AHI below 5 but still feeling tired

[kiri]

Hi, I'm new to the CPAP thing. I've been using my machine for 3 weeks. Usually I use my machine about 7 hours and have an AHI below 5. But when I wake up, I feel very tired. I take off my mask and have a nap without the mask for another few hours. My pressure is set between 8 and 9 cmh2o. Am I doing anything wrong? Should I increase the pressure to reduce AHI? When I increase pressure, I start having aerophagia and mask leaks..

Also, another problem, is I seem to get nasal congestion, and I've been tweaking the humidity and temperature to no luck. Any tips?

[kiri]

Here is the CPAP data for last night, which I feel is a fairly representative night. Not sure how to interpret it.

[ajack]

I would get the setup manual from http://www.apneaboard.com/adjust-cpap-p ... tup-manual

you are hitting the maximum ceiling of pressure at 9.2, I would raise that to give the machine room to move,
I would raise the max to 12 and the minimum to 9, the median pressure. I would see how that goes.
If you turn down the EPR it may reduce the CA that may come with an increase in pressure, but if they aren't high, I'd leave it. They should settle on their own. New cpap users can have CA, as they get use to it.

Do you use a nasal mask? there could be some mouth breathing. Bonjour at the site above has a good mask link to information in his signature, the machine also has a mask fit function that will blow increased air pressure to test the mask, while you adjust it.

[Julie]

I am curious as to why your high pressure setting is so low...so close to your low setting. There's no need for that at all - the low one is the meaningful pressure that determines how well you're doing and you could set the high one at e.g. 15, instead of capping it so low - that won't affect aerophagia. Not much point in having an auto machine if you don't let it do its job .

[xxxyxz]

AHI below 5 but still feeling tired

it's because ahi is a crude surrogate

your oxygen should be checked

[LSAT]

I am curious as to why your high pressure setting is so low...so close to your low setting. There's no need for that at all - the low one is the meaningful pressure that determines how well you're doing and you could set the high one at e.g. 15, instead of capping it so low - that won't affect aerophagia. Not much point in having an auto machine if you don't let it do its job .

I agree...The machine wants to go higher to stop events, but you have limited it with the low max setting.

[Pugsy]

Might be interesting to see the flow limitation graph. Can you include it and maybe omit the mask pressure graph? Don't really need 2 pressure graphs.
I am betting that is what is maxing the pressure out at 9.2. They may or may not be a factor in your not feeling the good numbers.

Are you waking often during the night? I see at least one break in therapy line so machine went off and back on again...so at least one wake up. Are there others and if there are approx how many?

Do you take any medications? If so, what?
Also, any other health conditions going on which might impact how you feel?

Your leaks are for the most part very well controlled. 4 or 5 large spikes...were those mask refit spikes and were you awake? I don't see them impacting the therapy itself but they could be impacting sleep itself which could of course impact how you feel.

Humidity in the air can affect the nasal mucosa and cause congestion. Some people need more added humidity and some need less and some don't need any at all. What settings have you tried? Any sort of improvement one way or the other to give an idea which way your nasal mucosa like things.

Also, for some people the weight of the mask on the sides of the nose will cause congestion. Does the congestion go way fairly quickly if you lift the mask up off the nose?

The bulk of your AHI is central/clear airway index. More pressure is unlikely to reduce the centrals and they may or may not mean anything more than some awake breathing getting flagged by mistake.

We need a little more information to have a better idea what might be going on.

[kiri]

I would get the setup manual from http://www.apneaboard.com/adjust-cpap-p ... tup-manual

you are hitting the maximum ceiling of pressure at 9.2, I would raise that to give the machine room to move,
I would raise the max to 12 and the minimum to 9, the median pressure. I would see how that goes.
If you turn down the EPR it may reduce the CA that may come with an increase in pressure, but if they aren't high, I'd leave it. They should settle on their own. New cpap users can have CA, as they get use to it.

