[CPAP] Self treating: Advice for tuning after first night OSCAR data?

[citrus1]

Hello, 

I was recently diagnosed with "mild" sleep apnea, based on a home sleep test (Phillips) that recorded the following

AHI: 10.1
Event %
* 87% OSA
* 10% hypopnea
* 3% central

I am 5'4, 122lbs

It's been a month, and I am still waiting to get booked for my titration study, so with the help of this forum, I decided to purchase my own CPAP (Resmed 10 auto) and start treatment on my own. 

Night 1 was pretty rough. I started at min pressure 6, but found it too uncomfortable, and had to gradually decrease the pressure until I was able to fall asleep at min 4.4, max 9. I also increased EPR to 3 bc I had a hard time exhaling. I think this is contributing to my CA events. 

I am using the resmed nose pillow "for her" and mouth taping. 

I managed to keep it on for about 5.5 hrs, before waking in the middle of the night and removing it. When I awoke in the middle of the night, I actually felt remarkably alert, and it took me about an hour to fall back asleep. I woke up for the day after 2 hours of sleep without the CPAP and felt a bit foggy, but not as bad as I usually do. I will try harder to keep the mask on all night tonight. 

I don't really know what to make of my OSCAR data (attached - hopefully I did this correctly), but am planning to make 2 adjustments to see if I can do better: increase min pressure to at least 5, and decrease EPR to 2 or 1, depending on what I can tolerate. Does this seem sensible? 

Any other advice? Thank you!

[SarcasticDave94]

Welcome to Apnea Board,

Obviously, the CA are a bit too high to accept. I'm taking a guess, therapy from this chart was at most ok.

Did you get the detailed sleep study report? If not, at least get the detailed sleep study. You want it for your personal medical file. And you should post a redacted of your personal info version here. It helps us define the CA, what to do about them, etc.

For now, I'll suggest a compromised therapy setup for one night just to see what OSCAR shows next. Try an almost static pressure 6-8, EPR 1. No Ramp is it's on now.

Current Min 4.4 negates the EPR 3 until pressure increased to 7. It's a math thing, EPR 3 attempts to reduce exhale pressure, but will not go below the AutoSet physical minimum 4.

Consider the edits and if you try them, follow up tomorrow with an OSCAR chart and tell us how you felt for the therapy. And do get the sleep study detailed info.

[citrus1]

Thank you @SarcasticDave94 

I will give those adjustments a try tonight, and report back. I do have a copy of the home study report, and attached the redacted files. (I apologize for the image quality - they were distributed to me digitally like that.) 

Let me know if you suggest trying something different as a result.  

Thanks again!

[SarcasticDave94]

Images are good enough, thanks. OK this tells us we're dealing with a CA aspect that's based on treatment emergent. This means your CPAP is helping you exhale CO2 a bit too efficient and it's then suppressing your breath drive.

Try those edited settings and see if it helps reduce CA. Notice though that it might make any other events go up some. This is what I'll call the teeter-totter effect. CA are on one side, everything else is on the other. Act to push CA down, inevitably the other side goes up, and vice versa. Reasoning is CA get treated in a different way to the others.

For context, all the other events are Obstructive Apnea, Hypopnea, and flow limits, all 3 diminishing levels of airway restriction.

[citrus1]

Alright! Night 2 is on the books. A little better but not ideal. I don't feel as sluggish as I usually do waking up, but still getting a lot of CA events. AHI 5.2. Charts are attached, including a zoomed in look at one of my events. 

Settings: 
- Pressure: 6-8
- EPR: 1
- No ramp

I'm thinking I should reduce EPR to 0?

Any other suggestions?

Thanks! Happy to be making some progress anyway.

[SarcasticDave94]

You could try EPR off as you mention. Besides EPR off, maybe try static 7, getting there by making Min 6 and Max 8 both a 7.

Something to consider is would the doctor switch you to a ResMed VAuto, a bilevel? You could present a case not so much about the treatment emergent CA, but if applicable, an argument to switch based on comfort and rest.

Between us here though it's somewhat about those CA. Because the VAuto has not only bilevel to assist, which is much like EPR, but there's a timing setting called Trigger which decides on sensitivity to trigger inhale. This alone may surpress some CA as it switches to IPAP, the inhale pressure. Also on the VAuto is inhale time duration called Ti Min and Max, but the focus mainly lies with Trigger.

[citrus1]

Thank you very much. 

I haven’t had my titration study yet, but will keep your advice in mind when they allocate the machine. 

I’ll try turning EPR off tonight and see if that helps without teetering the totter too much in the other direction. 

Thanks again for the help!

[SarcasticDave94]

Welcome. OK then ask the prescribing physician to request to try bilevel during the Titration. They probably will, but I'd rather be certain they are planning it.

[citrus1]

Better night after turning off EPR - AHI 2.89 

I set min pressure to 5.4 for comfort, max at 8.0.

Based on this chart, it seems like I should consider increasing both the min and the max? 

Thanks for all the helpful suggestions! I'm feeling pretty good this morning, and did not wake up in the middle of the night for a bathroom break like I usually do.

[SarcasticDave94]

Yes, an increase in pressure both Min and Max is indicated. The trick is twofold. Keep CA about this level while reducing OA and H (Obstructive Apnea, Hypopnea). If you see that top mostly flat pressure line, looks like it's skipping along the top, the CPAP wants to go higher to combat events.

If pressure increase lowers the OA and H, your 1.97 AHI - C may be tolerable.

Maybe dial both pressures up by 1.

Do watch the leaks though. Not bad just yet, however there's a few small leak bursts. Possibly mask movement. It's not a priority just yet. Your leak median is great at 0. However increased pressure may make this get worse.