Lower AHI but feel awful

This is my first time posting so please let me know if I've done anything incorrectly.

EQUIPMENT
AirSense 10 Autoset (6 years old)
Philips Respironics DreamWear Nasal Pillows

JANUARY 2025 SLEEP STUDY:
https://imgur.com/a/IhYKkOY

BACKGROUND
I first got diagnosed with sleep apnea back in 2019 with a 24 AHI. I tried a CPAP but it just made things worse even though the AHI was lower. I gave it about 6 months and then gave up. I tried different masks, changing pressure, etc. I even posted on here.

I'm back at it again. Just got a new sleep study which still shows moderate sleep apnea. I have been sleeping with the CPAP for about 3 weeks or so and have the same results. My AHI will hit 4 - 6 most nights according to the Airsense app, which I know isn't perfect, but I'll wake up feeling worse than I did before using CPAP.

Thanks so much for your help everyone.

Hello,

Other more experienced people on here will give you more detailed advice but you will want to get the leak rate under control. There are various ways such as cervical collars, chin straps and mouth tape. For me I need both a chin strap and mouth tape. If you have additional graphs that can expand on your night to night they will be helpful as the one you provided is only for 7 minutes.

I found it interesting that you have the same machine and pressure settings as I do. What jumps out on your OSCAR report is the very high number of Large Leaks and only CA apneas are being registered. I am not an expert but have many years of experience with APAP.

Have you done the Run Mask Fit? It helps to 1. Run it often. 2. Move around a bit while it is running. 3. Adjust the headgear while it's running. 4. Lie down while mask fit is running and get in sleep position. If you can do all that and keep a Green Smily on the AS10 screen you have a good fit. I have to adjust my headgear often to keep a seal.

If your mask is sealing well the leak source can be an open mouth during sleep. Some use chin straps, tape over the mouth, and/or a soft cervical collar to keep their mouth from opening during sleep. None of those work for me. I use a hybrid mask that covers the mouth. Evora FF and ResMed F40 are examples. (I prefer the F40)

It will be very interesting to see an opinion on how you have so many clear airway apneas and no others. I think I have it correct that the air pressure of CPAP therapy does not address CAs and can even cause them which is called treatment emergent central apneas.

ejbpesca wrote: ↑

Mon Mar 03, 2025 1:04 pm

I found it interesting that you have the same machine and pressure settings as I do. What jumps out on your OSCAR report is the very high number of Large Leaks and only CA apneas are being registered. I am not an expert but have many years of experience with APAP.

Have you done the Run Mask Fit? It helps to 1. Run it often. 2. Move around a bit while it is running. 3. Adjust the headgear while it's running. 4. Lie down while mask fit is running and get in sleep position. If you can do all that and keep a Green Smily on the AS10 screen you have a good fit. I have to adjust my headgear often to keep a seal.

If your mask is sealing well the leak source can be an open mouth during sleep. Some use chin straps, tape over the mouth, and/or a soft cervical collar to keep their mouth from opening during sleep. None of those work for me. I use a hybrid mask that covers the mouth. Evora FF and ResMed F40 are examples. (I prefer the F40)

It will be very interesting to see an opinion on how you have so many clear airway apneas and no others. I think I have it correct that the air pressure of CPAP therapy does not address CAs and can even cause them which is called treatment emergent central apneas.

Thanks for your response. If it is just registering CAs do you think that means I dont have obstructive sleep apnea or something might be wrong with the data?

tstiefler wrote: ↑

Tue Mar 04, 2025 9:25 pm

If it is just registering CAs do you think that means I dont have obstructive sleep apnea or something might be wrong with the data?

No,,,,, it is possible that you aren't seeing any obstructive apneas because the pressure used is preventing them from ever forming. Now if you didn't have any OAs and weren't using cpap pressures at all....that might mean no OSA.

One night of a 35% large leak rate and no obstructive apneas only tells us the leak rate was terrible and the therapy useless. And that's all.

