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[CPAP] Need Help: Still Tired with 1.67 AHI
#1
Need Help: Still Tired with 1.67 AHI
Hello,

I have ~1.5 AHI every night and I'm still exhausted every day (brain fog, need naps, emotionally unstable, can't do work, drowsy while driving). I sleep an average of 9.5 hours a night in the last 30 days according to OSCAR. I've been using the CPAP for 11 months now.

I'm also physically fit, male, 24 years old, and have done many blood tests to rule out vitamin deficiencies, thyroid problems, lyme disease, and even got one for C-reactive protein. All say I'm fine.

Of course my DME and nurse at the sleep center keep saying I'm doing great because my AHI is below 5, which is incredibly frustrating. Once in a while I get below 1 AHI and I feel much better. I would like to get below 1 AHI consistently.

Here is a screenshot of an average-looking night in OSCAR:
   

I noticed my flow rate has many spikes that aren't marked. What is that? This happens often. Here is one zoomed in:
   

I feel like these frequent micro arousals fragment my sleep and make me tired. Is my leak rate too high? Do I have high flow limitations?

Here's the variables I think I can change but I have no idea where to start:
1. Raise minimum pressure
2. Change to Soft Autoset or plain CPAP with static pressure
3. Lower EPR from 3 or turn it off
4. Switch from AirTouch N20 L to AirTouch N20 M (The L seems too big for me according to the measuring guide)
5. Switch to other mask (I ordered the P30i yesterday to test, I already tried the F30i and N30i and I got crazy leaks)

I currently tape my mouth shut to avoid leaks.

What do y'all think is going on? What additional information do you need? I'm at my wits' end with this.

Thank you.
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#2
RE: Need Help: Still Tired with 1.67 AHI
Welcome

Your overall OSCAR charts look ok IMO (0.00 95th percentile flow limitations).  

But that close up that you provided looks pretty nasty. I am not sure what is going on there.  

You have several OA's during the night, but none of them seem clustered together (that is a good thing).  

You have 5 things that you have thought of.  You can try all of these.  Start with number one and go at them one at a time (give each edit a few nights to see how it affects your sleep and OSCAR.  And try the settings changes 1st before you get another mask, etc.  

You have some leaks going on all night long.  

One of the 1st suggestions would be to read this from our wiki on mask leaks: 
Download OSCAR
OSCAR Chart Organization
Attaching Files


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.  
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#3
RE: Need Help: Still Tired with 1.67 AHI
Jay51 is right about your leaks being too high. Nasal cradles get compromised at a much lower leak than a full face mask.
You don't have many obstructed events, but the few flow limits are causing the pressure to increase.
Don't lower EPR, but lower your maximum pressure to 10 cm for a few nights to see if minimal swings in pressure make you feel rested.
If that works then slowly increase your minimum pressure 0.2 at a time to get close to 10.
Take your time.
When the P30i mask comes use lanolin to protect your nostrils.
Good luck.
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#4
RE: Need Help: Still Tired with 1.67 AHI
Your leaks are too low to worry about. Sleeprider says anything under 5.0 on the leak report on the left panel is okay.
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution and F&P Nova Micro

Link to thread about switching from Autoset to Bilevel:
https://www.apneaboard.com/forums/Thread...+a+bilevel

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#5
RE: Need Help: Still Tired with 1.67 AHI
Sadly, the leak chart show leaks above what would impact a nasal or pillow mask, these leaks might wake you up or cause microarousals.
They would be great for a full face mask.
The N20 mask is not great as it usually will leak once you fall asleep, in my experience.
The p10 or other pillow mask don't have that issue.
Do you have a hose hanger that would help keep the weight of the hose from pulling the mask?
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