2 month review. Should I be satisfied?

[nathanoj]

Hi All

After 2 months on CPAP, I'm mostly scoring AHI < 5. Should I be satisfied with this or is there tweaking I could do to further improve?

Leaks are still an issue.

Summary Data:


And some recent examples: Some greater than 5, cos it does happen.

[ajack]

If it was my chart, I would try min 9, I think that will clear some events. See how that goes, it may need a tad more.
The max increased a bit to 15, to give some more head room.

[Gideon]

Being under 5 you are considered treated.  Many of us are not satisfied with that.  At this stage we typically recommend only small changes and try them for several days. That said I have a Question for you.

How do you feel?  Are you comfortable?

Analysis of your charts.

Roughly about half of your AHI is Clear Airway/Central Apnea.  Not serious (you are under 5 AHI).  This complicates things.  
Generally with CPAP we try to lower pressure to reduce Clear Airway events.  For Obstructive events we raise pressure.   A bit of a conflict.
Frequently we see that EPR increases CA events.   It is not uncommon to end up at a fixed pressure when we see CA events, but not going there now.

Your AHI is good which also means your CA index is good.  It does mean that you do not want to make large changes for now.

I would recommend only small single changes so we know what the change does to your therapy,  to start just turn EPR off.


Let us know what you decide to do.


Fred

[Sleeprider]

Looks excellent for someone with a tendency to complex apnea. About the only thing you have left is turning off EPR and finding a pressure range that resolves the obstructive an hypopnea events. Pretty decent results in my opinion considering the complexity of your events.

[nathanoj]

Thanks All

I'll switch off EPR first and see how that goes.

Interesting that I have those CA events ( I had noticed the regular reporting of CA:OA ~ 50:50) when my original sleep test (images below) reported zero CA's and "severe obstructive sleep apnoea". My MD simply read from this report and echoed the recommendation that I try CPAP. I guess they can't be experts in all fields.

I feel fine on waking, but I never felt terrible before I was diagnosed. CPAP hasn't been the revelationary, road-to-Damascus, "how did I ever function without this?" experience that some have reported (including a good friend of ours).

[ajack]

They are more than likely pressure induced CA, the body balancing out the o2 and co2. Most people resolve them within a few months. There are only a few and I wouldn't worry at this stage. You have reduced from about 3 an hour, down to 2 so far. Turning off the EPR will probably reduce them some more. I think you still need to raise your pressure a bit.

[Gideon]

FYI your sleep study (pg 2) shows a mixed apnea index of 1.2.  This is the Complex apnea that SR called out and the 50/50 mix that i noted.

Low enough to not be a worry, but something yo keep an eye on.  And no reason not to try and tweak your numbers down.

Fred

[ajack]

Yes, it seems like complex sleep apnea, I'm sorry if I came across as disagreeing.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704546/
Complex sleep apnea syndrome (CompSAS) is a distinct form of sleep-disordered breathing characterized as central sleep apnea (CSA), and presents in obstructive sleep apnea (OSA) patients during initial treatment with a continuous positive airway pressure (CPAP) device....In most CompSAS cases, CSA events during initial CPAP titration are transient and they may disappear after continued CPAP use for 4~8 weeks or even longer.

[nathanoj]

Thanks for your input Gents. I've been quiet, waiting a week to see the affect of turning off EPR.

[heov]

I know the consensus is to make small tweaks and take a lot of time. But what I found successful when I started out was making major tweaks and monitoring those results. Now I think this was easier to do when you are brand new to cpap (at least for me) because I would wake up 4-6 times during the night getting used to the machine for the first few weeks... and that would give me an opportunity to look at my machine and see "did that improve or hurt my result?" and then I would adjust accordingly. I was going all over the place but then I quickly found out what works. FYI, my AHI is always below 1.0 and sometimes 0.0. I had numbers like yours at the beginning and found them unacceptable.

Once I got to around AHI of 1.0 I then started to tweak for comfort and improving results further. minor tweaks which really were more for comfort than anything else.

Looking at your data I would increase the min and max significantly.. but that is just me. Your min has no business being around 7. I would raise it to 9 and if that works better a quick sample then jump to 10. Your max needs to be much higher too. Actually, if it was me, I probably would jump to 10 and raise my max to 15.

Now you have leaks you need to deal with too... and I think part of the problem is your low min.. you go to sleep with a 7 which is way too low and you have no leaks and the machine spends most of its time (95%) above 11.. and your poor machine is capped at 11.6. Go to 10-11, fix your leaks while you are awake, and give the machine some room to go higher.

If you find it hard to sleep with min of 11 and no EPR then turn EPR on for now. I think your pressure numbers are way off.. or at least why you cap the max to where you do is the biggest mistake.