Low AHI but ongoing sleep fragmentation (oscar data attached)

[theswerve]

Hi all, 

I recently had an in lab sleep study completed (AHI 16.9 without any treatment, some central apneas, full results attached). 

I've started reusing CPAP. In the past APAP fluctuations would wake me and I do better with a fixed pressure I think. After reading this forum for a while now, I recognized clusters of apneic episodes and started recently wearing a cervical collar too, which has lowered my AHI with CPAP from around 5-8 to 2-5. 

However, I continue to wake up a number of times through the night. I sleep fairly continuously on most nights from bedtime around 11:30pm to around 4-5am when I first wake up to urinate (I'm in my 30s) and from there wake up briefly anywhere from 3-4 to 10+ times until 8am. This hasn't really changed despite lower AHI scores. I've tried adjusting EPR from 0 to 1 to 2 back to 1 without any discernible difference. 

I've attached oscar screenshots from the last two nights with epr 2 and 1. I would hugely appreciate any thoughts.

[Deborah K.]

It looks like you are using ramp.  Unless you can't get to sleep without it I strongly suggest that you turn it off.  You get virtually no therapy during ramp.

I also suggest that you turn your EPR up to 3.  You are having high flow limits, which are sort of like small apneas, and we need to lower them.  Sometimes this will cause an increase in CAs, but let's try it for now and see what happens.

I see that you are using Cpap mode.  Did your doctor suggest this?  Most of us use Apap mode with a range of pressure.  Doing this, at least at first, shows us just what range your body needs as your breathing changes during the night.  The majority of us stick with Apap, but some prefer no pressure change at all.  I suggest that you switch to Apap mode and set a pressure range of 8-15, then we can re-evaluate.

As to waking up so often, it's good that you are not removing your mask each time.  Lots of folks find this a difficult time as they get used to having a foreign object strapped to their head and face and having air blown up their nose through a hose.  It will pass and you'll start to feel better and better. Truly.  

[theswerve]

Thank you so much Deborah! 

I tried autopap over a year ago briefly (5-15) and would wake up from the high pressure fluctuations so I've been a little hesitant to try it again. I tried EPR 3 with CPAP 8 last night and seemed to be doing worse overall (more OA, CA, and hypopneas and higher flow limit - I have the oscar data attached). I tried to turn ramp off but I fall asleep easier with it on than off. 

Should I increase CPAP pressure, or try autopap (maybe 8-10 since higher pressures would wake me in the past)? 

Thanks again!

[Deborah K.]

I think autopap set at 8-10 would be good for now.  The other two nights you showed a little Positional Apnea, but last night you had quite a lot,  PA shows up on your charts when you see clusters of apneas bunched up together.  PA means you are sleeping with your chin tucked down towards your chest.  It causes something like a kink in a hose, but the kink in your neck reduces airflow rather than water flow.  Some people are able to correct this by sleeping on a flatter pillow.  Others buy and wear a soft cervical collar, which, when the right height, holds your chin up for you.  Your high AHI last night was due to the PAs.

It would also be good to lower your flow limits.  To do this Change your EPR setting to 3.  Flow limits are like small apneas and it's best to keep them low.