Help with optimising therapy

[voluhar]

Hello all!

I need some help with tweaking my therapy. 
Although my AHI is under 5 I have lots of everything - OSA, CA, H, RERA.

Can somebody take a look at my data and suggest what to do?

I'm using Philips Respironics Dreamstation 1, the new one made after recall, without the foam.
Since I'm a mouth breather I use PR Dreamwear FFM.

Eventhough my AHI is under 5 I feel generally exhausted in the morning and lately I've been taking afternoon naps after work although my work is not really physically demanding, it's an office work.

Thank you in advance and feel free to ask me any additional questions!

[voluhar]

Anyone?
This is my 2nd thread on this forum with no replies. What's the purpose of being a member and asking a question if noone wants to reply?

[ejbpesca]

Hello. I am not an expert.  

I noticed your pressure moves to the max of 12 cm and stays there quite a long time.  Have you considered raising the maximum pressure?

[sauerkraut]

voluhar;
I am not an expert either .. I use a Resmed apap .. 
If it were Me I would raise the min. pressure to 8 cmh2o ..
Raise Max pressure to 15 cmh2o ..
Raise flex to 2 if this helps maybe try 3 ..
Try this advice one adjustment at a time starting with Max Pressure ..
Try 1 or 2 nights then add the Min and Flex ..
Post another chart after You have tried each adjustment ..

I hope this helps You !!
Hopefully someone with much more knowledge then I will be along shortly
to help !!

Best of Luck sauerkraut ..

[Narcil]

Also new here but i agree with the others, your machine wants to give you more pressure. you're above 11.5cm for over half the night (median value) and your max is 12 and it looks almost maxed for the all night. And you have flow limitations (meaning your airway is partially obstructed) and snore so more pressure should help i think. 8-15 worked well to start with but i really have no idea how Philips machine work..

The FL events seem quite clustered (at 4am most notably) is it possible you kink your airway when you sleep or sleep on your back? known as positional apnea which cannot be treated by raising pressure, need to change your sleeping position and/or use a cervical collar.

[Sleeprider]

Your therapy is capturing most of the obstructive events, but you are beset with flow limitations and the consequential RERA, Snores, and hypopnea. This is what a chart looks like when an individual has UARS (upper airway resistance syndrome) but is not using a bilevel therapy with pressure support or EPR. If you zoom into your respiratory flow rate chart, you will see most breaths have flattened or downward sloping peaks, rather than smooth rounded peaks. This is because as you inhale your airway becomes increasingly resistant to the flow. So as you increase inspiratory effort to breathe, your airway resists any increase. This causes inspiration to be longer than expiration and the respiratory effort is extremely fatiguing. You never get a good night of sleep.

The ideal solution is a bilevel pressure device. The Philips CPAP simply does not offer a good solution other than higher pressure, but you need pressure support or the mechanical assistance of a higher inspiratory pressure, and lower expiratory pressure. There are many good machines that can provide this with Resmed Aircurve/Lumis and Lowenstein Prisma Auto S/ST. With the Philips, you must start at a higher pressure to open your airway more. I would suggest increasing your minimum pressure to 8.0 and maximum pressure to 14.0. Increase Flex level to 2.

[voluhar]

Sleeprider, thanks a lot!
Main culprit for my UARS, which I always thought I had, is most likely severe septum deviation. So far had two canceled surgeries, one in 2022 due to catching Covid 3 days before surgery and one canceled last year because surgeon was not available. Right now currently waiting for new appointment.
I'll set the machine as per your recommendation and see how it goes.