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My AHI numbers are good but I don't feel great most of the days. - Printable Version

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My AHI numbers are good but I don't feel great most of the days. - sndraco - 08-12-2020

Hi

I have been using an APAP (Resmed Airsense 10) for about 8 months, my AHI numbers are pretty good usually between 0.8 to 3. (Majority of the time its 2 or less)

However, a few days (less than 10% of the time) I wake up after around 7-8 hours of sleep and feel great, able to jump out of bed with lots of energy. Some of the time 30-40% of the time, I sleep about 9'ish hours (9-9.5) hours and can get out of bed but am still pretty tired. And Rest of the time about 8-9 hours and don't feel great, but don't feel too tired either. 


I dont see any correlation between the AHI numbers and how I feel. 

I was wondering if where I am at is best that a machine can do, or if there is further optimization i can do. I have tried soft cervical collar and doesn't make much/any consistent effect on the AHI numbers or on how I feel. 

My setting is EPR 2 (I had EPR 1 for a while but didn't like it and felt a wee bit worse), pressure 6-12, ramp on. Have a heated tube and humidity (both auto). 
I am a 50 year old male, 154lbs, 5'9". AHI of 24.6, with hyopneas of 22.8 from my sleep study. 

There is still a big difference from using the machine, as pre machine would sleep 10+ hours and still need/want 1-2 hour naps most days, and energy, mood etc was quite low, so I do see a lot of benefit from using the machine just wondering if there is more benefit I can get, ie have more days I feel great (comparitively) and less days I am feeling not as good. 

Thanks

Shri

Longer background if relevant is that for a few years 3-5 (maybe more) I had a very difficult time getting out of bed, and when I did or had to for work, felt very tired, and needed to take naps the majority of the days when I could. Very low energy/motivation etc. 

Finally mid last year, I saw an allergist, and he recommended Allegra. The first few days I took it, it was a huge positive difference, I woke up earlier with much more energy. In parellel, since it was improved sleep (no other difference re syptoms with Allegra during day), I also got a home sleep study and had an AHI of 24.6, and have been using my Resmed since December of last year.


RE: My AHI numbers are good but I don't feel great most of the days. - staceyburke - 08-12-2020

Can you post the Oscar charts. It is about the only way anyone can see what might be going on.


RE: My AHI numbers are good but I don't feel great most of the days. - sndraco - 08-12-2020

[attachment=25533][attachment=25534]I will do so. I was thinking there is something that isn't shown in OSCAR given the low AHI numbers.


RE: My AHI numbers are good but I don't feel great most of the days. - mesenteria - 08-12-2020

I didn't look at both charts, just the first.  You have some serious leakage spikes here and there, and they may contribute to arousals.  Also, if you look up top, to those vertical coloured lines, and then look at the summary table at extreme left, you see some events.  They cluster, as depicted in the chart at the top, to the right of the summary table in the left margin.  Those clusters may be due to chin tucking, or some other sleep arrangement/position, that causes a cluster of 'events' often of the same kind.

Clusters are bad, generally, because they cause a piling-on effect and get you to some potentially serious oxygen deficits in about two minutes or so.  Even if those deficits aren't in the dangerous range, the reduction in saturation may cause an alert response in your brain and commence the process of arousals.  Arousals are bad because they too often disrupt your progress through the various stages of sleep...which is exceedingly important.  If you miss a REM cycle, as an example, it's gone until the next night's stack of them.

Technically, with an AHI of about 2+, your treatment is deemed to be effective (anything under 5 is taken as 'treated' by the industry and by underwriters).  But, we are almost certain to do better with some tweaking, and maybe you'll have to wear a soft foam cervical collar to keep your chin up...literally.

I haven't analysed your pressures; I'll let the savviest people here take a look and comment.  Please be patient...


RE: My AHI numbers are good but I don't feel great most of the days. - staceyburke - 08-12-2020

I agree with the chin tuck. But what I sawwas the large number of flow limitations. I would move your min up to 7. It may need more but one step at a time.


RE: My AHI numbers are good but I don't feel great most of the days. - Sleeprider - 08-12-2020

I don't see leaks as the big issue here, but rather, you seem to break therapy a couple times, and there is no obvious reason. AHI and events seem reasonably controlled and at 6-12 cm pressure with EPR 2, you seem to do pretty good. Increasing EPR from 1 to 2 seems to have helped, and you might want to go to 3. Nothing obvious to me.


RE: My AHI numbers are good but I don't feel great most of the days. - sndraco - 08-12-2020

The times I break therapy are when I take the mask off to use the restroom.

I have tried using a cervical collar and it didn't make a difference. I used to have EPR at 3 and backed it down to 2 and my numbers improved.

I can set minimum pressure to 7

Thanks all appreciate all the advice


RE: My AHI numbers are good but I don't feel great most of the days. - Sleeprider - 08-13-2020

Minimum pressure at 7.0 seems like a pretty good move. Your median pressure is well above that anyway, and it will reduce some pressure variation.


RE: My AHI numbers are good but I don't feel great most of the days. - AshSF - 08-14-2020

There are 2 reasons broadly for feeling crappy after a great AHI:
1) sleep architecture is fragmented. This can be caused by frequent large leaks or by apap mode.

2) you are not getting enough o2. Typically due to low pressure. So raising min helps there.

In my case, sleep arch was fragmented due to pressure variations so I went to fixed pressure. That solved it. I stayed at 7cm for a long time. Then increasing constant pressure from 7 to 7.5 made even more improvement in my energy levels thruout the day.


RE: My AHI numbers are good but I don't feel great most of the days. - sndraco - 08-20-2020

Thanks

How would I know if my sleep architechture is fragmented ? What Oscar data/graph would show me that?

Thanks

S