Still Tired after 1 year + Analysis

[Jimmy-Bills]

Hello everyone,
It will be 1 year and two months 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.
Yet my AHI is often very low (~1) and I sleep around 8-9 hours a night.
I'm sending you screenshots of OSCAR from the last two nights.
Do you have an idea?
Should I change some device settings?
Thanks

[Julie]

Hi, the thing that stands out most in your charts is that your minimum pressure setting is low - 4 is difficult for most to breathe at and isn't as effective as 6 or 7 would be, especially as the rest of the numbers are pretty good. I'd leave the max setting where it is for now and see how you feel in 4-5 days - please stay in this thread to tell us.

[Pugsy]

Are the leaks causing wake ups?

Do you take any medications of any kind? If so, what?

Do you have any other physical or mental health issues going?

[Jimmy-Bills]

Thanks a lot for your answers.

You mean I start the device at 6-7 rather than 4, right? How to program this on the device?

I rarely wake up at night, if ever. Maybe the leaks wake me up but I don't realize it.
Regarding my condition, I do not take any medication and I have no health problems (except allergy problems).

[Julie]

I mean you set your min. pressure at 6 or 7... when and how you start the machine is another story- do you understand what pressure settings are and how to change them? If not, ask... it matters.

[Jimmy-Bills]

Thank you for confirmation.
Yes, I went into the machine settings and set the min to 6 (I kept the max to 14). ( For those reading us : https://www.youtube.com/watch?v=tBgNdoJ6-bI )
We'll see what happens in 4-5 days. I will also post screenshots of OSCAR.

[ElusiveSleep]

You may want to try turning Pressure Relief (EPR) on and see what happens. The EPR setting is accessed in the clinical menu, which allows selecting the expiratory pressure to either 1, 2 or 3 units below inspiratory pressure.

I decided to turn off pressure relief recently in attempt to lower maximum inspiratory pressures in the hope of lessening hose turbulence and air venting noises, which sometimes wakes me. Indeed, EPR off does eliminate big spikes in inspiratory pressure without affecting AHI (typically <2), but unfortunately, am waking up more with pressure relief turned off. Perhaps my system is just not able to tolerate the higher EPAP.

Looks like I'll be going back to an EPR = 3, which has been the previous setting for the past three years since start of therapy. Sometimes you just can't win with these machines.

[Jimmy-Bills]

I return after 5 nights with a minimum pressure of 6.
I always feel tired in the morning, I yawn a lot, I have trouble getting out of bed and in the afternoon I want to sleep.
There are always a lot of leaks. I don't know if it comes from my mouth or it's because I'm used to moving around a lot (or both). I am attaching screenshots of OSCAR.
What should I do? I am lost and tired.
- Reset low pressure to 4? I feel like my nose is more stuffy than before.
-Put constant pressure?
- Another idea?

Thanks for your help.

[Miss Emerita]

Because you're still feeling sleepy during the day despite generally good numbers, it might be worth figuring out whether your sleep is being affected by leaks, pressure changes, and/or flow limitations. For many people, these would not be factors, but they might be for you.

Leaks. Do you have a dry mouth sometimes? That would point to mouth leaks. Or are you an active sleeper whose mask slips around some? That would point to mask leaks. Or you might have some of each. Depending on your answers, we can make some suggestions for addressing your leaks.

Pressure changes. Your pressures are being driven to a fair extent by your flow limitations, so that is one piece of the pressure-change puzzle (see below). In addition, if you wanted to try an experiment, you could set a narrower pressure range for yourself. For example, you might make your minimum 7 and your maximum 9. You could even make your minimum and maximum the same, e.g., at 8. It's an experiment; if you feel more rested without seeing more obstructive events, it'll be a success.

Flow limitations. FLs are restrictions in your airway that fall short of obstructive events. Yours may be caused by swelling in your nose; if so, then changes in your settings are unlikely to help, and effective symptom control for your allergies would be the key. But the FLs may be partly or entirely caused by relaxation of tissues lining your airway further down. If so, the best way to treat them is to use EPR. EPR drops your pressure by 1, 2, or 3 when you exhale. By the same token, it increases your pressure when you inhale, thus helping you overcome the FLs. You could start with 1 to see how it goes.

