Gotten AHI lower but still tired - help with OSCAR data

[ZenHighs]

Hello everyone, I have been using my CPAP for 4 months now and was diagnosed with a lab study when I was 20 but started CPAP therapy last year at 27 (mild SA 8.9 AHI with at home study). Through reading and tweaking I have gotten my last 30 days average AHI to 3.5, some days will be sub 2 while some will be 5+. Throughout this time I have not noticed any difference in my daytime sleepiness - nor do I notice a difference when I have a really low AHI night. I also feel as if I wake a lot during the night and it seems during/right after a REM cycle when I am dreaming (usually no issue falling back asleep).

I was hoping someone could help me with the data and can see something I am not about why I am still so tired, brain foggy, and slow, or how I can optimize to bring my numbers down even lower. Thank you, please let me know if I can provide anything else!

[Deborah K.]

You would do well to raise your pressure range a bit. Since your median pressure is between 9 and 10, I suggest you use 9 to 13 for your new range.

You show just a little Positional Apnea.  PAs show up where you see clusters of Os and or Hs.  Please sleep on a flatter pillow.  Most here wear a soft cervical collar, but try the flatter pillow first. It might be enough.

Again, welcome, and best wishes on achieving great therapy and comfort!  

[ZenHighs]

Thank you Deborah, I set my min pressure to that because when I was 5-20 for the first two months the average was 7.8, now that I set that to the min the average is in the nines. I will try 9-13 starting tonight with a flatter pillow, if I still have clusters of OAs or Hs I will invest in a cervical collar.

I've been reading about flow limits but don't understand the acceptability range of them - do you see any issues with flow limits in my data?

[Deborah K.]

Yes, your flow limits are somewhat high.  You can lower them by setting EPR full-time, set at 3.  You have a lot of CAs, and using the EPR as I suggest will probably make them higher.  I would still use EPR at 3, and see how it goes.  It's important to lower flow limits.  They are short-lasting apneas that are not reported but can still disrupt your sleep.  Did you have a lot of CAs in your sleep study?  If you don't know, post a redacted copy of your sleep study.  Ask your doctor's office for one if you don't have it.  By US law they must provide it if you ask.  If you did not have a proportionately high number during your sleep study, they are treatment-emergent and will lessen as time passes.

[ZenHighs]

Thank you!!! I have attached my most recent at home sleep study. I started off my treatment with EPR at 3 but was getting a lot of Hs so I turned it off and it reduced it some what. Granted my min pressure was lower - I could try EPR 3 with this newer higher min.

[Deborah K.]

Your sleep study refers to the CAs as mild, so I don't think you need an ASV, but you might benefit from using a Bilevel machine. Let's watch your daily charts and see how you do.

[Dormeo]

Just a footnote to Deborah K's posts. We dream during all sleep stages; more here:

https://pmc.ncbi.nlm.nih.gov/articles/PM...EM%20sleep.

Also, it's normal to wake up briefly after REM sleep.

[ZenHighs]

Hi Deborah, hope you are well!

I have had a few nights on 9-13 with EPR 3. Most nights have been around 5 or 5+ AHI with a lot more CAs (I have attached them below). There was this one random night on Friday where I only wore my mask for 5 hours but had a 1.81. Other than this one night, do you recommend I get a cervical collar? Should I still continue with EPR on? Please let me know your thoughts