New CPAP user, OSCAR data - Advice needed

[dodenboombie]

I Have been dealing with brain fog, cognitive issues, and fatigue for probably 8+ years, but has gotten noticeably worse in the last 2 years.  I eat a mostly organic whole food diet, no drugs, alcohol, caffeine, or nicotine.  I am 30 years old, male, 5'8" 150 lbs, and I exercise regularly.  I sleep 7-8 hrs every night, generally fall asleep easily, and normally sleep through the night (or so I thought). However, I very rarely have dreams.  I wake up exhausted every day. I am light headed, borderline dizzy frequently.    

I took a Lofta home sleep test (Watchpat) and was diagnosed with OSA with an AHI of 10.3 and RDI of 20.6.  I also took a home sleep study through Kaiser which was a NOX sleep device which had a pulse ox, belts, and tubes in the nose.  That one came back with an AHI of 5.1, and they prescribed a CPAP.  I did not get a titration study. 

I have been using the CPAP for 6 weeks now, and my symptoms have not improved, and I am still not dreaming.  I am still waking up brain fogged and exhausted.  I tolerate the mask well and am usually asleep within 10 minutes of lying down.  

I use Airsense 11 autoset, Mirage FX nasal mask.  Ramp off, Humidity 5.  I started out at a pressure range of 4-20 (how they sent the machine), then lowered max pressure to try to eliminate all of the CA events I was having.  I have tried EPR on, EPR off, fixed pressure CPAP mode with pressures of 7, 8, 9.  Highest AHI I've seen was 4.3 at 9cm pressure EPR off. Last night I turned auto set back on at a pressure range of 8-12 with EPR set to 3.  I am unsure of what settings to try next.  I have worn a soft cervical collar for a handful of nights to prevent chin tucking which had no effect. 
 
The thing is that since starting CPAP therapy I have had a couple random days where I wake up totally refreshed, mental clarity is improved, and my energy is unreal, way higher levels of energy than I have ever had in the last few years.  On the nights preceding these good days, I have alot of dreams which indicates my sleep quality is better.  The next day I'm back to being a zombie.   

I have attached some OSCAR charts.  I have been tracking heart rate and SPO2 with a wellue O2 ring.  In the beginning I was regularly desating to 86 every night, lowest being 83. In the recent weeks I  usually stay in the low 90's which seems to be improving.  

I am still exhausted every day and I am not dreaming.  
Any advice is much appreciated.  Thanks in advance!

[PeaceLoveAndPizza]

It could be a number of things, but let’s try titrating a bit first before going down a rabbit hole.

Mode APAP
Min pressure 8
Max pressure 15
EPR 2 full-time
No ramp

That will tell us two things. First, is EPR causing the CA’s, and second, is the pressure the correct range for you. Use that for a few nights and post the result.

It is possible some of the CA’s are treatment emergent and will resolve over time, but I like to make sure we are in the right range for your pressure and pressure support before trying other things.

[dodenboombie]

Thanks for your reply.  Last night I had it on APAP, 8-12, EPR 3, no ramp.  And I feel pretty bad today.  AHI was 3.73 with lots of central apneas.  I will try moving the max to 15 and epr to 2 if you think I should.  


Also, I do not know how I forgot to put this in the original post (thanks brain fog) but I consistently had lower AHI when I was at a lower range of 5-7 on apap mode with epr off.  I had 2 days below 1 AHI on those settings, and I felt A LOT better on those days.  But I also saw AHI of 2 to 2.9 with bad daytime symptoms on those same settings.  

Not sure How relevant this is, but I am seeing sleep wake junk as well as movement spikes and heart rate spikes preceding the vast majority of the CA events.  I assume this means I am having arousals, and the CA events are happening as I am falling back asleep.  I thought I might be having the arousals due to respiratory effort, that is why I tried moving to higher pressures. But AHI seems to be climbing and I feel worse as I increase the pressure.

[katbrat]

It can take awhile for your body to heal and catch up from the issues you were having and healing never happens in a straight line. Some days you'll feel good, some days you'll feel like it's not working at all. It's encouraging to know you are at least having some good days! Hang in there!