[ElusiveSleep]

Your OSCAR results look very similar to mine. The large leaks are mainly due to mouth opening and they coincide with increased flow limitations. As the airflow becomes restricted, the mouth opens involuntarily to bypass the constriction of the area in the throat at tongue level and above.

In the past, I have used a soft cervical collar to reduce mouth opening, but after a while it stopped working. Mouth taping did not help much either. However, realize that adding either of these things may compromise quality of sleep.

As I suggested above, try turning on the EPR setting which will make breathing more comfortable on exhales. Also, because the venting on the P10 mask is lower than other types of nasal masks, it could be a little harder to breathe through. I recently tried the P10 because of its minimal headgear, but found the breathing more difficult than the DREAMWWEAR nasal mask, which has higher venting - through the cushion and also at the hose attachment on top.

If the percentage of large leak time is between 5 to 10%, that should not be a major concern (this parameter is shown in OSCAR on the Statistics tab). I recently met with my sleep doc, and she said leaks in this range are not compromising therapy.

[luciferin]

You've got to deal with those leaks, my friend. Anything could be hiding in there. I had very similar looking leaks with nasal pillows. Turns out I have an upper airway obstruction or floppy soft palate that restricts nasal flow and can force my mouth open. And it happens to me roughly every 90 minutes, right when I start REM sleep. Sometimes I'd be so exhausted that I'd sleep through it with my mouth open, more often it would slightly wake me and keep me from REM.

I'm not saying you're the same as me, I'm just giving an example of something that could be hiding in those large leaks. If you can't fix them with the nasal pillows, you should really try a full face mask.

Look at your leaks on the 4th, they're happening like clockwork.

[Jimmy-Bills]

Thank you for your answers and all this information.
Concerning the leaks, I happened to wake up with a dry mouth with my tongue stuck to the palate. But it also happened to me to wake up several times with the mask badly positioned and the air blowing next to the nostrils.

At first, I will try to put constant pressure. And see what happens for several days. Then I will look at what concerns the EPR.
I keep you informed.

[Miss Emerita]

So it sounds as though your leaks are a mixture of mask leaks and mouth leaks.

For mask leaks, you could try going up or down in the size of your P10 pillows, if you have the fit-pack with all three sizes. You could also try positioning the head straps to produce a little more tension. Be sure to wash the head gear once a week; this helps to prevent the straps from getting stretched out.

For mouth leaks, here are some ideas:

1. Tongue position. Try putting the tip of your tongue behind your upper front teeth. Then position the main part of your tongue up against your upper palate. Finally, give a little suck or swallow to create a bit of suction. You should now be able to open your mouth while breathing entirely through your nose. Practice this during the day, and see if you can get it grooved in deeply enough to help while you are asleep at night. For some people, this is really all it takes to avoid mouth leaks.

2. Collar. If your jaw tends to drop down during the night, pulling your mouth open, then a soft cervical collar, or a firmer snore collar, can be a big boon. More here:
http://www.apneaboard.com/wiki/index.php...cal_Collar
3. Although chin straps tend to pull the jaw back, which is not helpful, the Knightsbridge Dual Band strap has a design that pulls the jaw straight up, which makes it a possible alternative to a cervical collar.

4. Tape. Some people (including me) rely on tape to keep the lips from opening. (I can't rely entirely on the tongue thing.) When the lips open, all too often that eventually leads to a noisy and disruptive mouth leak. To see whether tape would be feasible for you, I recommend that you invest in a box of Somnifix strips. They are very gentle on the skin but hold very well. Be sure to curl your lips inward per instructions before placing the strip. If these work for you, then you can experiment with lower-cost options.

[zonker]

In the past, I have used a soft cervical collar to reduce mouth opening, but after a while it stopped working.

just so you know, the cervical collar breaks down over time. i find i can get approximately 3 months of use out of it before i have to replace.

[Jimmy-Bills]

Thank you for all this information, I will try these methods. I had already done tongue exercises with myofunctional therapy but I had given up.
Here are the results for 3 nights. On the 3rd, I tried another mask, "AirFitP30i" but I didn't like it and I woke up a lot of times. The other nights, I feel like they were quite deep, I dreamed a lot.