[Pressure] Help Needed Dialing in CPAP Setting

[wesleytrents]

Hi Everyone,

I'm a new CPAP user and struggling to find the right settings. My AHI is usually around 5 or below, but I’m still waking up frequently during the night and not feeling refreshed in the morning.

I’ve been experimenting with different settings but can’t seem to find the balance between controlling hypopneas and minimizing clear airway apneas. Here's what I’ve tried so far:

• Initial Settings: Pressure 5-10 with EPR @1.
  
  
• Current Settings: Pressure 8.6-10 with EPR @2. These settings are controlling my hypopneas well, but they seem to increase my clear airway apneas.
  
  
• Experiment: Lowering the minimum pressure to 7 and turning off EPR, but centrals were still relatively high.
  
  

As I’m new to this, I’d really appreciate any advice or tips to help me fine-tune my settings.

Thank you!

[Deborah K.]

Did you have a lot of CAs in your sleep study?  If you don't know, post a copy so we can help you figure it out.  If you don't have a copy ask your doctor's office for one.  By US law they have to provide it if you ask.

If there were not a lot of CAs in your sleep study then yours are treatment-emergent and will lessen as time passes. For now, just ignore them.

[wesleytrents]

Hey Deborah, 

Thanks for getting back to me. I've had 3 at home studies done through 2 different providers, but no in lab sleep study (just a titration study). I should also probably mention I live at altitude (6800 ft). My watch studies were all done at home, but my titration study was done at lower elevation (4500 ft)

Sleep Study #1


[*]Severity: Severe obstructive sleep apnea.
[*]Key Findings:

• PAT Apnea Hypopnea Index (pAHI): 55.8/hour.
  
• Central apnea events: 14.1/hour (notable for suggesting central sleep apnea components).
  
• Oxygen saturation nadir: 83%.
  
• High average heart rate disturbances.
  

[*]

Sleep Study #2 (Different provider)

• Severity: Moderate obstructive sleep apnea (sAHI3% = 17).
  
• Central Apnea Events: None explicitly noted (but I'm fairly sure I remember them telling me they didn't register any CA).
  
• Key Findings:
  • Moderate sleep apnea with mild oxygen desaturations.
    
  • High sleep fragmentation (33%).
    
  • Reduced sleep efficiency (80%) despite adequate duration.
    

[*]
Sleep Study #3 (Different provider)

• Severity: Moderate obstructive sleep apnea (sAHI3% = 23).
  
• Central Apnea Events: None explicitly noted (but I'm fairly sure I remember them telling me they didn't register any CA).
  
• Key Findings:
  • More pronounced apnea severity than October 31's study (sAHI3% = 23 vs. 17).
    
  • High sleep fragmentation (39%) and periodicity (7%).
    
  • Overly long sleep duration (11h 29m), potentially reflecting compensatory sleep or inefficiency.
    
  
  
  

[*]
Hope that helps. Thanks again for taking a look!

[SarcasticDave94]

Study 1 did have Central Apnea listed at 14.1 per hour. Total duration not listed.

I'm wondering if the consistently inconsistent attribute with Central Apnea plays a part here. Secondly, your higher elevation may be contributing to these as well.

You might need to request your doctor issue a new order for a ResMed AirCurve 10 or 11 VAuto bilevel. Complain about the therapy on the CPAP being uncomfortable.

You'll want to progress to VAuto so you can use the Trigger High or Very High setting, to avoid CA that you can't now.

A doctor script change should be acceptable through insurance to pay their part.

You need to know that even if you get the VAuto, you may also fail it, and need to swap up further into the ResMed AirCurve 10 ASV. This is a bit different, as it actually actively treats CA, not avoids them like VAuto or AutoSet.

[wesleytrents]

Thanks Dave, 

That's really helpful. I believe I have a check in with my doctor in a few months, so if I can't find a way to balance my CA's, I'll see if they will upgrade me to a Bilevel.

Very appreciative of all you seasoned pro's sharing your knowledge. I'm just starting my journey here and learning day by day, but I still have a lot to learn.

[SarcasticDave94]

Welcome. My opinion I'd give this about a month and if it's not working call the doc to get in sooner.