Low AHI but still unrefreshed

[Dormeo]

Bobby, actually I needed to switch to the VAuto machine, which provides more pressure support than the Airsense 10 Autoset. With pressure support (like EPR) of 4.8, I see just scattered, small FLs. I'd like to use even more PS, but I run into centrals and aerophagia when I try 5.

[bobbysnuts]

I've upped the pressure to 7.0 and EPR set to Full Time 3

I was in bed for over 10 hours last night but still feel so unrefreshed, it's so frustrating.

Here's a screen of last night, does anyone have any further advice

[mper6794]

Hi, Bobby

_ no intention on diagnostic, however respiratory pattern around 4;36 ...4:46 has called my attentiion. For how long can you observe this patterns in your nights? are they significant?

all the best

[mper6794]

..... you might want take look at this paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459210/

[Sleeprider]

Bobby, your therapy looks overall very good an AHI has really improved. The oscillating flow rate around the time you had some CA events is not unusual. That and the CA events are pretty common in new users to CPAP that use the higher EPR setting, and it usually improves as you become more adapted to CPAP therapy. It comes from the improved ventilation from the EPR and as your CO2 levels change, your respiratory drive fluctuates, so we see these oscillations, and brief CA events. In simplistic terms, your drive to breathe increases as CO2 rises and drops as CO2 drops. Ventilation from EPR or pressure support can cause you be near the "apneic threshold" https://journals.lww.com/jcejournal/abst...in.12.aspx This is transient an nothing to worry about. If you find CA events and respiratory oscillations increase in frequency or are disruptive to your sleep, the simple solution is to reduce EPR from 3 to 2.

Nice start on your new therapy, and good luck as you continue.

[bobbysnuts]

Hi, Bobby

_ no intention on diagnostic, however respiratory pattern around 4;36 ...4:46 has called my attentiion. For how long can you observe this patterns in your nights? are they significant?

all the best

Hi thanks for the reply,  do you mean the changes in flow rate?

I've added a few more screenshots which are similar?

[mper6794]

--- yes, the change in FR, periodicity and some centrals;

--- hopefull, the SleepRider explanation may be correct. Is new for me.

all the best

[Dormeo]

Bobby, by the numbers you are doing very well. The EPR has improved the flow limitations and hypopneas, while not producing CAs in anything like a number to worry about. (Sleeprider has explained the periodic breathing; it too is nothing to worry about.)

So the question is what else can you do to feel more refreshed? It may be that time alone will do the trick. Although you've made an excellent start, your sleep may still not include as much REM and deep sleep as would be desirable, due to a continuing adjustment to the novel sensations of PAP therapy. You are still relatively new to the whole thing. To the extent adaptation is what's going on, your sense of refreshment will improve with time.

I also wonder whether you might do better if you didn't spend as much time in bed. Lying there during those final, lousy hours is probably not doing you much good and might even be contributing to a feeling of stupor during the day. If you're game, you could try for a week or two just getting up when you feel you've hit the end of half-way decent sleep.

Finally, I'm pasting in a list of the guidelines the medical community gives for better sleep. I have to confess I thought they were mickey mouse and didn't really apply to me; then in desperation I tried them. They helped!

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

[UARS.DDS]

Could you post your Resp. Rate for the entire night last night?

[bobbysnuts]

Could you post your Resp. Rate for the entire night last night?

Hi, is this what you mean?