New CPAP user, OSCAR data - Advice needed

[dodenboombie]

I Have been dealing with brain fog, cognitive issues, and fatigue for probably 8+ years, but has gotten noticeably worse in the last 2 years.  I eat a mostly organic whole food diet, no drugs, alcohol, caffeine, or nicotine.  I am 30 years old, male, 5'8" 150 lbs, and I exercise regularly.  I sleep 7-8 hrs every night, generally fall asleep easily, and normally sleep through the night (or so I thought). However, I very rarely have dreams.  I wake up exhausted every day. I am light headed, borderline dizzy frequently.    

I took a Lofta home sleep test (Watchpat) and was diagnosed with OSA with an AHI of 10.3 and RDI of 20.6.  I also took a home sleep study through Kaiser which was a NOX sleep device which had a pulse ox, belts, and tubes in the nose.  That one came back with an AHI of 5.1, and they prescribed a CPAP.  I did not get a titration study. 

I have been using the CPAP for 6 weeks now, and my symptoms have not improved, and I am still not dreaming.  I am still waking up brain fogged and exhausted.  I tolerate the mask well and am usually asleep within 10 minutes of lying down.  

I use Airsense 11 autoset, Mirage FX nasal mask.  Ramp off, Humidity 5.  I started out at a pressure range of 4-20 (how they sent the machine), then lowered max pressure to try to eliminate all of the CA events I was having.  I have tried EPR on, EPR off, fixed pressure CPAP mode with pressures of 7, 8, 9.  Highest AHI I've seen was 4.3 at 9cm pressure EPR off. Last night I turned auto set back on at a pressure range of 8-12 with EPR set to 3.  I am unsure of what settings to try next.  I have worn a soft cervical collar for a handful of nights to prevent chin tucking which had no effect. 
 
The thing is that since starting CPAP therapy I have had a couple random days where I wake up totally refreshed, mental clarity is improved, and my energy is unreal, way higher levels of energy than I have ever had in the last few years.  On the nights preceding these good days, I have alot of dreams which indicates my sleep quality is better.  The next day I'm back to being a zombie.   

I have attached some OSCAR charts.  I have been tracking heart rate and SPO2 with a wellue O2 ring.  In the beginning I was regularly desating to 86 every night, lowest being 83. In the recent weeks I  usually stay in the low 90's which seems to be improving.  

I am still exhausted every day and I am not dreaming.  
Any advice is much appreciated.  Thanks in advance!

[PeaceLoveAndPizza]

It could be a number of things, but let’s try titrating a bit first before going down a rabbit hole.

Mode APAP
Min pressure 8
Max pressure 15
EPR 2 full-time
No ramp

That will tell us two things. First, is EPR causing the CA’s, and second, is the pressure the correct range for you. Use that for a few nights and post the result.

It is possible some of the CA’s are treatment emergent and will resolve over time, but I like to make sure we are in the right range for your pressure and pressure support before trying other things.

[dodenboombie]

Thanks for your reply.  Last night I had it on APAP, 8-12, EPR 3, no ramp.  And I feel pretty bad today.  AHI was 3.73 with lots of central apneas.  I will try moving the max to 15 and epr to 2 if you think I should.  


Also, I do not know how I forgot to put this in the original post (thanks brain fog) but I consistently had lower AHI when I was at a lower range of 5-7 on apap mode with epr off.  I had 2 days below 1 AHI on those settings, and I felt A LOT better on those days.  But I also saw AHI of 2 to 2.9 with bad daytime symptoms on those same settings.  

Not sure How relevant this is, but I am seeing sleep wake junk as well as movement spikes and heart rate spikes preceding the vast majority of the CA events.  I assume this means I am having arousals, and the CA events are happening as I am falling back asleep.  I thought I might be having the arousals due to respiratory effort, that is why I tried moving to higher pressures. But AHI seems to be climbing and I feel worse as I increase the pressure.