Low AHI / numbers good - BUT still tired...other breathing issue happening?

[Snoozer76]

Hi Everyone,

I firstly want to say how much this forum is a blessing in terms of the support and guidance it provides, particularly for those of us who are struggling with treatment and just need that encouragement.

I've been on CPAP for around 5 years now. I was diagnosed with mild sleep apnea with around 7 events per hour (combination of OSA and Hypopneas).

I had never woken up feeling rested and was starting to become more anxious and was wondering why anxiety was happening given that I had always been a relaxed person.

Following the diagnosis, I starting on CPAP. It has been a constant battle since that time as I have never felt much improvement following compliance - this is despite my AHI figures being very low.

I started looking more deeply into what might be stopping me from feeling better and my suspicion is that, even though my AHI events are low, I must be having some disruptions during sleep which preclude me from feeling rested the next morning.

Traditionally I have stayed on Fixed pressure of 10 with EPR of 2. However, last night I road-tested increasing the EPR to 3 as I read on this forum that this can address Flow Limitations which might be causing disruptive sleep. I slightly increased the pressure to 11 (which I am aware you need to deduct the EPR of 3 to give a net pressure figure of .

The screenshots of last night are attached.

To be honest I don't feel any better, even though the Flow Limitations, Leaks, AHI look great.

I am wondering whether there is another issue going on with my breathing that might be causing me to feel this way?? Hoping that the veterans on this board can assist with their trained eyes!!

Many thanks.

PS Male / Height 5'11 / Weight 195 pounds / Machine Resmed Airsense 10 Auto / Mask Phillips Dreamwear FFM

[Julie]

Any particular reason you're on plain cpap vs auto?

[Pugsy]

Can you please clarify exactly what symptoms you are having that compose "not feeling better".

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

I don't see anything on the report that stands out needing fixing.

[Snoozer76]

Hi Pugsy

I wake up each morning feeling as though my head is still foggy and that I haven’t had enough oxygen throughout the night. Never feeling rested. I’m a fit and healthy guy in my mid-40s. I just get the weird feeling that I’m having disruptions all throughout the night that I’m not registering as major events but I still causing me not to have a restful night sleep and that is what is creating these outcomes for me. It’s frustrating as sometimes I feel as though I would prefer more obvious stand out problems to be occurring so that I could rectify them.

[Snoozer76]

Any particular reason you're on plain cpap vs auto?

Hi Julie

I started many years ago with a minimum of four and an open maximum at 20. I was finding that that was waking me up throughout the night so I went to straight CPAP at the titrated level.

I’m certainly open to any ideas and I would be happy to go back to a narrower range APAP if you felt that it was worth a try.

[Pugsy]

You could be having arousals that are impacting your sleep quality. You may or may not remember those arousals.
There are 2 kinds of arousals....airway related and what are called spontaneous arousals which means no known cause.
Airway related arousals the cpap machine can help reduce. Spontaneous arousals the cpap machine use can't help because whatever is causing the arousal it isn't airway related and the machine can only fix airway problems.

You might go here and watch all the videos and learn how to scroll through the flow rate to identify arousal/awake breathing irregularities and see how many you are having.
http://freecpapadvice.com/sleepyhead-free-software

Arousals can kick us out of sleep stage progression and cause us to not progress normally in each sleep stage so we end up with not enough time spent in each sleep stage for the restorative powers of sleep to work their magic.

I have probably 20 to 30 spontaneous arousals and remember maybe a half a dozen of them. Mine are related to back pain and not the airway. I wake up and have to change position to relieve the pain. I have done the zoom in counting of arousal irregular breathing instances. This is my "normal" unfortunately. The nights that the pain is lessened I will have less spontaneous arousals and usually feel better during the day.

Here below is a good example of spontaneous arousals and false positive flagging. This guy doesn't have OSA at all despite all the apnea flags. Those flags occurred while awake or semi awake from an arousal unrelated to the airway. We know this because he had an in lab sleep study and his diagnostic AHI was 0.8. He doesn't have sleep apnea but he does have crappy sleep quality from something not related to the airway itself.
I think you can easily distinguish between asleep breathing and awake/arousal breathing.

[georgelewisray]

I am feeling better than I have been in last 5-6 years. . . . .

SICK HOUSE ?? :: was what happened to me. >> Drier Vent in the outside wall and $50 4" duct fan to pump outside air at the intake of my AirCurve 10
There is LOTS to say about the many things I was investigating , positional monitoring, neck brace, SPO2 monitoring , things were sort desperate. . . . .

