3 months in, feeling sleep deprived

[Macka]

Hi I would be grateful for any advice on my machine settings. I have a Prisma20A. I use n30i mask and mouth tape. Machine set to apap mode, 5minute ramp, pressure 7cm  - 11cm (Oscar reporting this incorrectly but everything else seems ok) I was getting more and more centrals using softpap and some nights a series of cheyne-stokes periods. So stopped using softpap and they immediately went away. I currently feel comfortable with the settings I have but suspect I am still being disturbed and wake many mornings with little deep sleep and sleep deprived. Attached clip of an average looking night for me where all went ok but feel like crap.

           

[PeaceLoveAndPizza]

Can you repost using the standard format here? See my .sig for the OSCAR organizing link.

[CPAPfriend]

EPR isn't just a comfort feature but instead will also affect your physiology. Increasing EPR is increasing the pressure differential, which in turn will increase ventilation (removal of CO2), so when you turned it on, you got rid of more CO2 than before, which diminished your respiratory drive, which created central apneas. In other words, EPR on got rid of more CO2 than usual, and CO2 is responsible for your drive to breathe.

[Macka]

Hi Thanks for the help, my machine has a lot of event flags that I couldn't get rid of in the side panel! Also, Oscar is reporting incorrectly the max presssure as 7cm when its currently set to 11cm. The pressure trace wont display correctly either without minimizing the side panel . This is last nights data

         

[CPAPfriend]

To me your pressure looks too low, as the hypopneas are not being treated and you have a considerable number of RERAs too. The problem is, you're on an APAP algorithm, so you can increase the band, but fixed also might be the answer. People have quite a bit of force behind their opinions on APAP versus fixed. I personally advocate for fixed, because of the reason above; that is, APAP algorithms vary between machines and vary their effectiveness between patients. CPAP compliance is best with a fixed, low pressure. 

What have you tried so far?

[Macka]

I had started to gather that I should try raising minimum pressure. My median pressure has shown recently to be 7.5cm and 90% is at 9.5cm, yet I am using min7. I have also just noticed that Oscar is reporting some events differently than Lowenstein's own PrismaTS software. Is Oscar marking events independently based on the data or  displaying marked events by the manufacturer? Lowenstein software marks most of these Hypopneas as Central.

I started out 3 months ago on cpap @ 7cm and was getting more than half of the hypopneas reported as central which got worse as I added softpap. I tried CPAP @ 10cm a few times but found the leaks were too hard to manage as I was trying to sort mask preference at the same time and was focused on that pretty heavily. Because I was classed with mild OSA, I was happy to prioritize comfort and low pressure and work upwards towards control.
I settled on an n30i and moved to APAP to try control apneas when the few I was having occurred. So I set min pressure @ my then median, and max pressure @ 1 above my 95%. Also tried softpap 1, 2 & 3 which after 2 months, was giving me more and more centrals and some CSR.

I have left the settings where they are @ 7-11cmH2o for some time now, but slowly am realizing I am restless and lacking deep sleep volume many nights. Lowenstein is still reporting more than half my hypopneas as clear airway events so am unsure what to do next. I have been without Oscar all this time as I only just found out the update checker wasn't working. Anyway, Oscar is working well enough with my machine now and it has led me here and to the great detailed info available so I am only just starting to grasp the finer details of treatment protocols and their effects.

[Macka]

Switched mode last night ready to give constant pressure a go. Started at 10cm, ignore Oscar reporting max pressure 12, that's just lowenstein compatibility issue. I have been reading some more and I think I am starting to understand the need to identify arousal breathing signals and the clues in the waveforms to what is happening in the airflow, also dependant on sleep position, leaks, sleep stage etc.

Last night didn't feel any better than usual and highest AHI Ive had but my Oura sleep score did jump from 50's to 80