The overview shows obstructive events, on practically every night.

First step: you have to get the leak under control, consistently.

Here are a few more nights along with some experimentation. I assume the biggest issue is leaks and therefore finding the right mask. One thing I've noticed is the nasal pillows probably aren't the right fit even though I'm really taping my mouth shut.

MARCH 2nd
- F40 (full face mask)
- set to nasal pillows
- EPR on
- I think the mask isn't the right fit so I ordered a large mask replacement as I'm currently using a medium MARCH 3rd
- Nasal pillows
- set to nasal pillows
- EPR on MARCH 4th
-Nasal pillows
-set to full face
-EPR turned off

Please omit the calendar on top left. It isn't needed but some information below it (now hidden) might be useful.
Please include the flow limitation graph....it is useful and needed.

If you are taping your mouth shut and the tape isn't coming off then those leaks are mask movement leaks....from sizing or fitting or both.

No problem.

is anybody seeing this?

tstiefler wrote: ↑

Wed Mar 12, 2025 10:30 am

is anybody seeing this?

Your data is showing up, so yes we can see it.

You started the thread with:

tstiefler wrote: ↑

Thu Feb 27, 2025 6:23 pm

BACKGROUND
I first got diagnosed with sleep apnea back in 2019 with a 24 AHI. I tried a CPAP but it just made things worse even though the AHI was lower. I gave it about 6 months and then gave up. I tried different masks, changing pressure, etc. I even posted on here.

I'm back at it again. Just got a new sleep study which still shows moderate sleep apnea. I have been sleeping with the CPAP for about 3 weeks or so and have the same results. My AHI will hit 4 - 6 most nights according to the Airsense app, which I know isn't perfect, but I'll wake up feeling worse than I did before using CPAP.

Thanks so much for your help everyone.

What I'm seeing in the data you posted is this:

1) Some confusion (on my part) about your normal sleep period. It looks like you tend to go to bed very late (often after 3:00 or 4:00 am) and that you also then sleep rather late---often until around noon or later. So it begs the question: Are you a night owl? Do you work an evening shift? And is the sleep schedule a problem for your life style?


2) Leaks seem to be a problem. And there are two good reasons for getting them under control:

A) Large leaks can make it more difficult for the machine to maintain enough pressure to keep the airway propped open; hence when the leaks are high, it's possible for more obstructive events to occur.

B) Leaks can trigger restless sleep. And restless sleep leads to waking up not feeling at your best. Restless sleep can also lead to higher AHIs being reported by the machine since restless sleep can lead to a vicious cycle of "sleep-wake-junk" (SWJ) breathing where false events get recorded as you are bouncing back and forth between very light sleep and wake. Often these false events are scored as centrals, and they represent sleep transitional central apneas that would not be scored on an in-lab sleep test because they occur as you are transitioning to sleep: Part of that transition is handing off control of the respiration to the autonomous nervous system and resetting the CO2 trigger for "inhale now" a bit higher. The result is a normal temporary pause in breathing. This wouldn't normally be a problem, but if you get "stuck" in a prolonged SWJ period, you're not getting high quality sleep. The problem is not the higher than expected AHI; rather the problem is just that you're not getting past the transition to real sleep---you're stuck in a nether world between real sleep and real wake, and that's not "good enough" for the body to feel the benefits of high quality sleep.


3) Lots of your events are scored during the last hour you are in bed. And that brings up (yet again) the question of whether you are actually sleeping or just dozing. If you are spending a lot of time in bed just dozing while hoping to fall back to sleep to get some more decent (real) sleep, that strategy of staying in bed while not really sleeping might need to be looked at more carefully.


In other words, looking at your data, I see things that raise additional questions rather than things that suggest easy tweaks to fix a particular problem.

So ...

Some questions:

1) Just how restless is your sleep? (Sleep fragmentation was mentioned on your sleep test, but the assumption would be a significant fraction of the fragmentation would be caused by the arousals triggered by the obstructive apneas and hypopneas when sleeping without a CPAP.)

