Help with 9.52 AHI from CA events

[YouTakeMyBreathAway]

I did do a sleep study and got 17 AHI w/ them being exclusively Hypopneas. I believe 1 was “mixed” and 16 hypopneas per hour.

Do you think the next step should be trying fixed 7 pressure OR EPR set to 1?

Also when you look at my other post you can see all my days during the titration study. For some reason the EPR of 3 was less of an issue there, maybe because the median pressure was lower?

[OpalRose]

Go ahead and try EPR 1 for a day or two. If Hypopnea or FL rise, then you know you need some EPR in the mix.

It's going to be a balancing act... more EPR may cause more CA's, but EPR is needed to lower FL.

[YouTakeMyBreathAway]

Ran the night w/ EPR still at 2 and APAP set to 7.0-7.0. Results look comparable to previous night, but:
- There were longer stretches were oxygen was at its peak for a while.
- I felt less tired when I woke up.
- I didn't take the mask off.

   

[OpalRose]

- There were longer stretches were oxygen was at its peak for a while.
- I felt less tired when I woke up.
- I didn't take the mask off.  

All positive!  

When your ready, try EPR 1.  Keep the pressure at 7-7 auto mode.

[YouTakeMyBreathAway]

I had a check-in w/ my doctor and they recommended taking down the pressure to 4-15, since that had given me a pretty low AHI during my titration study (1.69 - 2.09).

Instead of taking it all the way down, I took it from 7-7 to 6-6:
- 2.36 AHI (decreased from 3.52)
- Most (not all) of the CAs now look like "False CAs", with a spike 1-2 breaths before the CA.
- Had two OA events, so I'm probably reaching the bottom of how far I can go in terms of pressure setting.

There still seems to be some room for improvement. 

Next step could be taking EPR to 1, since decreasing pressure to 5-5 will likely further increase OAs?

What is a good target AHI / fully treated AHI?

   

[YouTakeMyBreathAway]

Same settings today, but I woke up extremely tired. Looks like I had a few RERA events, but AHI stayed similar to before. What could the reason be?

   

[OpalRose]

What is a good target AHI / fully treated AHI?

An AHI under 5 is considered clinically treated, but most of us like to see a lower number.   There isn't a "fully treated AHI" number, unless you can reach 0, and that's unrealistic.

Instead of looking at the total AHI number, focus on the makeup of that number.
You're attempting to lower pressure to decrease Obstructives.... but you don't have that many Obstructives showing up.  The CA's could be an issue, but they usually decrease over time.  What I'm trying to say is that focusing on how low we can get the AHI number doesn't always equal how we feel.  

Then there's Flow Limitations and Reras.   These events can cause you arousals many time during the night, and some you're not even aware of.  Needless to say, you're not going to feel that great the next day.

Keep in mind that to lower FL, you need EPR.... but EPR can cause an increase in CA's.  
Higher pressure can also aggravate CA's.

I think I commented earlier that it could be a balancing act.  You'll have to decide what settings you can live with and how you feel, not so much the total AHI.

I suggest you start keeping notes on the settings you've used and the breakdown of events and how you feel the next day.

[YouTakeMyBreathAway]

That makes sense, where would you go I go next from 6-6 w/ EPR 2?

It seems like I was not just subjectively way more tired this morning, my oxygen also looks to have been lower during the night, despite no increase in AHI. Flow Limitations were increased a bit, maybe that was the reason. I do remember having a bit of a stuffy nose.

[OpalRose]

I wouldn't take it below 6. Try EPR 1.
I think your CA's will lessen in time, and the other events are low. Just watch your oxygen levels.

[clownbell]

OP's OSCAR chart for June 30 and July 1 both show Flow Limit of 0.03, not large enough to be considered a problem. AFAIK, it is generally desired for flow limits to be below 0.10 so OP is in good shape there.