Low AHI but feeling super tired and affecting blood pressure

[alexdw1]

Could you please review my charts.  I got diagnosed with an AHI of 20, so I purchased a machine (Prisma 20a), and they set it up with the minimum settings in the shop. I've never had titration study.  I felt good for a while but 4 months later I feel terrible again, I feel it pushing up my blood pressure, although my AHi is low.  My o2 is stable at 96% , when sleeping I can get 6-15 drops a night to 88%, with the machine.  Thanks in advance.

Here's my OSCAR files: https://www.dropbox.com/t/ldiQOrN1YTYTygBQ

   

[alexdw1]

My Vibratory Snore / VS index is 150->400 depending on the day.

[staceyburke]

Very few of us have had experience with your machine but I would set softpap to 3.  That should help the flow limits.

[alexdw1]

Thanks so much for the reply.

Softpap is already on 3.

The machine is in APAP mode.  I really only have 2 settings to change.  Min and Max.

[PeaceLoveAndPizza]

What are your current settings? The left hand bar is not visible which contains the needed information. Give the "Formatting OSCAR charts" link in my signature a quick glance to know how we prefer things formatted.

I suggest increasing pressure and using SoftPAP=2 to help with the snoring, but there are significant flow limitations going on at the same time. I expect they are inter-related. I cannot suggest a new pressure range without knowing to what the current settings are configured.

When you do repost the chart, please replace Tidal Volume with Respiration Rate.

[alexdw1]

Please see I have 2 graphs where I set minimum pressure 5:
   

Minimum Pressure 6:
   

Upping the minimum pressure took VS from 200 to 100.

[PeaceLoveAndPizza]

I believe you fall into the category of being able to get a low AHI at low pressure, but it is not enough to deal with the snoring and arousals.

I suggest as a starting point the following:

Min pressure 8
Max pressure 12
SoftPAP 2 full-time
No ramp

That should tell us quite a bit as to whether the additional pressure will reduce the VS and FL events, and how it will affect the arousals.

After a few nights we can start tweaking from there.

[alexdw1]

Thanks so much for the advise.  Today was the first day of using OSCAR, it's really great!  I will take your advise about increasing pressure and post the results.

[AshSF]

I was in a similar situation when I started out (low AHI on min pressure of 4cm and max of 12). I titrated it to 6-11. But I was still not getting a "restful" sleep.

What worked for me finally was going to a fixed pressure of 8cm. On reading some research papers, it came up that upto 17% of Cpap users can't deal with variable pressure. It messes up the sleep architecture (less slow wave and less REM sleep). Thus even with low AHI, you feel like crap the next day.

If titrating to a close range does not work, then I would set the machine to a fixed pressure (or APAP mode with min=max) of your 95%ile pressure and evaluate after 1 week.