No improvement despite low AHI

Hello,

New to the forum. Apologies if any mistakes.

I am 25 M from texas, been using CPAP for three months. I am still getting daytime sleepiness, fatigue, headache. Mainly i am unable to think clearly which is affecting me as a student. Pleas help me out.

Stack:
Resmed 10 Autoset mode
Pressure 10-12
EPR 3
Cervical collar
Intake breathing
Flonase and neilmed
Mouthtape
Rio nasal pillow mask

My ent/sleep doctor told that my major obstruction is in nose /tongue. Asked me reduce weight since i have high neck circumference. Have been put on allergy shots to relieve nasal congestion. He set the pressure on 7 initially. Doctor is telling me that treatment is working since ahi is less than one .My initial ahi was 27 without cpap.

I consulted with CPAPfriend who instructed me to increase my pressure from 7 to 10-12 gradually. He looked over my oscar graphs and asked to increase because he told there is limitation in my flow rate as seen in irregular curves at the top. But even after increasing i don't see any changes. My ahi is low mostly less than 1. What steps should i take next?

Welcome! By the numbers, you're doing well, but clearly you're not yet getting restful sleep.

Your friend is right to say that there are some deviations in your flow rate from a nice rounded inhalation trace. What is less clear to me is whether increasing your pressure is of any help. If a primary location of flow limitation is in your nose, then increased pressure won't help, because the nose is too rigid for PAP pressure to stent the nasal passage.

If you're as physically comfortable with your current settings as you were with your original settings, then just keep them. If you were more comfortable with earlier settings, try reverting to them.

You might talk with your doctor about additional medications to help you with nasal symptoms of allergies. Two drugs my allergist prescribed were Singulair (pill) and Azelastine (spray, used along with Flonase). I've now completed my allergy shots, and I'm just using Azelastine. So you may just need medications to help you during the allergy-shot years.

I notice that your chart shows less than 7 hours of machine usage. Did you do some additional sleeping without your mask? Or was that your entire night? Many people need well over 7 hours of actual sleep to feel properly rested. Can you work on your schedule so you can leave 8+ hours between going to bed and getting up in the a.m.? That leaves time for falling asleep and periods of wakefulness during the night.

You might consider signing up for a free account at SleepHQ. It's a different way to display data from your machine, and one advantage of it is that if you share a link to your charts, people can zoom in and scroll through themselves, with no need for you to post zoomed-in Oscar charts.

focus more on the 'flow limit' chart, those period with clustered flow limit (e.g., 4:45-4:52). Those flow limitations could be short in duration to be counted as AHI events but could cause arousals/microarousals, and disrupt your deep sleep quality.

what might help:
1. increase pressure gradually as your friend suggested
2. try to maintain side sleep posture as much as possible