Advice to fine tune CPAP

[SpicyPigeonBird]

Hi everyone, 

I've been using my Resmed AirSense 10 for Her for several years already, after a sleep study showed the following results: AI 0.4, AHI 7.6, AHI+RERA 29.7

I don't really get follow up from the device provider anymore and the sleep specialist I saw basically dismissed me after my first clinical reports from the machine showed my apnea was under control. 

In the meantime I saw an ENT because I wanted to get rid of the CPAP, turns out there's a good chance I could get off the CPAP (for a while, at least) if getting my deviated septum fixed, and I just recently got the surgery about a month ago. 

Now, I decided to check my CPAP data more in detail with OSCAR and there's almost no difference from last year and the past week in terms of events. The average for the past year is this: 


AHI: 0.73
OA: 0.11
H: 0.02
CA:0.6
RERA:0.01

I have the pressure set at Min. 4.0 and Max 8.0, using nasal cradle mask. Average pressure 5.8.

So, my main questions, is there anything I can do to reduce the CA? It's the bulk of my current AHI. Would it be worthwhile to get another sleep study done to see if the RERAs are lower without the CPAP, since I can't really see an improvement on the data?

[Narcil]

0.6/h is already pretty good, you could experiment to try and reduce it but it's never consistently going to be 0, at least on APAP.

Post some daily oscar charts so we can see all your currents settings maybe someone will suggest something. wiki on how to present charts here.

[BoxcarPete]

Give it a little more time, my ENT told me to wait three months post-op to follow up with a sleep study. There is lingering inflammation for a little while, and then your body needs to re-train its normal breathing patterns with the improved nasal breathing. I am one of the lucky ones, my PSG came back squeaky clean so I am off-PAP for the time being.

I also hadn't noticed all that much different in my OSCAR charts. Certainly some things had improved, but not dramatically.

[SpicyPigeonBird]

So here's a few daily charts, please let me know if it's more helpful to have specific sections zoomed in and I'll post those. 

Also that's very interesting BoxcarPete, I'm glad you got such a great outcome from the surgery!    I do see some gradual improvements still, so it would make sense to wait another couple months before I do another PSG.

[OpalRose]

So, my main questions, is there anything I can do to reduce the CA? It's the bulk of my current AHI. Would it be worthwhile to get another sleep study done to see if the RERAs are lower without the CPAP, since I can't really see an improvement on the data?

I'm not sure how the system works in your country, but here in the U.S., you probably wouldn't be recommended for a sleep study with such low numbers.  Of course, sleep quality is important, but that doesn't seem to be an issue?  

The CA's you are showing are miniscule... nothing to worry about.  Most of us see a few now and then.  What causes them to happen could be a number of things, like simply moving around in your sleep and holding your breath.  

Your charts don't show a necessity to change pressures, but if it were me, I would use 6cm as my minimum pressure, if anything for comfort and not to feel air starved.

Just from what I've seen, your Cpap therapy looks great. There's not much to fine tune, unless you are not sleeping well.

[BoxcarPete]

Agreed that those charts look really good. I never was able to get good results myself at such low pressure; it was worse than mask off.

I disagree though about not getting a sleep study. Ask for an in-lab study. Be persistent and polite, but do not take no for an answer. It's the only way to know for sure where you stand in the current state of things, and if you can go off-PAP it will make things a whole lot easier. Your previous diagnosis and surgical intervention should be enough to get a study done, as the system will probably be pleased to get you off their case load for a while. Just don't put it all completely behind you; things may end up getting worse with age and you'll at least know where to start looking if you start having problems again. I know I will need to because this was my second surgery for sleep apnea, 25 years after my tonsils got taken out as a kid.

[SpicyPigeonBird]

I am in fact not sleeping well with the CPAP, but it might be more to do with just having the headgear and not the actual settings of the machine, since I'm a very light sleeper. I get good results for AHI with the machine, but my deep sleep readings on my fitbit are abysmal. Granted, it's not exactly the gold standard of sleep analysis, but it still gives me a bit of an indication. 

I'm not as tired as I was pre CPAP and pre surgery, for sure, but I'm also nowhere near a normal person in terms of feeling the effects of sleep debt.