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Only feel good at zero AHI?
#1
Only feel good at zero AHI?
Hello folks,

I'm on this journey for 8 months now, after 25+ years of fatigue. I'm happy with my Aircuve 10 VAuto and think I've found the right settings for me (4.0-8.4 PS4.4).

When I'm feeling better step by step, one thing strikes me in particular. I only seem to feel good when my AHI is zero or close to zero (0.2 at max). Even if it's only slightly higher, I won't feel rested and experience brainfog again.

I was wondering if others have the same experience. It seems odd that this tiny variances have such an impact on how I feel. Especially because doctors tend to say that every AHI below 5 is just fine.
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#2
RE: Only feel good at zero AHI?
What are your flow limits doing? You will likely need to view 3 minute segments to determine but OSCAR charts should show some indication.
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#3
RE: Only feel good at zero AHI?
Check your flow limits chart. FL are not calculated in the AHI but are small apnea. We use ps (higher) to control FL.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: Only feel good at zero AHI?
Thanks. I guess FL have been successfully addressed. Oscar consistently reports 0.00 (95%) and 0.02-0.07 (99.5%). I know this is only an indication but these numbers are pretty good ain't they? Furthermore the flow graph (3 min. segments) looks pretty smooth either.
Most of the bad days I've had some extra leakage. At times of leakage the flow graph will show irregularities. But I have to say that my 95% leakage rate never exceeds 15l/min.
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#5
RE: Only feel good at zero AHI?
When I look at my wave form I notice this bumpy little plateau at inspiration. Is this normal? And if not, what does it have to say?
   
   
   
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#6
RE: Only feel good at zero AHI?
And here some screenshots from another night:

   
   
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#7
RE: Only feel good at zero AHI?
On a closer look the bumpy little plateau is located just below the zero line so I guess it takes place at the end of expiration.
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#8
RE: Only feel good at zero AHI?
The little bumpy area is normal. That's your heartbeat, which shows up between inhalation and exhalation.

What does your leak rate graph look like on a day you feel rested, compared to one when you don't? Mask leaks, which you then correct, are a sleep disturbance even if the machine does not record an apnea.
Useful links
Download OSCAR (current version is 1.4.0)
Best way to organize charts
How to attach charts to your post

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#9
RE: Only feel good at zero AHI?
Based on your OSCAR chart, I question if you even need CPAP therapy. Does CPAP help in any way? I have doubts that you have sleep apnea.
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#10
RE: Only feel good at zero AHI?
Most users start feeling better when AHI is 2-3 or less. Feeling significantly better or worse if AHI is 0 vs 0.2 is imo unlikely to be due to a sleep disordered breathing phenomenon and more likely due to poorer sleep quality/well being in general. The reality is that everyone gets falsely flagged events with these machines and AHI consistently less than 1 are usually in large part falsely flagged events with people holding their breath when changing sleeping positions etc. Another term for these falsely flagged events is sleep wake junk (SWJ).

Brainfog isn't specific to apnea and could be caused by numerous other factors. Poor sleep, short sleep, hormones, neurochemicals, medical conditions, the list is nearly endless with apnea being only a single entry on it. If your AHI is consistently less than 2 and symptoms persist then imo this is usually because the symptoms are not caused by apnea.

UARS is the one somewhat exception to this but without EEG data and RERA data it is impossible to diagnose. The best you can do is self titrate to what feels best which you have already done. If your data always shows good as it sounds like it does the only thing you can do is get an in clinic sleep study done to see if it indicates RERA's as still being an issue although if it is still an issue and self titration is already complete your options to treat the issue are pretty restricted unless there is an obvious structural issue with airway that can be surgically dealt with.
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