MildOSAHighRera's therapy tuning thread

[Crimson Nape]

MildOSAHighRera - Since your 2 threads were related to your therapy, I have merged them. This provides the reader a history of your past settings and results. Having the ability to see past attempts and their results will help to form better recommendations. Please use this thread for all your therapy related posts. I have maintained your latest thread title to be more inclusive of the subject.
- Red

[MildOSAHighRera]

    Hi All,

I’ve been on a CPAP for about 10 months now for mild apnea/UARS, and have done a little tuning of my own therapy since then, and am looking for guidance for where to go from here. For some background, here’s my initial sleep study results:

Full sleep study diagnosis:
INTERPRETATION:
The patient had a sleep efficiency of 74.5% and a normal sleep onset time of 21.0 minutes. REM sleep latency, 205.5
minutes, was prolonged.
The overall apnea/hypopnea index (AHI) was 5.6 per hour; 1 apnea, 29 hypopneas, 54 RERAs were present. The AHI
during REM sleep was 11.7 per hour. The overall respiratory disturbance index (RDI) was 15.5 per hour. RDI during
REM sleep was 31.3 per hour. The longest duration of the respiratory event was 54.0 seconds, and the average
duration was 19.3 seconds. The baseline oxygen saturation was 94%; the minimum during the study was 91%.
Tracheal microphone monitoring revealed frequent mild snoring.
The Central Apnea index was 0.2/hour. The patient’s oxygen levels were below 88% for 0.0 minutes. Frequent
periodic leg movements during sleep were absent. Prolonged cardiac rhythm monitoring was unremarkable.

I’ve linked an old forum post of mine with with the entire sleep: https://www.apneaboard.com/forums/Thread...OSCAR-Data 

At the time, I was initially prescribed to run my Resmed Airsense 10 in APAP mode with range 5-15. After a month or two of that, my docto prescribed me a fixed pressure of 9 on EPR 1-2. Based on what I read here for UARS, I immediately upped the EPR to 3, and ran on pressure 9 EPR 3 for a while. This entire time, I was still waking up 1-3 times a night and overall wasn’t feeling greatly improved. I started dialing the pressure up further, first to 10 and then to 11, and at each jump I felt that I personally felt slightly better. Overall, I feel like I’m doing OK now, however I still wake up 1-3 times a night (though usually closer to 1). However, I can’t really see why in the data that might be the case, especially going from 10 - 11. My AHI in OSCAR was always pretty low (0.5 - 2) and going from 10 to 11 didn’t even have a significant difference in FL95 or FL99.5. I’m wondering if you all see anything in this data that would indicate why the higher pressure is helping me?

Finally, I’m wondering where to go from here? Should I continue increasing the pressure (as long as I’m not getting centrals) and go on feel alone? Should I just call it good despite waking up a few times a night still and still not feeling 100% a few days a week? Is there something in my data that can say why a pressure of 11 is working better for me than a pressure of 10? I’m hesitant to keep dialing pressure based entirely on the feel without data to back it up as I keep deviating further and further away from my initial prescription.

I've attached a night from a pressure of 10 and a pressure of 11 to see if you all can identify any differences in the data:

[Phaleronic]

Hello MildOSAHighRera,

I can't tell from that last chart, but I know that I slept better on my airsense 10 once I turned EPR off. I'd try that as the next move to help you sleep more deeply, EPR really makes things worse (less apnea control and more arousals).

That is also a clean chart so leave it at 10cm of fixed pressure and disable EPR for a few nights please and see how you feel.

[THEVGE]

Your story shouts UARS to me, and this means you probably need to increase your IPAP pressure. Contrary to the advice of Phaleronic I would advise you to use full EPR 3 all night. If you indeed have UARS, EPR will be required and helpful, and you will need higher EPAP/IPAP than you would say based on AHI.

Chances are you improve your therapy this way, but CPAP will probably not do the job for you if you have UARS. You likely will need bi-level. But playing with EPR is the first step.

Edit: I think you already have EPR 3 right at IPAP 11? Please show a zoom in of a few minutes of your flow rate profile. I suspect it is not optimal and it will help us decide if pressure needs to go up.

[MildOSAHighRera]

I do indeed have EPR at 3 and IPAP at 11, and did for both 10 and 11 pressures. Here is a zoom in of a flow limitation cluster from OSCAR from a recent night if that helps:

[THEVGE]

Seems to me you are still struggling for air, I see flow limitation and an expiration time almost the same as inspiration (expiration should be longer). I had the same on CPAP. With bi-level I improved on both but still struggling. Still have a strong UARS vibe with what you show.

[MildOSAHighRera]

What indicates expiration time equal to inspiration time on these charts? Is this something I could look to optimize by increasing pressure on my current machine or do you all believe bilevel is the only way?

[THEVGE]

You can see both timings on the left at statistics. On my CPAP my inspiration was basically equal to expiration, which indicates hyperventilation. I do not know the exact numbers and surely it is very dependent from person to person, but on my bi-level expiration is almost 2 x inspiration which is what is to be expected and it also feels natural.

I think (just my opinion) struggling for air creates hyperventilation which is seen, as in your charts, where expiration is close to inspiration. I do not know if this can be improved on CPAP, but you can now at least take it into accounts during your therapy optimisations.