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Less than 1 AHI but something is not right
#1
Less than 1 AHI but something is not right
Hi. I started CPAP treatment 2 months ago. My AHI was 10 but I had a lot of spontaneous arousals. I couldn't tell you if these were RERAs as the lab never told me what was the cause of these arousals. I use the Resmed Airsense 10 For Her and have gotten my AHI to below 1 for the past month. My pressure is 11-20 with EPR of 3 on full time. My problem is that I'm still tired throughout the day. When I look at my data on OSCAR I see a lot of short bursts of paused breathing. It's not enough to be counted in my AHI, but it happens so frequently that I still don't think I'm getting a good sleep. How do I fix this?


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#2
RE: Less than 1 AHI but something is not right
Welcome to Apnea Board.
OK a few things to think on and some homework.

1. Does the therapy feel comfortable as is or not? If not, we can assist in pressure edits. But note the stats are pretty good. Comfort is the 2nd half of successful therapy. So if it's not comfortable, we go with changes to gain comfort.

2. Do you have your sleep study and/or titration reports in either summary or detailed?

3. If you do not have either report, consider requesting them both in detailed, multiple paged format would be best. You need these for your personal health report, and you can avoid sleep studies in the future with today's report in hand. Post a redacted of personal info version here. By US HIPAA rules you are permitted your own copies of the studies. So don't let the docs office tell you that you can't have them.

4. Roughly how long do you think you may have had apnea that was not treated with PAP? If it's like most of us, that answer will be years. This is not putting you down or anything, but this fact is something a lot of us had to face. Years of untreated apnea did some damage, and cost us sleep. That damage and the sleep deficit we've got takes time to correct. It took me a solid month to begin feeling not as tired. The point is, apnea effects each person in various ways, and the damage isn't light switch quick in being fixed.

Hope the info helps. Feel free to ask more questions or give comments. We are here to help.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Less than 1 AHI but something is not right
1. I'm pretty comfortable with the therapy. The pressure and settings feel good.
2 & 3. I don't have the results with me anymore, but I can call and get them Monday.
4. It was likely years, but I couldn't tell you for sure.

Does this mean that my therapy looks effective? I'm so tired and still wake up during REM sleep. I still feel like my breathing during sleep is really disturbed despite my numbers.
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#4
RE: Less than 1 AHI but something is not right
You already have EPR 3 on so there's no further up to go there. OSCAR data looks fine, not much leaking, a few events here and there, but they're not clustered. Work on the reports, and consider sleep hygiene practices and see if you get any pointers there to enhance sleep a bit. PAP therapy is a new and weird experience. Consider all those unlucky ones that don't have a pet alien with a long tail that sleeps on your face. If you feel like therapy isn't comfortable, we can certainly discuss what and how to adjust. And you get to do your own adjustments, free to do and free advisement. You don't need a script to change these settings, but the doc and the DME do need that. And doc "permission" to change these isn't required either, but respectful mention of "I adjusted this on my PAP doc and here's why" ruffles less doc feathers and he/she would note it on your medical chart.

I just took note of your last comment. The breathing being disturbed during sleep...can you describe aspects or something about it? This is an area to focus on.

OK maybe if too much pressure is bothering, maybe you can drop the Max pressure down a few clicks and see if comfort is better. Keep the machine Off but plugged in. Wake the screen by clicking Home, then click/hold Home and Dial for 5 seconds. Go to Settings, should be top box of 2, find your pressure high number and highlight it with Dial then click Dial to select, then turn dial to 15 and click again. Your OSCAR chart says your max used pressure was just below 13 BTW. Click Home and scroll up to return to therapy screen. Try it and see if it feels better or worse. Don't hesitate to revert back to prior setting if it feels way off target.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Less than 1 AHI but something is not right
There's a little bit of fiddling with the charts that will help people help you as much as possible.

* Turn off the calendar by clicking on the little triangle to the left of today's date. That will make more information visible.

* Include the graph for pressure so we can see how it behaves over the course of the night. To fit it in, you will need to scrunch the other graphs a little. You can do that by grabbing the horizontal gray bars and lifting them.

* I'd like to understand the breathing in the zoom, but I think we need to view things a little differently. So could you do the following, by right-clicking on the "flow rate" label:
* Set the Y- axis range from +50 to -50,
* Add a dotted line set at zero.
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