[CPAP] CPAP Not Helping

[phoen1kx]

Hello everyone.

I have been on CPAP therapy for about 8 months now(since February). 
I am still feeling the same as without the CPAP. I think something is terribly wrong with my therapy. 

My doctors are not giving me any help, I called them countless times but I've been on the waiting list for all of those 8 months. They gave me the CPAP and they haven't even checked the data, not even once to see if it is working as it should.

My last resort is this forum, I don't know what else to do. I would ask you guys to please look at my therapy data and tell me how it looks. Even if I look at it, and I don't know much about sleep data, I can clearly tell that something is wrong. The breathing pattern looks very erratic and uneven, yet the machine reports an AHI of 1. On top of it, me feeling terrible every day would suggest that something indeed is wrong. 

I will attach the images of sleep data and additionally a "statistic.psstat" file, if someone would like to look at it in the software. 
My CPAP machine is prisma SMART(Lowenstein Medical) and the software used to view the data is PrismaTS. I'm not sure if Oscar is supported on this specific machine.
Link for PrismaTS software: https://www.apneaboard.com/forums/Thread...hines-only

[CPAP SETTINGS]
          

[GENERAL THERAPY DATA]







[GRAPHS/DETAILED SLEEP DATA]







[LINK FOR SLEEP DATA FILE]: https://easyupload.io/6j9lt5  (Can be accessed via PrismaTS software)

Thanks in advance, everyone.

[gainerfull]

What did your sleep study / cpap titration tell you pressure wise? It looks like you're having too many arousals during the night causing poor, fragmented sleep especially at the end of the night as noted with the yellow RERA events (respiratory related arousals).

The way to solve that is to raise the pressure to a more therapeutic level but it would be helpful to know the medical recommendation for pressure first. If it were me I'd change it to CPAP mode and raise the pressure to 10cmH20 and see how you do considering 90% of the time you're sitting below 11cmH20.

[Dormeo]

Oscar does support the Prisma Smart machine, and it'd be great if you could export your machine's data to Oscar and post a daily chart.

[Deborah K.]

Yes, you for sure need Oscar.  But even without that, I can see that your pressure settings are simply too low for an adult.  I suggest that you raise your low-pressure setting to 7 and your high-pressure setting to 15.  You may find that you feel better simply by doing that.  Oscar will help us see what else may be improved.

[Stubert]

I have the same machine and have tried a lot of settings during the last 11 months.
When I use softpap/EPR, I also get a lot of flow limitations and RERAS.

Try and set softpap to "off" for one night, it helped me a lot with RERAS and flow limitations. If still no change, then also try and change to CPAP fixed pressure of 10 and still keep softpap/EPR "off".

If you prefer APAP, I would raise minimum to 7 and max to 13. You are running in Dynamic mode, which can cause you to wake more up, as the machine reacts quicker/shoots pressure up than in standard mode.
If you feel you wake up because of pressure changes, then change to "standard" mode, which is more gentle and doesn't react as quick in changes.

Make sure you dont have any leaks, as small leaks can have a major influence. Sleep on your side.

[phoen1kx]

What did your sleep study / cpap titration tell you pressure wise? It looks like you're having too many arousals during the night causing poor, fragmented sleep especially at the end of the night as noted with the yellow RERA events (respiratory related arousals).

The way to solve that is to raise the pressure to a more therapeutic level but it would be helpful to know the medical recommendation for pressure first. If it were me I'd change it to CPAP mode and raise the pressure to 10cmH20 and see how you do considering 90% of the time you're sitting below 11cmH20.

The settings that they gave me when I first got the CPAP were:


Mode: APAP
Min P: 4
Max P: 10
EPR/SoftPAP: 2

I was later told by a user on this forum to try changing the min to 6 and EPR to 1, and those are the settings that I am using now:

Mode: APAP
MIN P: 6
MAX P: 10
EPR/SoftPAP: 1


I also use a humidifier on setting 1.

In the clinic, initial settings gave an AHI of 5 in the report and they let me go, the doctor said "4-10 should be good enough, you probably don't need a lot of pressure". 

Did they even do the titration or did they just eyeball it??

[phoen1kx]

Oscar does support the Prisma Smart machine, and it'd be great if you could export your  machine's data to Oscar and post a daily chart.

Here, I exported it to Oscar:

[OSCAR DATA - DAILY VIEW]
10/2/2023

[Dormeo]

Do you know what was happening during the final two hours of the night, when your respiration rate and "obstruction level" were elevated? Were you fully or partly awake? Restless? Sleeping on your back? Tucking your chin down toward your chest?

I ask because the earlier hours look pretty good. So it'd be helpful to know what created the trouble during those last two hours. At the moment, I'm more interested in that than in suggesting additional tweaks to your settings.

[Deborah K.]

You need to raise your upper pressure setting to 15.  You are bumping up against the 10 you have set presently, and that is when you have lots of OAs showing up.

[gainerfull]

Your pressure levels don't provide enough support for your sleep apnea especially at the end of the night. I still think a constant pressure of 10cmH20 will yield better results and give more information to make additional recommendations.