Having fluctuating results 3rd week in. Data attached

[Jscott321]

So I was diagnosed with Severe Sleep apnea after pushing for a 2nd study for years as my first was inconclusive (I didn't sleep with the equipment attached).  Long story short, I finally got a cpap 3 weeks ago and I'm having very good, but not great results.  

About me: 
42 Yrs old, 6'3" 230 LB fit male.   Gained a bit of weight the last few years, but still healthy.  Since I've gotten my cpap I've been working out daily again. 

sleep study was 36 AHI, 3.4 side, 54 Supine. 

Equipment: I have an airsense 11 and heated tube with F30i as I have a chronic cough for the last few years (seems to be GERD/Post nasal).  

After getting my CPAP, the first 3 days I felt like superman, it was soo good, then I had a hard time staying asleep, would get up at 3-4 and couldn't fall back asleep, this has since passed but my AHI has increased.  

Data attached, but here are some additional details: 

• I started at 6-16 pressure
  
• doc dropped to 6-9 after first 3-4 days,
  
• After that didn't work he increased it again (he screwed up and went to 20-20 so I changed to 6-13).  
  
• bought a wedge pillow 2 days ago, but using it on my back my AHI was the highest ever at 10 for the 2-3 hours I used it.  The same night I switched back to side sleeping and AHI dropped again (pic of that night below)
  

   

I'm having troubles with consistency in results, I've used the machine EVERY moment I've been asleep since I got it.  The gap in data was re-setting the time on the machine and clearing the card, but I have 0 problems with using the machine.  I actually prefer higher starting pressure due to chronic stuffy nose so don't ramp, I could probably get rid of EPR, I do love sleeping on my back.  Leaks DO seem to be an issue.  I have both an n30i and P30i on order as well to try out.  

I still feel better these last few days after that initial drop off, but what can I do to get my AHI down to under 2?  I see people getting diagnosed with sleep apnea who have AHI's lower than what I'm getting sometimes WITH a CPAP. 

I can share CSV data too, not sure how safe that is.  

Tends

   

Overview

   

I can share a couple more screenshots of OSCAR with high's and lows but I'm too new to post links

[staceyburke]

You have 2 main problems, first you have positional apnea and the other is high flow limits.

POSITIONAL APNEA
You can see positional apnea where either H or Oa ( AND UA) events are clustered together. Getting rid of as many as you can will lower your AHI. Positional apnea can NOT be controlled by pressure changes. You have to find out what position you are getting into and cutting off your own airway. Have you changed your sleep position? Sleeping on your back? Using more (or new) pillows? These things can cause positional apnea by chin dropping to your sternum and cutting your airway. Think of it of a kinked hose – nothing can get through – you have to unkink the hose…
IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar. I have a link to collars in my signature at the bottom of the page. It shows people who are not wearing a collar and the SAME person wearing a collar. There is a huge difference between the two.

FLOW LIMITS
We control flow limits (it is apnea just like O and H events only a shorter time) using EPR (exhale pressure relief). To use EPR you must make a couple changes in your settings.
First make sure your EPR is on and Full Time
EPR set to 3
Min set to 7 or higher.

Give those settings a try and try to fix the Positional apnea.

[Jscott321]

Yes, the positional apnea is something I'm trying to work with, I'll give a couple of options a go and see how they help.  I really want to like the wedge pillow so maybe I'll just be kind to myself and give a couple options a go without stressing about short term AHI.  

My EPR is set to 3 already, you're saying I should increase min pressure to 7 from 6? 


Thanks again!

[staceyburke]

Yes the min to 7 or 8.  The way EPR works is you subtract the EPR from the min to get the exhale pressure.  4 the the absolute LOWEST any cpap will go.  So if you are at min 6 - EPR 3 should be 3 but it can go no lower than 4.  You are getting only 2 EPR even if it is set to 3.

Min 8 - Epr 3 = 5
min 7 - Epr 3 = 4
min 6 - Epr 3 still = 4

[Jscott321]

I increased pressure from 6-7, and am going to a flat pillow.  I did buy a soft collar as you mentioned and tried last night with a wedge pillow.  Overall not a bad night but you can see a cluster, I definitely stayed in the same position here as a wedge pillow isn't easy to sleep on your side with.  For the last hour you see there I removed collar and slept on my back with a small pillow.  Here's last night 

   

I also finally received my P30i and N30i, I'm excited to try as I HATE the F30i.  I find it really cumbersome, and considering I only got it because of my cough and already feel the P30i is better in that regard, I'll probably hold onto the F30i only for those days where I have a cold and can't breath through nose.  

And here's a couple nights ago after I took your advice, I had increased pressure this night and slept on my side as much as I could,  yes I was up a lot but I drank a bunch of Kombucha before bed so I'll chalk it up to that. ;


   

other than changing the setting to "pillow" on the machine, any other advice on switching to the P30i?

[Jscott321]

One more update.

Switched to the P30i and I love it. But wife said I had mouth open a lot. Leak rate doesn’t really show much on my data.

Any tips here?  

Links below