Sick House stuff started in 2017:::
Several other people were in the old maybe sick building at same time and I was the only one who had easily noticeable symptoms, ?HyperSensitive to mold-ish kind of stuff?.
We knew the old building was questionable when we moved in but we run dehumidifiers 7/24/365 to keep RH less 50% and use the most expensive DYSON HEPA vacuum cleaner.
I am now (April 2020) about 6-8 weeks back from the dead after bringing in outside air and and ducting it to the intake of my ResMed AirCurve 10.

68yo active male recently tending to slightly overweight.......
(0) 10 year slow decent into tiredness after not listening to my wife ("you snore badly , get a sleep study" => I DID NOT GET Sleep Study) . . . Doctors all did tests and said you seem OK. No doctor suggested sleep test until ( but that is another story ).
(1) early 2017 , Moved into a 'temporary' free foreclosed project house on beautiful piece of land in a coastal town in SE USA.
(2) Slowly became couch potato, had no energy and brain was barely running.
. . . .HORRIBLE, the old me was dead at this point and I had to try deal with possibility that this was the new normal. (An Important but a different Topic)
(3) Late 2018 - Sleep study and I quickly got a ResMed AirSense 10.
. . . and it slowly helped but as I went from horrible to almost OK I would then relapse or alternate between almost-ok and bad-ish. Better than horrible but not good.
(4) Kept complaining to pulmonologist and doing my own research with help of great forums and YouTubers >>> upgrade to BiLevel ( AirCurve 10 - LOVE IT!)
. . . but still not great, just almost good sometimes.
(5) CHANGE >>>>> Nov 2019, Took a 5 week trip with wife in 'tiny' teardrop trailer (AirCurve with ResMed 12VDC power block) to SW US , Southern California and I noticed 'HOW MUCH BETTER I FELT'. Looking back there was a pattern of feeling better when away but it was easy for me to miss.
(6) I just happened to have first of year appointments with pulmonologist and GP . . . . Told them both I thought I affected by a ?sick? building and intended to pipe in outside air to supply the intake of the BiLevel during sleep. I got no argument but I got no particular help.
(7) We would like to move out of this old building but finances will not allow an instant move. We considered a trailer out of desperation but now things are much better so we will see what the future brings. GOOD LUCK to all of us.

[Snoozer76]

You could be having arousals that are impacting your sleep quality. You may or may not remember those arousals.
There are 2 kinds of arousals....airway related and what are called spontaneous arousals which means no known cause.
Airway related arousals the cpap machine can help reduce. Spontaneous arousals the cpap machine use can't help because whatever is causing the arousal it isn't airway related and the machine can only fix airway problems.

You might go here and watch all the videos and learn how to scroll through the flow rate to identify arousal/awake breathing irregularities and see how many you are having.
http://freecpapadvice.com/sleepyhead-free-software

Arousals can kick us out of sleep stage progression and cause us to not progress normally in each sleep stage so we end up with not enough time spent in each sleep stage for the restorative powers of sleep to work their magic.

I have probably 20 to 30 spontaneous arousals and remember maybe a half a dozen of them. Mine are related to back pain and not the airway. I wake up and have to change position to relieve the pain. I have done the zoom in counting of arousal irregular breathing instances. This is my "normal" unfortunately. The nights that the pain is lessened I will have less spontaneous arousals and usually feel better during the day.

Here below is a good example of spontaneous arousals and false positive flagging. This guy doesn't have OSA at all despite all the apnea flags. Those flags occurred while awake or semi awake from an arousal unrelated to the airway. We know this because he had an in lab sleep study and his diagnostic AHI was 0.8. He doesn't have sleep apnea but he does have crappy sleep quality from something not related to the airway itself.
I think you can easily distinguish between asleep breathing and awake/arousal breathing.

Hi again Pugsy,

Thanks very much for taking the time to respond. The amount of time you have dedicated over the years to helping people is incredible and it is sincerely appreciated. I have looked at the Lanky Lefty video on reading the Flow charts and then I have analysed my own charts. I have copied in some small snippets of how the arousals appear on the FLOW rate chart. There are about 20 of these throughout the night whereby the flow rate seems to almost flatline. In addition to that, I also get other areas on the chart where the line is quite erratic / squiggly which I assume is another form of arousal. Do these lines I have attached shed any further light to you? Looks like there are plenty of those that aren't flagged as events but are sufficient to cause restricted breathing.