Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

Need help reading flow charts. Very low AHI, still tired, algorithm wrong?
#1
Question 
Need help reading flow charts. Very low AHI, still tired, algorithm wrong?
Hello everyone, I've been following this forum for a while but this is my first post. Thanks in advance for your help.

I am a 27yo man, very thin (BMI 19) with a  healthy diet and lifestyle. I used to be physically active until apnea made it pretty much impossible to live a normal life.

First I'd like to tell you about my background: About 2 years ago I started having lots of breathing problems from my deviated septum and huge turbinates and I got a sleep study. The results were lots of hypopneas, loud snoring from mouth breathing and only 1 obstructive apnea. Most of the hypopneas were corrected at 8.0-12.0 with a Dreamstation One APAP. I used multiple FFMs that never really fit me well. At first I slept really well, but  aerophagia started to make me wake up multiple times at night from the intense stomach pain and my sleep was getting worse anyway, so I got turbinate and septum surgery. I slept more or less well for a few months without the APAP after the surgery and I returned the APAP to the provider. I had 100% compliance because life pre-CPAP was hell, but I was happy to return it.

Then my sleep started getting really bad again. I suppose my surgery went badly or wasn't enough. I noticed my nasal valves were collapsing and bought a Mute nasal dilator. I kept opening my mouth and snoring anyway, and my sleep quality was going down again, so I decided to buy an Autoset 10 For Her with a nasal mask. I bought the FH model because I always had AHIs < 5.0 with the Dreamstation but never slept well. I also suspect I might have UARS.

Now I'm using the Autoset 10 FH, Airfit N30i, a Wellue Checkme O2 Max and taping my mouth. This has been my self-titration process:
  1. I started with fixed 7.0, EPR 0. That gave me some CAs (AHI 2.0) and aerophagia was killing me again, so I started decreasing the pressure until I reached 6.4. This almost eliminated the CAs, but not the aerophagia, and I got to AHI ~0.5. 3/10 sleep from waking up so many times with a stabbing pain in my stomach.
  2. Knowing EPR effectively decreases the overall pressure, I started introducing EPR slowly. EPR 1 and 2 improved my aerophagia, AHI still ~0.5. Not waking up as often, but sleep still 3/10.
  3. Decided to switch to APAP 6.4 - 8.0, EPR 3, Soft response mode, to avoid aerophagia while hopefully correcting some variable I'm not seeing yet. Aerophagia pretty much gone, AHI 1.7 (mostly CAs), sleep somehow 5/10.
  4. Tried switching to APAP For Her mode but the pressure changes always made me wake up heaving from how aggressive they were.
My stats look mostly "fine" to me. Still, when looking at the flow rate charts, I see things like obvious flow limitations not even showing up in the chart, CAs and "OAs" looking very similar in the charts, and a correlation between elevated heart rate and respiratory events (whatever they might be). At least I've noticed the top region of the curve usually comes with two tiny peaks, could that be a sign of UARS?

So I would like to ask you guys in case you might have any ideas, and what you think is the next thing to try. More pressure? Different response mode? Different mask? Breathing exercises? I really don't know.

Sorry for the long post, and thank you so much for taking the time to read all this!

Uploading also a relatively normal looking flow chart rate for comparison.

PD: I can't say I'm satisfied with the SpO2 measurements from the Checkme O2. I haven't found any believable correlations with disturbed flows. I think it's because my fingers are thin and my hands are cold most of the time.


Attached Files Thumbnail(s)
               
Post Reply Post Reply






Donate to Apnea Board  
#2
RE: Need help reading flow charts. Very low AHI, still tired, algorithm wrong?
While I have UARS, I don’t have any expertise to share. However, I will say welcome to the site. I hope you receive useful support here.

Side note: have you tried an MAD?
Post Reply Post Reply
#3
RE: Need help reading flow charts. Very low AHI, still tired, algorithm wrong?
Welcome to the board.  It would be more helpful if you had the entire night instead of zoomed in charts.  They are fine to show problems you have but we need the whole night to help.

I will mention something, you wrote - 
  1. Decided to switch to APAP 6.4 - 8.0, EPR 3, Soft response mode, to avoid aerophagia while hopefully correcting some variable I'm not seeing yet. Aerophagia pretty much gone, AHI 1.7 (mostly CAs), sleep somehow 5/10.
EPR is exhale pressure relief.  Your inhale number is the min (6.4) your exhale number is min - EPR.  With what you have for a min 6.4 you are getting 2.4 EPR because 4 is the lowest the machine can go.  It is not a problem but if you want EPR 3 your min has to be 7 or greater.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
Post Reply Post Reply
#4
RE: Need help reading flow charts. Very low AHI, still tired, algorithm wrong?
Thanks for your reply, modernsportscar. I already have an appointment to get an MAD but I'm afraid that's gonna take months.

staceyburke, I didn't know the lowest pressure possible was 4, thanks for the tip.

Here are the entire night charts, let me know if posting any other charts would be helpful.

Both the CPAP period and last night (APAP) are included.


Attached Files Thumbnail(s)
               
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  Air Flow Interruption BuffaloBob 0 88 08-12-2022, 10:29 AM
Last Post: BuffaloBob
Question 3 Months on CPAP, still tired despite Dr saying my apnea is controlled highwaystar86 121 6,623 08-11-2022, 07:03 PM
Last Post: highwaystar86
  Flow Limits sm315 3 191 08-07-2022, 09:38 AM
Last Post: upsman
  Flow increase before the event ? VP75 2 195 07-27-2022, 02:19 AM
Last Post: Gideon
  Flow limitation DanEm 24 1,082 07-26-2022, 08:43 AM
Last Post: DanEm
  Still very tired every day even after 8 hours sleep with CPAP topdba7 24 1,296 07-26-2022, 07:20 AM
Last Post: topdba7
  Sleep horrible, number of nightly events have increased, charts provided. edyurgal 3 286 07-17-2022, 12:29 AM
Last Post: edyurgal


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.