[Treatment] new to cpap and getting clear airway apneas - what should I do?

[thann]

Hey guys, I've recently been diagnosed with severe obstructive sleep apnea (38~ AHI with no central apneas or RERAS) and started using a resmed airsense 10 auto-cpap about a week ago with a min pressure of 6 and max pressure of 20. While I am already feeling significantly better, I'm still experiencing some fatigue and have noticed some clear airway apneas on my Oscar daily reports which occasionally bring my AHI to around 5 (it may be worth noting that both nights where my ahi was at 5 were nights that I decided to sleep on my back). Is there anything I can change in my settings now to reduce my AHI and eliminate the clear airway events, or should I leave my settings as is for the time being and just see how things play out?

I've attached some my Oscar reports at the bottom of the post. There was one night where I had an AHI of 4.9 due to central apneas that I didn't include as the data didn't record on the SD card for some reason and another that I didn't include as the pressure hose disconnected from my mask for a large portion of the night, other than that everything I've got from my first week or so of cpap use is in there.

Thanks in advance for any advice!

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the last OSCAR report (could only attach 3 to the first post)

[Gideon]

Welcome to the forum.

Your CA events are occuring at your higher pressures.
Your flow limits (FL chart) are driving your pressure up.
EPR is the best tool to treat this but your EPR is effectively off since your Ramp is off (good) and your EPR is set to ramp only.
Set EPR = 1 FullTime, Be aware that this may cause an increase in CA events, it will help your flow limits which will help your pressure. I'm like higher but let's see what happens with 1 first.

Here is likely what is happening.
The higher pressure has "improved" your breathing so you are flushing out more CO2 then what you used to do. This lowers the CO2 levels in your blood apparently to lower than Your apneic threshold which results in no trigger to breathe and a central apnea. The thing is that increasing EPR also increases this flushing. The question is will the EPR flush less than your higher pressures? Thus the trial at EPR= 1 and the caution of not starting with a higher EPR.

[DaveCar]

Good catch on the Ramp Off and EPR on Ramp Only Gideon.  Machines will still allow us to configure illogical things.

Just curious, on a CA case like that, is there any value (or risk) in just dropping the max pressure , say to 9 or so ?

[Gideon]

Dave, always with a non-ASV machine it is a balance between favoring either the obstructive or the central side of the balance. In this case, the FL 95% value is high so my move was a bit in favor of the obstructive events, especially since there is no evidence of how these centrals react to EPR increase. Expect an adjustment depending on learning that, it could be either way.
BTW I did evaluate that option. I chose to attempt to correct pressure by treating the flow limits vs possibly increasing flow limits and other obstructive events with a pressure drop by itself. Without the elevated flow limits, I would have likely tried to lower the pressure first. In the end we may end up there, I don't know at this time.

[SarcasticDave94]

Most of the self titration is adjust, wait, and see. When we're dealing with CA, have to adjust, then wait for something to change, then see what that change is. Maybe it's that way for all Apnea, but even more with Centrals and their finicky consistently inconsistent nature.

[quiescence at last]

Thanks for info.  My friend is just about to start using their AirSense 10 Autoset (again).  They claimed that they felt as though they could not expel the air they were forced to inhale.  I am going to check this EPR setting first, then going to train them on how to mimic sleep breathing (inhale, then just allow the deflation without effort).  I'll bet they will find it reassuring once they feel themselves truly deflating, with the help of EPR.  It may take days or weeks for our brains to adjust to the machine.

QAL