your CPAP therapy.
trish6hundred
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#10
(08-20-2015, 11:26 AM)mk7579 Wrote: Thank you. Are there any threads or links you can point me to that explain how to choose an EPR setting?

My machine has a choice of 1,2, or 3 for EPR and I need to access the clinician menu to change it. On the Resmed A10 machines what this setting does is take an average of my breathing and then start adjusting the exhale pressure down to whatever setting I put in. the number is cmH2O to reduce the exhale presser to FROM inhale pressure. So and inhale of 10 will give a maximum reduction to 7 when EPR fully kicks in. The system will always try and bring you back to exhale = inhale pressure over time. This is quite different from a BPAP machine that will always keep exhale set to your setting.

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