Finally changed to a OSCAR supported device. Help me analyze my therapy please.

[vrapche031]

Hi everyone,

I dont know if anyone remembers me but I posted a couple of times because I was put on CPAP therapy at the beginning of this year and I had issues with still waking up tired and being sleepy during the day.  I was given a Prisma SMART cpap which isnt supported by OSCAR so we couldn't do much since I had to access to my sleep data. A couple of weeks back I finally managed to switch to a Resmed AirSense 10 AutoSet and yesterday I set up OSCAR


Before I continue, I would just like to say thank you to everyone here for helping me and all the other board members. Sleep medicine at the current stage is pretty horrible for the patients and doctors are usually useless after they diagnose you and send you home with a CPAP. For me personally this board became a support group when I was just getting used to CPAP and I got a lot of amazing suggestions which helped me to find the best solutions for me and get used to the therapy. Without everyone here, I would have probably be one of the many people who gave up on CPAP. Thank you.


The stuff below is going to be long because I want to include as much info as possible.

So far I had 2 sleep studies in a sleep lab and here are the results :

Sleep lab test 1, without much info :

Number of apneas: obstructive 7; mixed 0; central 3; hypopneas 145  ( in total AHI 21/h )

Oxygen saturation: continuous (average value) 97.0%; minimum during sleep 94.0%; ODI 4.9%; PLMS index 6.3 /h ;


Sleep lab test 2, with a bit more info:

AHI: 7,5/h
Middle 02 saturation: 94%
Basal 02 saturation: 89%
Snoring index: 102,8/h

Number of central apneas in total : 1
Number of obstructive apneas in total : 5
Number of apneas each hour : 0.9
Number of hypoapneas : 46
Number of hypoapneas each hour : 6,6
number of RERA : 0
Arousal part ( TST )
total number : 38
Respiratory : 4
Motoric : 8 
Spontaneous : 26

So I would be under the group of Mild or very low Moderate sleep apnea. I am 32, male, fairly fit ( BMI 22.3 ). I had 2 nose operations in the last 2 years, 1 septoplasty and 1 rhinoplasty. Besides that I always woke up tired, with muscle pain in my whole body and stayed tired during the whole day. 3 years ago things escalated because my sleep schedule changed and I started having really bad sensory overload problems suddenly. Thats when I started doing more digging into my sleep problems and found out that I have sleep apnea ( and ADHD apparently ) . I am taking some meds for ADHD now but besides that I am fairly healthy and these meds didnt make things worse when it comes to sleep.


My current problem is that even after 7-8 months on CPAP I still wake up feeling tired and I have fatigue during the day. I do not wake up with muscle pain anymore and I am not as tired as before, without CPAP I wake up feeling much worse. In these 7-8 months I had 3-4 mornings where I woke up fully rested for the first time in my life and it felt amazing, this did not happen right at the start of CPAP - it was 3-4 random nights during the whole 8 months. Now I would like to figure out why it doesnt happen more often


My current settings are on APAP 7-11. I barely ever have Obstructive apneas, that completely went away when I turned off the exhaling support option ( pressure relief ? ). I tried pushing the minimal pressure to higher numbers but that resulted in more central apneas ( I am willing to try that again on the new machine though ). 

I have attached the screenshots of the last 4 nights and would love it if someone can help me analyze the data. the numbers are already pretty good but maybe they can be better :

If you need different screenshots with zoomed in parts, please let me know.

[staceyburke]

you bumped into your max several times so I would suggest a max of 13. You never got near your bottom number so I would suggest 9.5. Turn on EPR full time set at 3.

[vrapche031]

you bumped into your max several times so I would suggest a max of 13. You never got near your bottom number so I would suggest 9.5. Turn on EPR full time set at 3.

EPR on 2 on my previous device gave me a lot of obstructive apneas. As soon as I removed that I got rid of all OA's. Do you think its still worth trying it again? 

I will try raising the the min and max pressure to 9.5 and 13.

[Melman]

I agree with Stacey on pressures and EPR. EPR should reduce the hypopneas. I will be surprised if it causes OA. Please post again after making changes.

[Gideon]

That shouldn't happen. EPR should be an important part of your therapy. Note that the application of EPR decreases the EPAP which is what treats Obstructive Apneas. Most users have their pressure set too high and adding/increasing EPR corrects that but in some cases it is necessary to adjust EPAP up, or on a CPAP/APAP increase min pressure to compensate. so definitely try again.

[vrapche031]

OK, will give it a go then. I usually had 1-4/h OA's each night and the night I turned EPR off, they completely disappeared. Looking forward to testing it tonight

[Melman]

My OAs fluctuate between 7-8 per night to zero with EPR at 3. Most nights are 0-4 with EPR always at 3. These are all reflect normal variations in effective treatment.

[SarcasticDave94]

Just as information and not to be critical of you, give the edits in pressures a trial. An off normal night that happens to coincide with a pressure change isn't trend making, and certainly not enough data to base your settings on. Glad you got the ResMed.

[vrapche031]

Uploading the screenshots from the last two nights. The change made was this :

1. EPR changed from 0 to 3
2. Pressure changed from 7-11 to 9.4-13

I dont feel any different. The positive thing is that my obstructive apneas did not re-appear, which I thought that would happen. 

The one thing I noticed is that last night I had a stop in therapy around 03:30 am, which is strange because I dont remember that at all.

[vrapche031]

Posting two more nights with the new settings. Should I stick with these settings or does anyone have any suggestions on what else I could do? 

Also, I dont have a humidifier. Does that make any difference between helping with not getting a dry nose/mouth ?