EDS Help- OSCAR Analysis

[OSAsucks]

Hi guys,

Need some help with my settings. Gideon helped me last year with my settings, but I forgot about this thread and wanted to address my persistent daytime sleepiness, so I am back. 

Background:

32 M, slim/average build, chronic history of LPR/GERD/OSA
AHI 15.2 & RDI 22.5. I was diagnosed with moderate OSA but after reading this forum and others, these numbers are indicative of UARS? 
Performed turbinectomy and septoplasty due to idiopathic turbinate hypertrophy which caused severe nasal congestion
DISE results = multilevel obstruction due to large tongue and epiglottis collapse 
On the lower range of testosterone, iron, and vitamin D. Currently using OTC supplements for the iron and vitamin D. Thyroid tests came back normal
Tried modafinil but had to discontinue due to severe heartburn and reflux. It did improve my EDS though 
Use dentist created mouthguard for bruxism
Use chinstrap and mouth tape because my jaw opens at night


I'm seeing if there's anything else on my settings that are causing the EDS. Can someone please analyze my charts and help? Thank you so much.

[Phaleronic]

Hello OSAsucks,

Welcome back to the forum

EDS is a cause of OSA issues with soft tissue being less supportive I thought?

I'm not sure why your min epap pressure is so low, I would raise that to 8cm and keep ipap at 25cm.

With EDS you likely need that epap pressure to keep your airway open (even though your chart is showing clear).

UARs is a valid issue with younger folks that are thin and in shape, you may want to think about changing the mode to s-mode and setting a narrow band of pressure to see if you feel more rested.

[OSAsucks]

Thank you. 

My reasoning for thinking it was UARS was because usually, RDIs are higher than AHIs in UARS. We made the pressure low with Gideon to see what would work best last year. 4-25 gave me the best AHI results but not refreshing sleep. I tried your suggestion of 8-25 but ended up with CA and I had a headache all day yesterday and today so I switched back to the original settings. Unfortunately, I forgot to put the sd card back in so I don't have the graphs to share from when the settings were 8-25.

[PersonInNY]

RDI is always higher than AHI because AHI is a part of RDI. So you had 15 apneas and hypopneas per hour and 7 RERAs. That's not a lot of RERAs.

Do you have Excessive Daytime Sleepiness or Ehlers Danlos Syndrome?

[OSAsucks]

I have excessive daytime sleepiness. I'm not sure what's causing it.

[SarcasticDave94]

How high were these CA? An OSCAR chart would be better than the number only.

You could lower PS to 3 while increasing EPAP to somewhere between 6-8. I'd also nix the Ramp that's holding therapy at 4 for 20 minutes.

[OSAsucks]

How high were these CA? An OSCAR chart would be better than the number only.

You could lower PS to 3 while increasing EPAP to somewhere between 6-8. I'd also nix the Ramp that's holding therapy at 4 for 20 minutes.

So I tried this and my headaches still occur. I didn't have any headaches with 4-25. Another note, my trigger is set to very high from last year's discourse with Gideon. I don't know if that is affecting anything. Here are my charts with your numbers.

[OSAsucks]

"Your device was under 5.52-9.52 cmH2O for 95% of the time"
If I set my PS to 3, epap to 7 and ipap to 25, would this make sense from my current charts? My Trigger is set to very high also

[SarcasticDave94]

High or very high trigger makes sense for ones susceptible to CA. Your recent chart has these CA at .11 which is excellent.

You can try 7 if you want.

[Phaleronic]

Helllo OSAsucks, that's fine, I'd lower max ipap to 18cm and set trigger sensitivity to medium. Also since you don't need epap raising set the mode to s instead of vauto.