Do you use a nasal mask? there could be some mouth breathing. Bonjour at the site above has a good mask link to information in his signature, the machine also has a mask fit function that will blow increased air pressure to test the mask, while you adjust it.

Thank you for the advice. I moved the max pressure to 12 (already knew how to access clinical menu)

CA = central apneas? So central apneas increase with pressure, and lots of EPR exacerbate it?

I use a full face mask (its in my sig), but it seems due to my blocked nose I often open my mouth to breathe. I don't get a blocked nose if I sleep without CPAP.

[kiri]

I am curious as to why your high pressure setting is so low...so close to your low setting. There's no need for that at all - the low one is the meaningful pressure that determines how well you're doing and you could set the high one at e.g. 15, instead of capping it so low - that won't affect aerophagia. Not much point in having an auto machine if you don't let it do its job .

Actually when I first got the machine they set it at min 9 and max 12. But I changed it to 8 and 9, because I would take a long time to fall asleep, and the machine would raise pressure all the way to 12, giving me aerophagia and stopping me from sleeping. But I'll try max pressure 12 again since my time taken to fall asleep has gotten lower due to getting used to the CPAP.

[Pugsy]

CA = central apneas? So central apneas increase with pressure, and lots of EPR exacerbate it?

Centrals can increase with more pressure but it isn't a given that they will. Some people can use pressures in the 20s and not have centrals happen.

And some people will develop centrals when using EPR (but most people don't).

Your centrals aren't numerous enough to be a problem at this point even if they were all real . You can check for duration by clicking on the Events tab above the statistics and going to the ClearAirway page and the number in parentheses is duration in seconds. Most likely they will be rather brief and not likely to cause a problem with oxygen levels since they are sporadic and random.

I suspect the pressure maxing out at 9.2 is related to the flow limitations since that is part of what the auto algorithm wants to fight.
Flow limitations are minor reductions in air flow that don't meet criteria for hyponea or OA. They are thought of as warning signs that the airway is trying to collapse and will drive the pressure up. They can cause arousals though...and thus disturb sleep so they are unwanted.

Only problem might be that the FLs is the FLs might be related to the nasal congestion and not necessarily the airway collapsing. The machine doesn't know where...it just knows the air isn't flowing as good as it should. If more pressure (allowing it to go higher) doesn't reduce the FLs then it's very possible that the FLs are nasal mucosa related and not the airway behind the tongue.

For some people the weight of the mask on the sides of the nose up near the nasal bridge will cause congestion. Don't know if you are one of those but I am so I know that I can't wear anything that touches that area of my nose. To test it out put your fingers up on the sides of the nose and press gently up by the nasal bridge area (on the side) and see if you get congested quickly and if you do remove your fingers and see if the congestion goes away fairly quickly...
If it does you might want to look at a full face mask that doesn't touch that area. The Respironics Amara View is the one I ended up having the best success with.

If higher pressures cause too much aerophagia...you may need to compromise a bit on the maximum especially if the congestion seems to be the cause of the FLs.

[kiri]

Might be interesting to see the flow limitation graph. Can you include it and maybe omit the mask pressure graph? Don't really need 2 pressure graphs.
I am betting that is what is maxing the pressure out at 9.2. They may or may not be a factor in your not feeling the good numbers.

Are you waking often during the night? I see at least one break in therapy line so machine went off and back on again...so at least one wake up. Are there others and if there are approx how many?

Do you take any medications? If so, what?
Also, any other health conditions going on which might impact how you feel?

Your leaks are for the most part very well controlled. 4 or 5 large spikes...were those mask refit spikes and were you awake? I don't see them impacting the therapy itself but they could be impacting sleep itself which could of course impact how you feel.

Humidity in the air can affect the nasal mucosa and cause congestion. Some people need more added humidity and some need less and some don't need any at all. What settings have you tried? Any sort of improvement one way or the other to give an idea which way your nasal mucosa like things.

Also, for some people the weight of the mask on the sides of the nose will cause congestion. Does the congestion go way fairly quickly if you lift the mask up off the nose?

