Low AHI and still tired during day

[JamesD]

Hello everyone,
It will be 1 year and half that I use ResMed AirSense 10 AutoSet.
Although I manage to sleep with the machine, I often feel tired during the day, I yawn a lot and I have difficulty concentrating.

Yet my AHI is often very low (~1) and I sleep around 8 hours a night.
I'm sending you screenshots of OSCAR .
At first, the machine was set to APAP but this caused a lot of big leaks.
So I put it on CPAP (pressure 7) and EPR 2 for more comfort.

Do you have an idea what can cause this problem?
Should I change some device settings?

Thank you in advance.

[Yoshuzimo]

I'm by no means a pro...but, I had the same issue, low AHI still felt tired during the day. In fact, like I'd fall sleep if I got too comfy in the afternoon (I'd sleep for at least 2 hrs, unless somebody woke me up). I spoke to my specialist and he said it might be narcolepsy (apparently it doesn't just happen when you get excited...it just means your sleeping or triggering sleepiness at the wrong times). He gave me some meds to help me stay awake during the day, and that not only helped with being tired during the day, but improved my AHI to nearly 0! Not sure if that's your issue, but worth talking to your specialist about it.

My specialist has a patient portal, which allows you to send messages to them (like questions/concerns your not sure constitute a full visit they could probably just answer online). If it does require a visit or tests, they will let you know. You might see if your specialist has a patient portal with all that. Seriously super helpful.

Anytime anything changes or I find something that might help or whatever I shoot him a message and we are working much more like a team since I found out about it. He's made adjustments remotely to my machine multiple times based on those quick messages.

[Yoshuzimo]

All in all though, sleep therapy is kind of a guessing game. You try something, see if it helps. If it does you keep it, if not, get rid of it. And sometimes what didn't help before can help later...lol. It can take months or even years to really notice any difference too. It takes your body time to adjust (hence why sometimes what didn't work before does now).

Just keep at it. Stay talking to your doctor, ask questions...in other words, your doing a great job, lol.

[Crimson Nape]

Hi JamesD!  -  
The OAs shown could be as you changed sleeping positions.  The EPAP pressure is responsible for controlling OAs.  Since you are using an EPR of 2, I would try increasing your pressure setting to 9 cm.  This would yield an EPAP pressure of 7 cm.  Hopefully this will address some of those OAs.  Also, avoid sleeping on your back, if you are now.

Please let us know if this works or not.

- Red

[JamesD]

Thank you for such quick and detailed responses.
Regarding my sleep doctor, I see him very rarely and he is often very busy, it is difficult to discuss machine settings with him.
I will try to increase the pressure to 9.
A few questions to help me understand things better:

- Since we want to increase the pressure, my AHI score is too high? Usually I am often below in 1.
- Is my flow limitations normal?

[Crimson Nape]

I forgot to add my reason for choosing a 2 cm increase.  I want enough pressure change to see if we are headed in the right direction, basically a proof-of-concept.   If it is promising, you can always try dropping to 8 cm and see if you are maintaining the same results.

Your flow limits are low and seem to be consistent, and follow along with the OAs.  You don't seem to be experiencing them without having an event.  Everyone has good days and bad days, I was really paying too much attention to your AHI.

- Red

[JamesD]

Here is a detailed report of my last night.
For the IAH it's the same as the other days, it hasn't changed anything.
On the other hand, I have the impression that flow limitations is lower than usual.
What do you think?

[mltam]

I don't think I can solve your problem, since I have the same one.
But, here are some things you could play with

1. Did you try mouth taping to prevent leaks?
   
2. You could try to turn off EPR, and instead use a v-com. I didn't feel a big difference, but I don't use EPR.
   
3. You could try increasing temperature to allow more humidity. Again, I saw it suggested for better breathing, but it didn't seem to help me.
   

Best is to talk with a good doctor (which I haven't found yet). lanky lefty 27 on youtube might also have good suggestions.
It could also be that not all your events are correctly flagged.

[Crimson Nape]

Looking good! The big question is, how do you feel?

Your flow limit and tidal volume both look good. Your OAs are so spread out, that they may be from chin tucking. Look at the times of both the OAs and CAs and see if they are near the 10-second minimum. If you feel that the pressure feels a little high, you might try reducing the pressure to 8 cm and see if the OAs stay low. If they climb, you can bump it back up, or since you have low flow limits, reduce the EPR to 1. I would opt for the EPR reduction first.

- Red

[RickEiben]

I agree. I used an auto CPAP for 2 weeks and the flex setting of C-1 was just enough.