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Low AHI but still unrefreshed
#1
Low AHI but still unrefreshed
       
Hi guys, thanks for letting me join this very helpful forum.

I've recently been diagnosed (6/03/20) with OSA, my AHI was 15.6

I'm using a ResMed AirSense 10 APAP, with settings off 4:20, also use a ResMed F20 FFM.

I've been on treatment now for just over a month with good AHI scores (mainly below 2), but still feel really unrefreshed.

I've attached a couple of reports from OSCAR, would anyone please have a look and see if there's anything I could improve on.

Or is there any other reasons why I could still be feeling unrefreshed, would be very much appreciated.
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#2
RE: Low AHI but still unrefreshed
personally, i would raise that 4 starting pressure up to what you can comfortably tolerate. then if you get used to that raise it again. the auto is meant to go up and down, but the more it spends time travelling up and down might harm you sleep patterns. seeing you go up there, i'd say to try to shoot for 14 low -18 high. but only do what you can tolerate. do not do it all in one night and fight with it. a lazy doctor gave you 4 - 20. after you get it dialed into something you are comfortable with.
First Diagnosed July 1990

MSgt (E-7) USAF (Medic)
Retired 1968-1990
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#3
RE: Low AHI but still unrefreshed
Welcome! A couple of observations and questions.

You have amazingly low leakage -- how do you do it??!

The two charts you posted show short periods of usage. How long do you usually sleep, and how much of that time do you use the machine?

Your starting pressure is 4, and for most people that leaves them feeling a bit air-starved. You might consider raising it to 6 or 7 just for comfort, but I would suggest a higher minimum than that so that the machine will have more of a running start on controlling your events. I'd defer to expert advice, but my suggestion would be that you try a minimum of 12 and see how that goes.

You have a busy FL graph, and your events are all hypopneas. You would probably benefit from turning on EPR at a level of 3.

Try those two changes and see what happens. Based on the results and your observations of your experience, more changes might well be warranted.
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#4
RE: Low AHI but still unrefreshed
Welcome to the forum.

Your Flow Limits are forcing your pressures up.

settings of 4-20 are ok for 1 night then to adjust for what is found and is usually a sign that the setting need to be optimized.  A pressure of 4 is often too low for adults.
To better manage these we need to utilize EPR so I suggest to set 

EPR = 2, fulltime and
Min pressure = 6 to allow the EPR to work throughout the night.
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#5
RE: Low AHI but still unrefreshed
Bonjour is an expert, so definitely do it his way!
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#6
RE: Low AHI but still unrefreshed
(04-12-2020, 12:32 PM)Dormeo Wrote: You have amazingly low leakage -- how do you do it??!

The two charts you posted show short periods of usage.  How long do you usually sleep, and how much of that time do you use the machine?

You have a busy FL graph, and your events are all hypopneas.  You would probably benefit from turning on EPR at a level of 3.
Hi thanks for the reply.

I think I've been very lucky that my mask seems to fit very well and I usually get very low leaks, I've had to adjust my sleep position to more on my side as I used to sleep more on my stomach.

I usually use the machine for 8-10 hours per night (the attached might not been the best examples). My sleep thoughout the night tends to follow a pattern, the 1st third of the night I think I sleep ok, the 2nd third seems to be quite a few awakenings, the 3rd part of the night I seem to wake very early and struggle getting back to sleep, at best very very light sleep/awake cycles.

Regarding the FL, I have a deivated septum, and I think I have large turbinates that maybe swell up during the night. I currently use a SinusPulse machine (3 hours before bed), and right before bed - Breathe Right Strips, Sterimar Spray and Vic Vapour rub, these all help massively but still wake quite a few times due to struggling breathing through my nose.

My machine is currently issued/rented via NHS in UK, should I contact my Sleep Clinic before changing any settings, or should I just give it a go? (I think they remote monitor my progress/settings).
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#7
RE: Low AHI but still unrefreshed
(04-12-2020, 12:33 PM)bonjour Wrote: Your Flow Limits are forcing your pressures up.

settings of 4-20 are ok for 1 night then to adjust for what is found and is usually a sign that the setting need to be optimized.  A pressure of 4 is often too low for adults.
To better manage these we need to utilize EPR so I suggest to set 

EPR = 2, fulltime and
Min pressure = 6 to allow the EPR to work throughout the night.

Hi thanks for the reply and the advice.

Do you think that the FL could cause the unrefreshing sleep?

I'm all out of ideas as everything number wise looks good.

My machine is currently issued/rented via NHS UK, is it ok to change the settings myself or should I contact them first, apologies but I'm very new to all this.
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#8
RE: Low AHI but still unrefreshed
I had a lot of flow limitations, and when I finally beat them down, I started feeling more rested. Part of the reason, I think, is that FLs mean you have to work harder to draw a breath. Fine if it's one breath, but if it's all night, it is tiring. Plus I am sure constant FLs make it easier for any little disturbance to bump us out of the deep and REM sleep we need.

You can go ahead and change the pressures yourself. You will probably be checked primarily for compliance, i.e., using the machine with sufficient frequency and duration. (Not sure of the precise rules for NHS.) If you are asked about it, you can say you made the changes in order to reduce FLs and sleep more comfortably. -- But if you have a good working relationship with your sleep specialist, you could just let them know ahead of time what you plan to do, as a courtesy.
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#9
RE: Low AHI but still unrefreshed
We are with the NHS our machines were left wide open 4-20 and the NHS in our area do not appear to monitor you very well. Compliance after 1-2 months then see you again in two years if you say you feel fine. Contact us if you have a problem.

We have adjusted our machines on a semi regular basis to fine tune our treatment and although the NHS dose not like it there is nothing they can really do about it. I think the NHS would find it very difficult to deny treatment unless you became totaly non compliant with regards getting close to the number of compliant nights on your machine.

If you see an improvement you are successfully treating yourself and If it does not work or improve matters change it back or try a different setting. Those movements in escaisting pressure would really mess me up.
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#10
RE: Low AHI but still unrefreshed
(04-13-2020, 10:42 AM)Dormeo Wrote: I had a lot of flow limitations, and when I finally beat them down, I started feeling more rested.  Part of the reason, I think, is that FLs mean you have to work harder to draw a breath.  Fine if it's one breath, but if it's all night, it is tiring.  Plus I am sure constant FLs make it easier for any little disturbance to bump us out of the deep and REM sleep we need.
How did you manage to beat down your flow limitations, was it just with increasing the pressure until they were under control.

I do feel as if I have to work harder to breath during the night, I always wake up unrefreshed (even after 9-10 hours in bed) and feeling like I've not slept or had good quality sleep.

I also wake with a tight feeling chest, but not sure if that's to do with some underlying anxiety.

(04-16-2020, 07:43 AM)plasticplumber Wrote: We are with the NHS our machines were left wide open 4-20 and the NHS in our area do not appear to monitor you very well. Compliance after 1-2 months then see you again in two years if you say you feel fine. Contact us if you have a problem.

We have adjusted our machines on a semi regular basis to fine tune our treatment and although the NHS dose not like it there is nothing they can really do about it. I think the NHS would find it very difficult to deny treatment unless you became totaly non compliant with regards getting close to the number of compliant nights on your machine.  

If you see an improvement you are successfully treating yourself and If it does not work or improve matters change it back or try a different setting.  Those movements in escaisting pressure would really mess me up.

Hi thanks for the reply.

I've been fully compliant with usage every night so might just go for it and adjust the settings and see if I can make any improvements to get some better quality sleep.
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