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[CPAP] Low AHI but overall fatigue - 2nd opinion
#1
Low AHI but overall fatigue - 2nd opinion
Hello all! 

I am looking for some opinions of my current treatment as my current DR does not really discuss anything because my numbers "look fantastic". I have a low AHI, but still waking up feeling exhausted, daily. 

Currently using an Airsense 11 that is set to APAP with pressure ranging from 6-20 with EPR of 1 and ramp on. These were default settings with the exception of the minimum pressure originally being set at 4, however, I felt starved for air and really struggled with this so I bumped it to 6. 

I am currently using Resmed P10 air pillows, but have also tried the rested F20. With the F20, I struggled for weeks with constantly waking up due to discomfort, constant leaks, and an AHI in the 5-8 range. I read on the forums that some folks that are slight mouth breathers could try a nose pillow setup, so I gave it a shot and have loved it since. 

Anyways, I am looking to see if someone hopefully has a time to look at some of my data and provided any recommendations. I have read and understand that just because you have a low AHI doesn't always mean you'll feel better and get the most out of treatment. 

Attached are my last 3 nights, please let me know if there is anything else I can provide to better assist in any sort of analysis.


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#2
RE: Low AHI but overall fatigue - 2nd opinion
Welcome!

I'm not an expert so can't speak to your settings or data.

Sorry you're still feeling exhausted. 
How long have you been using the cpap?

For some people it just takes time to feel improvement. 

Unfortunately, it's incredibly common for sleep docs to be less than helpful. AHI and hours using cpap is usually all they will look at, nevermind continued symptoms. 

Have you spoken with a general medicine doc (like primary care) to rule out other causes?

Hope you find answers and get to feeling better!
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#3
RE: Low AHI but overall fatigue - 2nd opinion
Flow limits are apnea the same as O and H events.  The flow limits are smaller and are not in the AHI.  They stop you from getting into deep sleep and can wake you up.  


Flow limits are controlled by EPR.  You are using it at 1.

I would try setting the EPR to 3 and the min to 7 to give it enough room for the EPR to work.  You should not even notice the changes but compare the flow limit charts after you have changed the EPR to 3.  If they are less it will take a few days to FEEL any difference in your tiredness and sleep quality.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: Low AHI but overall fatigue - 2nd opinion
(01-11-2023, 11:01 PM)Brazen Wrote: Welcome!

I'm not an expert so can't speak to your settings or data.

Sorry you're still feeling exhausted. 
How long have you been using the cpap?

For some people it just takes time to feel improvement. 

Unfortunately, it's incredibly common for sleep docs to be less than helpful. AHI and hours using cpap is usually all they will look at, nevermind continued symptoms. 

Have you spoken with a general medicine doc (like primary care) to rule out other causes?

Hope you find answers and get to feeling better!

Thank you for the response! I have been using cpap for about 2 months now, so not crazy long. 

I meet with my pcp next month and will talk a bit more about how Ive been feeling, but wanted to also make sure this isn't making it worse ha.
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#5
RE: Low AHI but overall fatigue - 2nd opinion
(01-12-2023, 09:00 AM)staceyburke Wrote: Flow limits are apnea the same as O and H events.  The flow limits are smaller and are not in the AHI.  They stop you from getting into deep sleep and can wake you up.  


Flow limits are controlled by EPR.  You are using it at 1.

I would try setting the EPR to 3 and the min to 7 to give it enough room for the EPR to work.  You should not even notice the changes but compare the flow limit charts after you have changed the EPR to 3.  If they are less it will take a few days to FEEL any difference in your tiredness and sleep quality.

That is what I was worried about after seeing it discussed numerous places, thank you for confirming. 

I actually planned on making this change last night, but I upped my pressure to 7 and forgot to change the EPR. I made the EPR change this morning, from 1 to 3, and will see what the next few days look like and report back. 

I attached a screenshot of last nights sleep, min pressure change to 7 but EPR left at 1, for future reference.


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#6
RE: Low AHI but overall fatigue - 2nd opinion
Hi. Welcome.
You are certainly not alone is not feeling amazing right away.
I, once, made the decision to change my settings, on my own, to try to fine tune things.
After a week, I looked at the data and to my surprise, the AHI numbers actually got worse.
I went back to the prescribed values and things improved again.
Talk to you doctor, although as noted, they don't have a magic wand to automatically dial in the perfect settings.

Also note, how long did you have apnea and not get it treated?
For me, I easily had it (but didn't know about it) for 10 years before seeking treatment as things were getting worse.
I was traveling a lot and thought that was causing the drowsiness.
Once I started the treatment, I didn't actually feel much different.
Then I learned about sleep debt. While not an approved official term, I believe that was what I had.
It took some time before things felt better. It took 5 years to pay off the debt. I still remember that morning when I woke up and said to myself
"Oh this is what I'm suppose to feel like after a good night's sleep. I had forgotten that feeling."

Now, I still dislike having to use the CPAP every night, but I now understand it is actually working and so I use it every night.
I even bought a decent sized backup power battery with AC outlets, in case we lose power at night. That's happens rarely but each time, I get the battery out, I plug into that and then go back to sleep. The next morning I then deal with any power outage issues with a clear head.
Later I learned why...
search sleep clears toxins from brain
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