Good AHI but not feeling rested

[Pirate of the West]

   
Hi,
Just discovered this forum and thought that you may be able to advise.

I've  been on therapy for 14 years.  Very little interaction with sleep doctor. 
They've just used the set and forget approach with me.
Last visit was 4 years ago and they issued me with what i now understand is a "brick". (Rsspironics System One 60 - fixed cpap)

I've never really felt rested in all this time and the pressure has remained approximately the same (14.5) with Epap of 3.

AHI has been very good  - A bad night is 5 and good 0.5.

RERA's may be something i need to look at but would welcome any advice. I know that I could feel much better but don't know how to proceed.

OSCAR chart is attached for last night

Thank you so much for your help.

[DeepBreathing]

G'day fellow Sandgroper! Welcome to Apnea Board.

Going by this one night's chart your apnea is under pretty good control, but there are a few things showing up which might be worth pursuing to really optimise the therapy.

Your respiration rate is a little on the high side resulting in a fairly high minute ventilation, so you are working fairly hard while you sleep, as well as having a pretty high constant pressure. I also note you slept for over 10 hours, which is quite a lot. But we need to have that in context - are you an old guy like me or a younger person? What body type? And overall health? Have you had routine blood tests including thyroid function and vitamin D?

The other thing that jumps out is that you have persistent leaks all night long. These are not excessive, but can disturb your sleep if the air is blowing in your eyes or causing "face farts". With a nasal mask like the Eson the leaks could be mainly through the mouth, which could result in a very dry mouth.

I'm wondering if a more flexible machine might improve your comfort and give you more restful sleep - a Resmed Autoset or even a Lumis 100 bilevel might be the way to go. Are you in a position to consider an upgrade?

[JoeyWallaby]

In addition to everything DeepBreather posted, you might as well post a couple flow rate close-ups (close enough to see individual breaths).

[Pirate of the West]

   
   

Thank you for your help.

DeepBreathing,
Thanks for the questions>  I am 59 carrying a bit more weight (abdomen) than I should.
I have AF (atrial fibrillation) for which I have just had surgery (12 months ago) as well as a leaky heart valve.

My health is reasonable but could definitely be improved.
All blood tests including thyroid and Vit D are all within normal limits.
I've just orders a resmed N30i mask to replace the old, wornout Eson nasal mask. Hopefully this will address some of the leak issues.
Unfortunately I am not in a position to acquire an Auto machine at this time as mine is government issue under medicare.

Joey Wallaby

Thanks Joe,  I have attached a couple of closeups on the flow  rate and breath pattern for you.  I am unsure what to look for here.

Thank you again for your help.

[JoeyWallaby]

Zoom in more and right click where it says flow rate on the left of the chart, hover over "dotted lines" and tick the box next to "zero". These pictures show different types of inspiratory curve flow limitation, which may or may not be present in your data.

[Pirate of the West]

   
   
   
Thank you JoeyWallaby

I'm afraid i am both a computer and OSCAR neophyte so would very much appreciate you taking a look at the following flow limit data and give me you impressions.

I dropped the pressure last night to 12 (from 14.5) and must admit that I felt more comfortable.

Many thanks

[Gideon]

For now you can use RERAs to indicate a Flow Limit issue. The charts are showing a lot of flow limitations.

Try higher levels of Flex try 2 then 3 and see how well you can tolerate it.

FYI, PR machines are not the best for RERAs or flow limits. Either BiLevel or ResMed are much better.