Need help for improvement

[Booby2210]

Hope you all are doing well. First, I'd like to say that I feel so happy and fortunate to find ApneaBoard and you all to share experience with. Before this, I always felts like I am fighting this battle alone. Even my PCP and Sleep Specialist could not help much.

I was diagnosed with OSA and have been using CPAP for 2 years but my fatigue has not been improved constantly yet. It is like some days I feel good, some days I got fatigue and bad brain fog. I will see my doctor in 3 weeks and see what is going on but I don't put my high hope on it. I always use the nasal pillow and my average AHI is 3.5, usage 6.5 hours, no leaking reported. Even the AHI is below 5 but it never like close to 1. I think I am a mouth breather so I will try to switch to the full face soon. One thing I have noticed on the OSCAR is that my AHI is almost 0 during the first 3 quarters of my sleep then the remaining is like 15. Just wonder if the AHI rising in the morning happens to everyone

I think my sleep quality is also bad. I know the data from Fitbit is not totally accurate but it reports my REM and deep sleep really low like 45 mins or so. So, I try to exercise more to improve my sleep quality but every time I exercise and got tired my AHI increases then I feel tired in the next days again. So I am in a loop basically.

Also recently, my pressure has increased from 7-8 cmH2O to 13cmH2O and my snore increased from 3 to 14. Has anyone know if this indicate something?
Would you mind take a look at my OSCAR daily view to see if there is any thing I could do to improve my AHI and sleep quality

Thank you guys and hope you all have a nice weekend.
Stay strong all

[OpalRose]

I would move the minimum pressure up to 8cm for now.

A respironics machine is slower to react to apnea events than a ResMed machine, which makes your minimum pressure of 5cm too low to do much good.

Also, to clean up your graph a little, turn the VS2 flag off. As far as we can tell, they aren't really snores. Leave the VS flag on.

What Flex setting are you using? If using 3, change it to 2.

Give this a day or two to settle and see how it looks.

[Booby2210]

Thank you OpalRose. I will try it for a few days to see how it goes. 

Have a nice weekend

[stanleydean]

Welcome to the Apnea Board Booby2210, you have taken a significant step toward improving your apnea journey. OpalRose has given you good input and you should be sharing positive results with us soon.                  Stan

[Dormeo]

Welcome! A question for you: do you think you change the position in which you sleep toward the end of the night? For example, do you wind up on your back after side-sleeping in the earlier hours, or is your head on a different part of the pillow, or do you curl up into a ball after earlier sleeping in a more elongated posture?

[Booby2210]

Hi all, 

I changed the Min to 8 and the Flex from 3 to 2, and I felt like these changes it made the difference for the past 2 days. 
I was able to keep the mask on for the entire night and woke up much fresher. (yesterday I had to wake up in the middle of the night because my stomach issue).
I think it will take me a few more months to keep up with the amount of sleep that I lost. 
To answer Dormeo, I think I change the position toward the end of the night, and usually I curl up into a ball after earlier sleeping in a more elongated posture.
I attached the data of the past 2 nights. Do you know why the Flow Rate chart appear on some days?
I am really excited to improving my health, because I almost lost my job and my relationship because of OSA. 

Really appreciate your help on this.

[Dormeo]

Opal Rose sure gave you some good advice! Because you are apparently no longer experiencing flurries of events during the second half of the night, my questions are no longer much to the point. (But if the pattern reappears, you might consider uncurling yourself if you notice you've curled.)

I believe that when there are no events of a given type to report, the relevant line does not appear.

Yes, it can take some time to recover from months or years of lousy sleep, so I suspect you will continue to see improvement in how you feel as time goes by. And that will probably go quicker if you can start getting more than 7 hours of sleep!

[Booby2210]

Sorry I did not attached the second screenshot.

[Sleeprider]

Your results improved with increased pressure. With the Philip Auto CPAP we need to optimize that lower pressure because it is slow to reach an optimal pressure, and a little too quick to drop below it. Your current median pressure is 9.0, and the 95% pressure is 11.0 to 13.0. I think you are going to need at least 9.0 and probably 10.0 as a minimum pressure to effectively break the snoring and flow limitation we still see in these results. The AHI is already acceptable, so it's your choice.

Flow limitation is the root of your problems. It is an obstructive condition that limits the flow rate in your airway and leads to hypopnea and respiratory effort related arousal (RERA). You did not include the flow rate chart, and that is where we could see the impacts. That is why we want to see Events, Flow Rate, Pressure, Leaks and Snores. The AHI and Time at Pressure charts are not particularly useful. If you were using a Resmed Airsense 10 Autoset, we would use EPR (exhale pressure relief) to resolve the remaining flow limitation, but the Philips is a one-trick pony and Flex does not offer that option. Anyway, the solution for your residual issues is to slowly titrate in more minimum pressure until you feel the effect of reduced flow limits, snores and RERA.

[Dormeo]

Sleeprider, my recollection is that with PR machines we don't see a FL graph/chart, just the line up in the Events. Is that correct? Or is my memory scrambled on this? Thanks.