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low AHI, still exhausted
#1
low AHI, still exhausted
Hi everybody. First, thank you to everyone for all the help you provide here. I've learned quite a lot just lurking on these boards.

I was diagnosed with OSA last June via a home monitoring test, and have been using APAP (ResMed AutoSense 10) for nearly 11 months. During this time my AHI has dropped from 29 at diagnosis to usually between 1-3. I used to have headaches each morning, and those have greatly reduced. 

However, I feel like my fatigue is mostly unchanged; I typically feel tired and brain foggy throughout the day. I often take 1 or 2 brief naps (10-15 minutes) throughout the day, without the APAP, which seems to work as kind of a reboot and helps me focus for a few hours.

I've tried noodling around with various settings over the past few months - mostly the Min/Max and EPR settings, but haven't really noticed any diffrences. I have been using the P10 nasal pillows throughout this time, except a few nights where my nose has been completely blocked up. Those nights I have used an F20 full face mask, although I've had a really hard time getting it to stay on my face without leaking. Using the P10, my partner has said that I occasionally seem to have mask leaks and/or open my mouth, but I have no awareness of this, and typically sleep through the night without waking. I'm a 40 year old male.

I've attached an OSCAR screenshot that is representative of a typical night. Looking at it I notice 1) a higher number of Clear Airway events than anything else and 2) a number of leak events, but I'm not sure what to do about this.


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#2
RE: low AHI, still exhausted
The leak events look like mouth leaks. What causes the leaks with F20? Have you tried different size cushions or the airfit (foam) style? The airfit might seal a bit easier but I prefer silicone ones even though I have to snug it down fairly tight.

How much does a pygmywhale weigh? Curious to get an idea of what your tidal volume should be as it appears to be on the low side but that might be because of your pygmy stature lol (or a sign of mouth breathing perhaps, especially if it increases when using full face mask).
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#3
RE: low AHI, still exhausted
(05-11-2021, 06:31 PM)Geer1 Wrote: The leak events look like mouth leaks. What causes the leaks with F20? Have you tried different size cushions or the airfit (foam) style? The airfit might seal a bit easier but I prefer silicone ones even though I have to snug it down fairly tight.

How much does a pygmywhale weigh? Curious to get an idea of what your tidal volume should be as it appears to be on the low side but that might be because of your pygmy stature lol (or a sign of mouth breathing perhaps, especially if it increases when using full face mask).

About 150 pounds. Actually I am a person of short stature (<5ft) so if that's useful information, then there it is. Smile

How can you tell if they are mouth leaks? With the F20, I just never seem to get it to stay on my face without leaking from the sides, and I end up basically bolting it to my face to stay on. 

I do have some facial hair and I know that doesn't help, so maybe I should get rid of it and try again. Thanks!
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#4
RE: low AHI, still exhausted
Mouth leaks are common especially if you have nasal congestion (it is the reason I used FFM), they often have that slower rise then plateau as well that yours show. Yours aren't horrible(no large leaks) but I think you might be mouth breathing which means you aren't getting full benefits from PAP. I started out with P10 and couldn't stop mouth leaks so eventually bought the F20 and it improved my treatment quality (I prefer its quietness and less venting too as I am a light sleeper, the mouth leaks used to wake me up). If you are waking up with a dry mouth at times then that is a good sign of mouth leak as well.

If you just have some scruff that should go anyways I would say shave it off and try FFM and you will probably see leaks go away/minimize. If you would prefer to keep facial hair you could try the foam airfit cushions which seal better around facial hair, I personally prefer the silicone ones but everyone is different.

Tidal volume is the volume of air you breath during a single breath. Your average at 260 ml is at the lower end for your height/weight (6-8 ml/kg is a common reference range but that is often from predicted weight based on your height and I don't know exactly how weight factors in. This could potentially be because you are mouth breathing (note how your flow rate is lower when your leak rates are higher). If you look at tidal volume chart you might see that it is lower during periods of leaks.
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#5
RE: low AHI, still exhausted
I have the F20 airfit and a goatee and I find it seals well. Watch out to make sure the mask doesn't slide down your face so that the nose portion pinches your nostrils and affects the flow. I much prefer an N30i or P30i.  Perhaps the large leaks are disturbing your sleep?  Do you have a chin strap?
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#6
RE: low AHI, still exhausted
I've tried both AirFit silicone and AirTouch memory foam and couldn't get a consistent controlled leak state. I went over to the Fisher & Paykel Vitera and it is much better than the F20. I would tend to believe the leaks need controlled first then we can dive into other areas.
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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#7
RE: low AHI, still exhausted
I don’t believe your leaks are serious. With that being said, any leak does effect your therapy and please do try Eliminate as many as possible 

I think I would try to limit your centrals (most events) and your obstructive apnea. It may help to cut back on your EPR. I would go to 2 and move up your min by one.  That will narrow the difference between the two pressures, helping with centrals. Plus moving up the min would make the machine help obstructive event more quickly.
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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#8
RE: low AHI, still exhausted
And since it hasn't been mentioned yet, switch off ramp, or at least switch it to 'auto' rather than 20 minutes.
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#9
RE: low AHI, still exhausted
For interest sake the leak rate level isn't that bad, the main thing that caught my eye is how often it increases/decreases. What this likely indicates are sleep disturbances being caused by the air flow through your mouth (mouth leak starts, body reacts shutting mouth, repeat). These disturbances might not be enough to wake you up but they can still affect your sleep quality.

My chart looked similar before I made the change to FFM and it was getting worse. I was aware mine were mouth leaks though because they were waking me up at times and causing dry mouth issues.

If nothing else your partner will appreciate reduced leaks.
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#10
RE: low AHI, still exhausted
FFM was mentioned often here. Do you mean masks that cover mouth an nose, or one of those that are like diving googles that also cover the eyes? 

I have a nasal pillow with AHI of around 3-5 and a very dry mouth and feel very tired.
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