Looking to optimize my APAP usage w/Oscar and sleep study info

[BionicSpud]

I'm looking for suggestions on anything I can do to optimize my usage of my APAP.  I've included a typical night of usage and my sleep study result.  APAP is Airsense 10 Autoset and I'm using the Resmed N30i nasal mask.  No changes have been made to the Airsense, typical pressure of 4 to 20 and ramp and all settings default.

Here is the info:

[SarcasticDave94]

The same APAP mode
7-16 pressure
EPR 3
If Ramp was active turn it off
Check the positional Apnea wiki due to the event clusters.

[Dormeo]

Welcome, BionicSpud. Congratulations on having an excellent machine and on using Oscar!

How long have you been using your machine? And how would you describe your nights (lots of wakefulness? pretty solid sleep? or...?) and your days (rested, energetic, sharp, or sleepy, slow, foggy, or ...?)

You are right to think you need some optimizing. As in your sleep study, you are having obstructive events, hypopneas, and flow limitations. (You are also having central apneas, though these may be correlated with full or partial wakefulness -- "sleep-wake junk." I'd recommend putting them to one side for now.)

My own recommendation would be to increase your minimum pressure to 11 for now, to see whether that helps with the OAs, and also to increase your EPR to 3, to see whether that helps with the Hs and FLs. Once you've had a few days at those settings, further adjustments might be warranted.

It looks like you are using the ramp feature. Do you think you could hack turning it off? If not, try at least raising the minimum for the ramp to 7.

One additional thought: your OAs are tending to cluster, which can indicate a positional issue. If you use a high pillow, or several pillows, try using one low, firm pillow. If you sleep on your back, see whether you can do more side sleeping. And if you tend to tuck your chin down toward your chest, try using a soft cervical collar at night to keep your airway better aligned.

[BionicSpud]

That you for the advice.

I have been using my machine for almost a month now.  Generally it takes me about 30 minutes or so to fall asleep and I may wake up a few times a night, but go back to sleep within about 10 minutes.  I wake up feeling just "OK", but do get tired around lunch (whether I eat or not).  I would say my mornings are somewhere between slow to rested.  If don't remember a time when I have woken up and felt great and energetic.

I can try turning off the auto-ramp feature, but I have no idea as I have never had it off.

I have a crushed memory foam pillow that I use and also a smaller pillow between my knees.  I tend to sleep on my back and to my left side the most.  I do not sleep on my stomach as that causes me back problems.  My pillow is the best one I've found so far.  If it tuck my chin, it must be subconsciously as I don't do it and remember it.

I must say that I am a little overweight, but terribly so. I am 5'10" and weigh about 190lbs.

[Dormeo]

Thanks for the additional information. It sounds like you've made a very good adjustment to using the machine. I think you'll start feeling better during the day when your settings are better optimized.

I didn't see Dave's post before I made my own, and I'm glad we're generally on the same page. Do you know how to change your settings? It's easy: just hold down the home button and the round dial simultaneously for a few seconds until the Clinical Settings option appears. After each change, be sure to press the round dial to lock the change in. When you're done, exit the clinical settings.

You can make a smaller increase in your minimum, as Dave suggests, or a larger one. Your call. Either way, the data we can view after the change will be helpful in further fine-tuning.

We can revisit clustering issues down the road. If you happen to notice chin-tucking during the night, that could be a helpful clue. Meanwhile, whenever you don't really care, choose side-sleeping over back-sleeping.

[SarcasticDave94]

Either way is fine with me as well. It needs to be a minimum of 7 min though to allow EPR 3 to do its thing.

[BionicSpud]

UPDATE

I don't seem to be doing any better.  Screenshot attached.

[Sleeprider]

Increase minimum pressure to 10.0 cm so you start at 10/7 with EPR at 3, and read about positional apnea and the soft cervical collar at the links below
Positional Apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar http://www.apneaboard.com/wiki/index.php...cal_Collar

Between increasing pressure and dealing with bending your neck which blocks your airway, you can get your AHI to less than 3. The CA events will have to wait until we resolve the OA and flow limits. The obstructive events are clearly clustered and you either need to lose a pillow or look into the soft cervical collar.

[Dormeo]

You saw some modest improvement in FLs and OAs, but we can see that your CAs increased. Before offering further advice, let me ask whether you have a copy of your sleep report that you could post. If yes, black out personal information first. If no, could you request one?

I ask because I'm wondering whether you had both obstructive and central events during your sleep test.

[Dormeo]

I'm glad Sleeprider has posted. Please follow his advice!