2) Any history of insomnia? Particularly sleep maintenance insomnia? If so, what (if anything) have you done in the past to try to keep it under control?

3) What's your sleep hygiene look like? How much caffeine do you consume? How much alcohol? Do you use marijuana in any form on a regular basis? If so, how much? How much time between supper and bedtime? Do you spend a lot of time lying in bed watching TV or playing with your cell phone or a laptop computer?

4) Any other medical problems? If so, do you take any medication on a regular basis? If so, do any of the medications have known side effects that might make it more difficult to get and stay asleep?

5) Are you a shift worker? Or is there some other reason that you are going to be so late and sleeping so late? If your very late sleep schedule is an accepted part of your lifestyle, what does your sleep environment look like after the sun comes up? In other words, is your bedroom reasonably dark even though most of your sleep period is after sunrise and before noon? A lot of light coming in through the windows might be triggering some of the restlessness we see in your flow rate data. Is your bedroom reasonably quiet when you are trying to sleep? Or are you living with a house full of people on a more typical "daytime schedule" who make a lot of noise when you're trying to sleep? (This includes young children and pets if you've got them.)

Thank you for your responses. I recently switched (last two nights) to a full face mask. Are things looking better? Answers below.
https://sleephq.com/public/teams/share_ ... fc3a337a68

Yes, I am a night owl, yes. And my remote job allows for flexible hours.

Sleep trackers I have used in the past report I rarely get a good nights sleep. But there is no understanding of why or what to fix.


1) Just how restless is your sleep? (Sleep fragmentation was mentioned on your sleep test, but the assumption would be a significant fraction of the fragmentation would be caused by the arousals triggered by the obstructive apneas and hypopneas when sleeping without a CPAP.)

Consciously I wake up one or two times a night while wearing the mask. I rarely "wake up" when I'm not.

2) Any history of insomnia? Particularly sleep maintenance insomnia? If so, what (if anything) have you done in the past to try to keep it under control?

No history of this.

3) What's your sleep hygiene look like? How much caffeine do you consume? How much alcohol? Do you use marijuana in any form on a regular basis? If so, how much? How much time between supper and bedtime? Do you spend a lot of time lying in bed watching TV or playing with your cell phone or a laptop computer?

don't drink or do drugs of any kind. I consume caffeine no later than 4pm. But I do eat snacks right before bed and sometimes watch a show right before bed. But I usually read for at least 30 min before I fall asleep.

4) Any other medical problems? If so, do you take any medication on a regular basis? If so, do any of the medications have known side effects that might make it more difficult to get and stay asleep?

Just antidepressants which do not impact sleep.

5) Are you a shift worker? Or is there some other reason that you are going to be so late and sleeping so late? If your very late sleep schedule is an accepted part of your lifestyle, what does your sleep environment look like after the sun comes up? In other words, is your bedroom reasonably dark even though most of your sleep period is after sunrise and before noon? A lot of light coming in through the windows might be triggering some of the restlessness we see in your flow rate data. Is your bedroom reasonably quiet when you are trying to sleep? Or are you living with a house full of people on a more typical "daytime schedule" who make a lot of noise when you're trying to sleep? (This includes young children and pets if you've got them.)

Bedroom is dark (sleep mask). I live alone.

tstiefler wrote: ↑

Fri Mar 14, 2025 11:54 am

Just antidepressants which do not impact sleep.

What meds do you take for depression or anxiety? Name, strength, dose and how long have you been taking it/them?

Pugsy wrote: ↑

Fri Mar 14, 2025 12:16 pm

tstiefler wrote: ↑

Fri Mar 14, 2025 11:54 am

Just antidepressants which do not impact sleep.

What meds do you take for depression or anxiety? Name, strength, dose and how long have you been taking it/them?

I've been taking them for 6 years.

Lamictal 200mg
Wellbutrin 200mg
Celexa 40mg