How can I treat primarily "Clear Airway" events?

[mcrick]

After a few months of tinkering with settings and masks, here's where I'm at (as a healthy young male, healthy weight, untreated 10.0 AHI, not a mouth breather):

• Airsense autoset 11
  
• Set to CPAP mode, constant pressure of 11.0
  
• EPR full-time at level 2
  
• P30i large pillows
  
• Heated hose set to 86 deg and humidity level 4 (if I go to 5, I run out of water by morning and it hurts my throat)
  

Now, most nights, I am around 0.5 to 1.5 AHI, almost entirely "Clear Airway" events as notated in OSCAR.
Occasionally I'll get a bad night with other events, which are usually hypopneas or OAs.
I rarely/never get UAs, CSRs, or REs.

Here are a bunch of recent nights' data:

1. Jan 30
   
2. Jan 29
   
3. Jan 28
   
4. Jan 27
   
5. Jan 26
   
6. Jan 25
   

I know this AHI is low, but I really want to improve it because I am still not sleeping restfully. I often experience fatigue, eye twitching, and dry eye during my day and evening.
I am very groggy in the morning.
I often wake up fully a couple times per night.

Some questions...

1. Should I schedule a second sleep study? My first was without a CPAP and now they want me to come back for a titration study, but I'm not sure how much this would help.
   
2. Is there a different kind of professional I should consult with (like a LankyLefty type of technician who can help me interpret the OSCAR data)?
   
3. Should I raise/lower my EPR? I tried last night with EPR of 1 and pressure lowered by 1 and it went horribly. I'm worried about lowering it much as it may increase my flow limitations.
   
4. Should I raise/lower my pressure? It seems there may be some overventilation happening (from some quick research) but I am still trying to understand all of this stuff.
   
5. What else can I try? My sleep hygiene/habits are strong and science based. Do I need to try a BiPAP? Should I request to try this at my titration study if I get one?
   

[Gideon]

Sorry, I don't manage SleepHQ very well on my phone.

[BoxcarPete]

What's your height and weight? Doesn't look like overventilation to me unless you are 5'6 and 130lbs or something. Your minute vent seems to stabilize between 6 and 7L/min which is pretty much where I was at 6'3 200lbs, and I was experiencing spontaneous arousals as a result of underventilation until I had my nose rebuilt. You do show some spikes that are often associated with arousals, and your REM latency appears to vary a bit, but I don't see any smoking gun from a quick glance.

[Sleeprider]

Your event rate is consistently less than 1 AHI. What's the problem? Your settings are 11.0 CPAP with no EPR. I f you want to try for better comfort, try Autoset mode, minimum pressure 9.0, maximum pressure 12.0, EPR on, full-time, EPR setting 2. That will reduce flow limits a bit, but you clearly have completely acceptable results.

[SarcasticDave94]

If your AHI is about 1, there's nothing to do but use the machine and get some rest. Self advocacy with CPAP doesn't need nor justify getting a zero AHI. Decently under 5 OK, from there comfort. A 1 or so AHI should allow you to be doing well.

If anything, you may have to edit pressures to give at least a small pressure range, and add in EPR. Maybe the CA go up slightly, but I'm betting also the obstructive events won't increase, and comfort goes up.

PS if you're concerned over centrals, then Ramp should be off.

[dataq1]

@ Dave, 

PS if you're concerned over centrals, then Ramp should be off.

Am I missing some concept here, how does the ramp impact centrals?
I can't visualize how, after the ramp period is over, having had the ramp on for a short bit of the night could spawn centrals that evidence themselves hours later.

[PeaceLoveAndPizza]

We prefer OSCAR for a variety of reasons, so please use that going forward.

Regarding ramp, if you don’t absolutely need it to sleep, you may as well turn it off. You are not getting sufficient therapy pressure during the ramp interval to help, so unless it is needed it is not of much value.

Your symptoms are likely related to the ongoing flow limitations that are contributing to arousals along with the need for more pressure to handle them. SleepRider’s suggestion is a good one, but if you want to stay with fixed pressure you can try increasing it to 12 and set EPR to 3. 

Once you get things to settle down a bit you will likely notice the difference. You are in the fine-tuning phase as you did a great job finding some settings that work for you. The improvements will be small and not as noticeable as early one, so a bit more patience is needed.

Jason Saxema (LankyLeft27) is a good one for helping. He has his own view on things that work well for many and there is nothing wrong with having a few sessions with him if you don’t mind the cost.

[ahuman]

How many sessions do most people need with Jason? It's a bit hard to determine what it will ultimately cost.

[mcrick]

What's your height and weight?

6'3", 192 lbs roughly. Slim, somewhat athletic build (I lift weights and walk a lot).

I've had two nose surgeries to correct deviated septum and enlarged turbinates, and I breathe very well through my nose now.

---

Your event rate is consistently less than 1 AHI. What's the problem?

As mentioned in my post:

"I know this AHI is low, but I really want to improve it because I am still not sleeping restfully. I often experience fatigue, eye twitching, and dry eye during my day and evening.
I am very groggy in the morning.
I often wake up fully a couple times per night."

[PeaceLoveAndPizza]

Go to [SleepTest #1] for all the pricing info.

-----
Moderator Action: DME Link Removed

To maintain our status as an educational organization, links to DME-owned or DME-operated websites and links to pages that sell prescription-required items are prohibited in forum posts.  This is stated in the Apnea Board Rules.

-----