AHI low at all pressures - Eye issues and still tired

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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johantv
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AHI low at all pressures - Eye issues and still tired

Post by johantv » Tue Oct 21, 2014 7:06 am

Hi,

I'm new here (from the Netherlands). Since march 2014 I'm using the PAP. My AHI on average is 0.7 and in 7 months of PAP my AHI never exceeded 2.3
Since treatment started I'm having fatigued eyes. The Eye specialist couldn't find anything and suggested lubricating the eyes. Since this didn't help much I varied a little with pressure Iooking for possible eye-improvement.

The strange thing is that my AHI is the same (<1) at all pressures (4 months APAP 5-8.6 cmH2O, one month CPAP 5 cmH2O, one month increasing pressure to now APAP 6-12 cmH2O).
The period at CPAP at 5 cmH2O I got really tired and noticed Flow limitations were much higher as during APAP.

Currently I agreed with my specialist (She's not very experienced unfortunately) to have the pressure range set to 6-12 cmH2O and looking at the results at the beginning of December. The average (med.) pressure now is around 8 and the 95% pressure at 10. Most of the time the max pressure is between 10,5 and 11.5.
Still having some flow limitations (Sleepyhead 95%=0.06 and max every night around 0.5). Don't know If that's acceptable or not? With Sleepyhead v09.8-1 User Flags I also noticed a lot of small disturbances in flow rate.

With the higher pressure (max 12) I'm feeling some pressure/tingling heath on cheeckbones area during the day, stil feeling tired and sometimes some dizzyness.

QUESTIONS:

1) So I'm still looking for tips on the best pressure (never used EPR).

2) What is an acceptable flow limitation (sleepyhead).

3) Any comments on my AHI being the same on all different pressures is also welcome. My specialist was puzzled?!

4) Also advices on eye issues are welcome (no leak into eyes is present due to nasal mask p10).

Kind regards
Johan

PS. Sorry for all the typing errors...
PS. Is it not possible to upload pics?
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
No Pressure, no Diamonds

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Sir NoddinOff
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Re: AHI low at all pressures - Eye issues and still tired

Post by Sir NoddinOff » Tue Oct 21, 2014 7:17 pm

johantv wrote: 4) Also advices on eye issues are welcome (no leak into eyes is present due to nasal mask p10).
Bump.
I can't answer your other questions but I like Blink eyedrops, they seem to work all night long, they may give you some temporary relief. I've tried just about all the others and IMO Blink eyedrops are the best.

_________________
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I like my ResMed AirFit F10 FFM - reasonably low leaks for my ASV therapy. I'm currently using a PR S1 AutoSV 960P Advanced. I also keep a ResMed S9 Adapt as backup. I use a heated Hibernite hose. Still rockin' with Win 7 by using GWX to stop Win 10.

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OkyDoky
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Re: AHI low at all pressures - Eye issues and still tired

Post by OkyDoky » Tue Oct 21, 2014 7:42 pm

Did you eye specialist test your eyes for dryness with the test strips in your eyes? I have extremely dry eyes and when I first started treatment I was using an airfit N10 just the venting of the mask would irritate my eyes. When I switched to a p10 it was much better but then I have tear duct plugs, which was supposed to conserve my tears, but they also prevent any air from traveling from the nose to the eyes which is a possibility just like tears drain through the nose. I have used eye lubricants at night which come in a little tube and are kind of like petroleum jelly but now the drops seem to control the night dryness.
ResMed Aircurve 10 VAUTO EPAP 11 IPAP 15 / P10 pillows mask / Sleepyhead Software / Back up & travel machine Respironics 760

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johantv
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Re: AHI low at all pressures - Eye issues and still tired

Post by johantv » Wed Oct 22, 2014 2:14 am

Thanks for the eye responses.

I don't think any strips were used during his investigation. To my specialists opinion it could have two reasons:
1) Bad quality of the natural tears
2) A blocked of tearpassage (hard finding right words in English) for tears going to eyes.

By using teardrops (I tried several, could check if IMO blink is available in NL) I didn't have much "Tears" anymore so he said option 2 can be excluded. (My Tearpassage was very narrow he said and couldn't open it without a certain tools which needed another appointment). Since 2 was excluded he never did that.

Remaining are now the tired eyes. At evenings I'm seeing things more blurry and the whiteness of the eyes has a pink shade.
The tear duct plugs are new to me. The specialist indeed said air could go through the nose to eyes (inside the body that is) and could also give issues. I will look into that. Thanks.
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
No Pressure, no Diamonds

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johantv
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Location: The Netherlands

Re: AHI low at all pressures - Eye issues and still tired

Post by johantv » Mon Oct 27, 2014 1:41 pm

johantv wrote:QUESTIONS:
1) So I'm still looking for tips on the best pressure (never used EPR).
2) What is an acceptable flow limitation (sleepyhead).
3) Any comments on my AHI being the same on all different pressures is also welcome. My specialist was puzzled?!
Anyone for the above questions.

For the record hereby an image of sleepyhead

Image
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
No Pressure, no Diamonds

tan
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Re: AHI low at all pressures - Eye issues and still tired

Post by tan » Mon Oct 27, 2014 2:28 pm

johantv wrote:
johantv wrote:QUESTIONS:
1) So I'm still looking for tips on the best pressure (never used EPR).
2) What is an acceptable flow limitation (sleepyhead).
3) Any comments on my AHI being the same on all different pressures is also welcome. My specialist was puzzled?!
Anyone for the above questions.