The bulk of your AHI is central/clear airway index. More pressure is unlikely to reduce the centrals and they may or may not mean anything more than some awake breathing getting flagged by mistake.

We need a little more information to have a better idea what might be going on.

Thank you a lot for your advice and the help you give to others in this forum.

Yeah sometimes I turned the machine off. I also sometimes removed the mask or partially took it off to scratch my face or refit the mask. I think I may have partially woken up to scratch myself or change settings 3-4 times during the sleep.

I haven't tried all the combinations of tube temp and humidity, but so far it hasnt help with congestion. But putting the mask higher up my nose seemed to help. I suspect my mask is slightly too small. I use a small size, the medium was too big, but when I got measured they said I was between small and medium. I have a very sensitive sinus and I get sinus infections from minor triggers easily, if that info somehow helps.

Sometimes, I breathe out and then I just don't breathe back in, until I partially wake up, then I breathe in. Is that central apnea?

Here is my flow limitation graph by the way:

[Julie]

If you were to wear a medium mask but add liners (from Padacheek.com) you might be more comfortable and not get major leaks - look at the site (the owner's a member here and designed the things) and see what you think.

[Pugsy]

Sometimes, I breathe out and then I just don't breathe back in, until I partially wake up, then I breathe in. Is that central apnea?

Yeah, most likely. Hold your breath for 10 seconds...that's pretty much a 10 second central apnea (has to be 10 or more seconds to earn a flag).
If you are awake or semi awake it's not real though and even less cause for worry.

See this video...might help you because he shows a "central" that is occurring immediately following an arousal (we may or may not remember) and while it technically is a central it isn't the central we worry about.

https://www.youtube.com/watch?v=1OQFESwNXm0

If you are waking up to refit the mask...that's a definite arousal and any event flagged near a refit of the mask (because you are usually awake when you refit since you are remembering it) simply has to be ignored because this is sleep apnea and not awake apnea. Gotta be asleep before we even think about worrying about any flagged events.

Do the finger test I suggested above...you might do better with a mask that doesn't even touch that area of your nose. Something to think about and don't wait too long if you want to try a different mask for free. A lot of DMEs limit people to 30 days. You can always go back to this mask if you want to.

For congestion...does a hot steamy shower help or make things worse. If it helps crank up that humidity and see what happens. Air hose temp is simply your comfort plus prevent rain out (condensation)...so whatever works. It's not usually the temp that is affecting congestion...it's usually the humidity either not being enough or being too much.

For future screen shots (no need to redo this one) here's a few hints.
You are using imgur.....so log in...find the image you want to share...click on that image and look for a box of addresses on the right side (gotta be logged in to see the box)...see right below those addresses where it says thumbnail? ....Click on "Large thumbnail" and then copy the last line in the box of addresses which I think is called linked bbc code. This will make your image less huge and we can easily click on it if we need to enlarge it but sometimes large thumbnail is sufficient. See the image below and test it by putting your mouse cursor on it and click on it.
When including your Flow Limitation graph just do it along with the pressure graph because we need to compare the flow limitations to the pressure to see if the pressure is going up because of the FLs. There is no need for the other graphs below FL graph. It's more important to have the basics in one nice clean image...helps the evaluation process. No need to redo this report though....let's see what happens with the increase in the max and the FL graph.
If more max causes more aerophagia issues...the FLs might need to be allowed to happen and if they are nasal related more pressure is unlikely to help so no sense in causing aerophagia trying to kill nasal congestion FLs....there are better ways to deal with nasal congestion.

[nicholasjh1]

I've also been taking Acuity AZ and unforgettables which has a lot of anit-alzheimers and helps grow neurons, and I've felt more awake and aware lately. It's possible you need brain support (choline, fish oils, etc) in order to rebuild your brain. I think the initial recovery is pretty exhausting because your body has to rebuild your brain. (at least if you have severe there is probably brain damage)

[ChicagoGranny]

Acuity AZ and unforgettables

There's a sucker born every minute.