What changes to maximize therapy benefits?

[janelleb1985]

Hi Everyone,

I am newly diagnosed with moderate OSA. During my home sleep study my AHI was 24, and my O2 levels dropped to 72%. I was given a Resmed Airsense 10 with the pressure set 5-15. My respiratory tech advised me not to change *anything.* They were supposed to call me at the 1 week mark to discuss how my therapy is going and go over any changes that are necessary. I never got the call, and when I called myself I never got a callback. So, I feel kinda on my own and out of my depth in seeing what changes (if any) might be beneficial.

My current average AHI is 0.67, and I have noticed a big change in my energy levels & alertness. My resting heart rate has also dropped. Overall, I feel like the therapy is going well, but  sometimes I do feel tired and sluggish during the afternoon. I know it may take many months to feel the full benefits, but if there is anything I can do to help myself via the settings I would love to be proactive and maximize the benefits.

I have a couple specific questions. I noticed my average pressure is around 10, but I do hit 15 regularly. Should my minimum pressure be raised? What about the settings for exhale pressure?

Is there anything else on my charts that looks concerning or that I should be paying attention to?

I attached screenshots zoomed out for my best night, and then for my worst night zoomed out and close up on an event. I can attach more if that would be helpful.

Any responses are much much appreciated!

[janelleb1985]

Hi Everyone,

Didn't get any responses on this one, and wanted to try again adding more information to try and fine tune my machine settings. I am still trying to figure out what is the best pressure setting for me. I tried raising the minimum pressure to 7 and the EPR to 2 and had two pretty good nights of sleep, although I did notice some odd waveforms on one night. I've gone through a few other nights and do see similar waveforms, although not always and usually <5 instances when they do occur. What might these be?

I am also still wondering if my minimum pressure is high enough. I wake up 3-5 times per night and would love to get that under control. I am wondering if that is due to the flow limitations, and how I might work on those? My understanding is raising the EPR helps with flow limitations, so would I be best off raising that up to 3 and the minimum pressure to 8? Or should I raise the EPR to 3 and the minimum pressure closer to my median/average?

Thanks!

[Crimson Nape]

Your flow limit is a little rough.  Based on your chart, I think I would try the following:

1. Turn the Ramp off.
   
2. Set your EPR to 3 - Full Time
   
3. Set your minimum pressure to 11
   
4. Set maximum to 14
   
5. Make sure NOT to sleep on your back.
   

While you are at it, please reset your charts to the Standard view and default order (View > Reset Graphs > Standard). To take a screenshot, use the F12 key for Windows and Linux, and the Fn+F12 key combo for a Mac.

See if you get better sleep and lower numbers.
- Red

[gainerfull]

Hi Janelle,

Since you're brand new to CPAP I'd say stick with the settings that are giving you the best sleep quality and give your body a chance to adapt to the treatment. One thing to keep in mind is your sleep is inherently variable so aiming for 0 AHI or the same AHI every night may be unrealistic.

Aside from waking up - what other complaints do you have? How do you feel after using CPAP overnight? How many nights have you used CPAP so far?

[OpalRose]

Let's see if we can bring the FL down a bit more by using EPR 3 in addition to raising the minimum pressure to 9cm.

Besides lowering the FL, this should also help with Hypopnea and Reras. If we can get the FL down, the pressure swings should be a bit smoother. It's the FL that causes the pressure to rise, which may be causing awakenings.

Overall, everything else looks ok.

[janelleb1985]

Thanks everyone, I split the difference between the suggested pressures last night and raised the minimum to 10 with EPR 3. I left the max at 15 and may trying lowering it to 14. Last night I only woke up twice, and my flow limitation graph looks better than it has. I am normally a side sleeper, but will sometimes roll onto my back. I've been using the apap for about 6 weeks. I've had a noticeable improvement in energy levels and alertness. I do sometimes still feel sleepy and groggy during the day, but I suspect that's more related to either not getting enough sleep or waking up quite a few times. I'm going to leave these settings for a few weeks and see how it goes as I get used to them.

Thanks everyone for the feedback, any other suggestions for improvement are appreciated! I attached last nights chart.

[OpalRose]

Yes, much better results, but FL is still a bit higher than we like to see.

Since you're maxed at EPR 3, consider using Red's recommendation of raising the minimum pressure to 11cm. Hopefully, that would bring down the FL more and help minimize any wake-ups.

But overall, it looks good.