Lowered pressure from 8 to 5, AHI is 0.5 but a bit tired

Dear CPAPTalk,

I could use your advice -

My prescription is for a pressure of 8. But I was getting aerophagia so I lowered it to 5. I've been sleeping at the new pressure for about 30 days.

The AHI dropped from an average of 0.91 (averaged over 90 days, no EPR) to 0.71 (averaged over 35 days, with EPR 1).

Here is a representative sleepyhead graph (an average night of sleep): http://imgur.com/a/wS2cd

It looks normal to me, but I'm not an expert.

I still feel a bit tired sometimes. Maybe I need more sleep, or it is work or marital stress (sleepyhead average over last 6 months is 7:45, so lets say 7.5 hours of actual sleep).

I just want to know whether it could be because of lowering the pressure - or if I could try something like turn EPR off?

Thank you so much,
appo

The chart says that 95% of the time you were at 7.7 or lower and that your high pressure was 8.7. It must have been your minimum pressure that you changed
to 5 which really does very little for your aerophagia. You really do not need EPR at these low settings. These are very low pressure, but if you are happy with them....great.

Next time you do a screen shot can you do it in the format shown in this thread with examples. No need to redo this image though.
You have included a lot of graphs that aren't needed and omitted the leak graph which might be useful.
Plus the graphs you have that are useful are a bit tiny and hard to evaluate ....like the flow limitation graph.
viewtopic/t103468/Need-help-with-screen-shots.html
On the right side with the graphs....only need these
Events
Flow rate
Pressure (just one..either the mask pressure or the regular pressure)
Leak
Flow limitation (only available on ResMed machines)

On the left side hide the calendar and turn off the pie chart (preferences/appearance tab remove check mark) and this will allow the AHI and each category of events to show up along with some useful statistical data which right now can't be seen.

I can't see your settings. You are in auto adjusting mode and looks like you lowered the minimum to 5 cm and the machine goes up as needed. It never goes very high with the max at 8.70 on this night.
I don't see anything on this particular report that is just screaming "fix me and you will feel better". There's nothing pointing to something urgently needing fixing.

EPR is personal preference...if you feel you sleep better with it then use it and if you feel you sleep better without it turn it off.
For some people using EPR sometimes allows more apnea events to happen but I don't see it happening on this report. If it did we would just allow for it and adjust the minimum upwards a bit if you like EPR. Not a big deal one way or the other.

When we don't feel the good numbers (or as good as we would like to feel) then we need to look at other potential culprits because not everything can be fixed with a nice low AHI.
Hours of sleep...looks like you should be getting enough sleep at 7 to 8 hours but how is the quality of those hours? Do you wake often for any reason and if you do any idea why? Fragmented sleep will totally mess with how we feel during the day despite having adequate number of hours.
Also look at any medications you might be taking because often there are unwanted side effects that mess with how we feel during the day.
If we can't blame our unwanted symptoms on fragmented sleep or medications then maybe it is time to do some detective work and try to figure out if it's something else going on.
Now it might be that you just need more time getting use of the machine but while "giving it time" you might as well be doing some detective work in an effort to see if something else is a factor in how you feel.
Pain...that's a potential culprit for not feeling well rested. This one I unfortunately have considerable experience with. Best AHI and software reports in the world mean nothing when I have had a crappy night due to pain.
Other health issues is also a potential culprit.
Bed comfort.
Insomnia.
Just to name a few potential culprits.

appo,

Your chart looks quite good. As pugsy pointed out there's nothing in that chart that screams "Fix Me."

So I don't think undertreated OSA is the cause of your continuing problem with residual daytime tiredness.

You do write:

appo wrote: My prescription is for a pressure of 8. But I was getting aerophagia so I lowered it to 5. I've been sleeping at the new pressure for about 30 days.

Did lowering your minimum pressure to 5 take care of the aerophagia problem?

If not, how often do you experience it? How painful is it? And do you ever wake up in the middle of the night with pain from aerophagia?

I still feel a bit tired sometimes.

How often is "sometimes"? And how much is "a bit tired"?

Are you talking about feeling like you're dragging a bit in the middle of the afternoon one or two days a week?

Or are you talking about being tired enough to have some trouble doing what you want to get done several times a week?

Maybe I need more sleep, or it is work or marital stress (sleepyhead average over last 6 months is 7:45, so lets say 7.5 hours of actual sleep).

Stress from any source can make you tired. Do you have any healthy ways to manage your daily stress?

And while 7.5 hours of actual sleep is plenty for many people, it's not enough for others. If it's possible to get a bit more sleep (like aiming for 8 or 9 hours instead of 7.5), that may help. But if you go to bed earlier and then just lie in bed not sleeping for an hour, that's not going to make you feel any better.

Also: Do you remember a lot of restlessness or middle of the night wakes on the days you feel at your worst?

I just want to know whether it could be because of lowering the pressure - or if I could try something like turn EPR off?

My guess is that neither the lowering of your min pressure nor your use of EPR is what's causing the residual tiredness.

You could try turning EPR off. It might not change much. It might make the aerophagia come back. Or not.

Bumping up the min pressure is more than likely going to retrigger the aerophagia. And aerophagia can be very disrupting to the overall quality of your sleep and that can increase the tiredness.

Finally, when was the last time you have a full physical exam with blood work? A thyroid test and a Vitamin D test are two things that should be checked out. If you happen to be male, it may also be worth having your testosterone levels checked.