For the record hereby an image of sleepyhead
What does your doctor say about your RERA index after the sleep study? Just a guess yours may be high. Your doc may have just looked at your AHI and dispensed the machine like a pill, thinking that should take care of all your issues. In my case, my AHI without xPAP was 4.95, which is considered normal, but RERA index was 17, which is moderate. Imagine what would have happened if my doc had looked just at AHI? Dismissed.

Also, could it be that your upper pressure limit is too low? You stats indicate 11.96 as the maximum, which is very close to your pre-set max of 12. Can you tolerate higher pressures? If you do, I would play with that.
Last edited by tan on Tue Oct 28, 2014 4:22 pm, edited 2 times in total.

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johantv
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AHI low at all pressures - Eye issues and still tired

Post by johantv » Mon Oct 27, 2014 2:51 pm

@Tan,

Thanks for your answers.

Great that your specialist checked everything including RERAs.

My specialist didn't mention anything about RERA. They just said OSAS, AHI 43, desaturation till 79%, but nothing else.
If I read my somno report (see below) it seems they either did not measure it or they are zero, but I assume they are zero.
I'm not sure how I should interpret the flow limitation figures (don't have any references to others).

My upper pressure is seldom above 12. Most nights the max is in between 10,5 and 11,5, so I think 12 is about right.
I'm more thinking of raising the lower pressure to 7 or 8 and than perhaps use EPR 1 or 2 (now no EPR).

Image
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
No Pressure, no Diamonds

tan
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Re: AHI low at all pressures - Eye issues and still tired

Post by tan » Mon Oct 27, 2014 4:10 pm

johantv wrote:@Tan,

Thanks for your answers.

Great that your specialist checked everything including RERAs.

My specialist didn't mention anything about RERA. They just said OSAS, AHI 43, desaturation till 79%, but nothing else.
If I read my somno report (see below) it seems they either did not measure it or they are zero, but I assume they are zero.
I'm not sure how I should interpret the flow limitation figures (don't have any references to others).
You have a relatively small amount of the rest of the RERA (27 total, 3.8 per hour), but your report cannot be used to make any definite conclusion, except that, yes, obviously, your apneas have been taken care of, but it does not mean your RERAs are good now (most likely they are not if you still don't feel good). I am pushing to have a second study to determine whether my RERAs are reduced or eliminated. Maybe you should do the same, if you can.

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johantv
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AHI low at all pressures - Eye issues and still tired

Post by johantv » Tue Oct 28, 2014 11:21 am

In my last contact with my specialist I suggested this but they didn't responded positive. Just try pressure 6-12 till beginning of december and we'll see from there.

I hope stop taking my medicin (simvastatine) will hopefully change my fatigue and your discovery of my insommia .

If not I'll raise my minimum pressure to 7/8 and start using EPR.
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
No Pressure, no Diamonds

tan
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Re: AHI low at all pressures - Eye issues and still tired

Post by tan » Tue Oct 28, 2014 4:22 pm

Just discussed and got an agreement from my sleep doc that a second sleep study would be conducted to see whether I have any RERAs; also, I had myself examined by a second ENT who confirmed that I may benefit from several ENT surgeries recommended by the first ENT (turbinate reduction, rhinoplasty for flimsy nostril and UPPP)

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johantv
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Re: AHI low at all pressures - Eye issues and still tired

Post by johantv » Thu Oct 30, 2014 11:17 am

Good for you to have another sleepstudy.
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
No Pressure, no Diamonds

Paralel
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Re: AHI low at all pressures - Eye issues and still tired

Post by Paralel » Thu Oct 30, 2014 3:42 pm

johantv wrote:In my last contact with my specialist I suggested this but they didn't responded positive. Just try pressure 6-12 till beginning of december and we'll see from there.

I hope stop taking my medicin (simvastatine) will hopefully change my fatigue and your discovery of my insommia Image.

If not I'll raise my minimum pressure to 7/8 and start using EPR.
It is unlikely your simvastatin had anything to do with it, and stopping it, if your lipid profile is deranged, is a very bad long term idea.

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johantv
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AHI low at all pressures - Eye issues and still tired

Post by johantv » Fri Oct 31, 2014 1:52 pm

@Paralel, I just wanted to exclude the possibility simvastatine is the cause of dizzyness and pressure and heat around cheakbones and wakening up a few times during the night. I started Simvastatine 1 or 2 months before raising my pressure. After 2 weeks without simvastatine I will evaluate with my docter. After a week I'm not feeling differently, so I assume I will continu simvastatine in a week. Thanks for the warning
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
No Pressure, no Diamonds

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johantv
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AHI low at all pressures - Eye issues and still tired

Post by johantv » Tue Nov 11, 2014 4:33 pm

Started with Simvastatine again. No changes in the 2 weeks without simvastatine so I think changing pressure is the probable cause of my issues.

My osas consultant now advised CPAP 8 or 9 cmH20 should do the trick. I'm not sure with the FL's but am trying CPAP 8cm now. No improvements unfortunately . Still feeling fatigued, waking up a few times a night, during daytime pressure on cheakbones and some dizzyness. AHI obviously below 1, as always.
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
No Pressure, no Diamonds

tan
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Re: AHI low at all pressures - Eye issues and still tired

Post by tan » Wed Nov 12, 2014 12:49 pm

johantv wrote:
My osas consultant now advised CPAP 8 or 9 cmH20 should do the trick... Still feeling fatigued, waking up a few times a night...
My understanding is that, unless the adviser is a person with certain superpowers, only a titration study can tell what, if anything at all, actually does the trick. Your statement makes it apparent that your adviser lacks the certain superpowers.

My case is like yours. Raising pressure to 9 with EPR2-3 hasn't helped. Flow limitations are visibly lower but are still there. So is constant snoring. Similar lack of superpowers