[CPAP] BelovedMonster - CPAP Treatment

[BelovedMonster]

I'm sort of at my wits end - keeping the CPAP on all night now consistently, no trouble falling asleep, data looks good, yet I am still always exhausted. Maybe it's time for another sleep study or a new sleep specialist? I've shared a couple of my recent OSCAR charts here - am I missing something??

[SarcasticDave94]

My personal experience, another sleep study will get you nowhere except you'll have a new medical bill. Beware if you change "sleep specialists", that will very likely require another sleep study for their record and gives billing department a new source of income. And it'll probably have similar data that your current study revealed. It is a one night snapshot.

Take this info from a guy that has had several new sleep specialists and sleep studies costing insurance about $35,000 and the result is no better treatment and zero machine. I was on a higher level ASV and also have emphysema based COPD.

The ongoing sleep issue may be something in addition to apnea, although that doesn't mean not to treat apnea still.

[BelovedMonster]

That's a good perspective, thanks for sharing that Dave. I'm not really sure where to even get started troubleshooting potential other sleep issues, but it's a good callout that I should keep up the CPAP treatment regardless.

[PeaceLoveAndPizza]

I am in a similar place. Low AHI, but still not quite happy with my restful sleep time.

One thing SleepRider pointed out to me in my therapy thread is the “splky stuff” in the flow graph are usually  micro-arousals caused by flow limits and other things. You have a similar flow rate and flow limit graph and even though it may be within tolerance, you may be one of us who is pulled out of deeper sleep by those arousals. What I did was raise my pressure slightly and increased my PS (Vauto equivalent of EPR). That has resolved most of the arousals and helped quite a bit.

As you are on an Airsense 10 Autoset you are limited to 3 cmH2O of EPR and already there. Something to consider is slowly increasing pressure, maybe by 0.2 steps and see how it impacts the spikes. Alternatively you could find out about getting a Vauto so you can have more PS/EPR to play with. With a bit more pressure support it may not only reduce the flow limits, but the pressure changes that they cause and may be part of what is disturbing your sleep.

Hopefully those better schooled in the mysterious way of CPAP can jump in to correct me or make recommendations. Hang in there!

[BelovedMonster]

I think you're right - I went down the EPR rabbit hole a few months back and it's the only thing that I can't play with with my current set up. I did increase the pressure a bit back then for the same reason, but I will try to increase again and see if that helps. At this point it may be worth getting a machine that gives me more control in that area though. Thanks for the encouragement

[Deborah K.]

You might benefit by raising your high-pressure limit to 16. You sometimes bang against the 14 line now. If you don't need the higher pressure you won't go there, so it won't hurt anything to move to the higher setting.

[PeaceLoveAndPizza]

As your apnea is being treated by the current pressure, the goal now is to improve sleep quality. When I was dialing things in, I increased my pressure by 0.2 and monitored things for 2-3 nights. Only after that would I increase it further. When I got to the point that I created new problems, I backed off by the same increment to the point they went away.

Good luck and let us know how it goes. Be sure to give any single change a few days to get used to it, unless it is obviously wonky.

[BelovedMonster]

Thank you - I will try exactly this!

[Millstone50]

You may need bilevel to get some more pressure support. The APAP algorithm is trying to deal with your flow limitations by increasing pressure but it's not successful.