New Apap user

[Lovableluciferian]

Hey everyone,

I had a general question about my treatment.  Before that here's a little background.  I'm a 36 year old male who has probably had sleep apnea for 20 years if not longer.  After battling with my insurance for two years I finally got a diagnosis.  After I found out it was actually cheaper for me to buy a cpap than to rent one from my insurance, I bought a new shiny airsense 10 autoset and airfit 20 mask online from easybreathe.  

The change in my life was dramatic from day one.  More energy, better mood, etc.  For the first week I left everything on default settings.  I noticed I would be woken up if the pressure went up past 10 so I tried lowering the top end pressure to 8.6 for two weeks.  My AHI looked good but after having an episode of choking and sleep paralysis I bumped the high end up to 16.  I did that for a week, looked at my 95% percentile pressure and put it down to 13.  Things were okay at 13 but I really had to keep my mask super tight and it was a lot harder to fall asleep.  I moved my pressure to 10 on the high end and while my sleep improved dramatically my numbers are a lot worse.  Going from 1 to 3 AHI to 4.5 to 5.5.  I recently downloaded OSCAR and while it's an amazing tool, I noticed some people will get fixated on making their treatment perfect at the expense of how they feel.

So with that out of the way, is it okay to have an AHI of 4 to 5 if you feel great or is it better to get it down to 1 to 2 AHI and feel almost as bad as not having cpap?  I'd like to avoid getting in to weeds too much but I do have OSCAR data for the past 4 nights and I can post screen shots if you guys think it will be useful in giving me advice.  Thank you all in advance, I've seen how you have helped dozens of people figure out their treatment here and ask for absolutely nothing in return.  It's very kind and should be recognized.

[staceyburke]

Welcome to the board. There are a lot of very knowledgeable people on the board that will help you. But to be of help we need to see OSCAR charts. See the last link in my signature for charts, it gives info on OSCAR (free download at the top of the site.

Be sure your flow limits are included in the charts. It sounds like that MAY be the problem but there is no way to know for sure without Oscar.

[Lovableluciferian]

Okie dokie

[Gideon]

You left off the most important Flow Limit chart. Your Flow limits are out of sight. This, as Stacey suggested is best handled with EPR which you have off.

You are correct in that comfort stumps all, but let us try for that comfort while directed by your data.

Set Min Pressure = 7 as this allows EPR to fully work.
Set EPR = 3, fulltime. This is the max value for EPR but your Flow Limits are really bad and I want to hit them hard.

Do this, I assure you it will be better than your current settings. Your min pressure will actually be 4 so lower than it currently is.

[staceyburke]

I of course agree with Gideon about EPR but I see a little bit of positional apnea also. Positional apnea is when your chin drops down to your Sternum cutting off your airway. There is NOT major positional apnea but sometimes for you to watch. 

If you are sleeping on your back try to stop. If you have more than one pillow or a very high pillow - trade it for a flatter pillow. If positional apnea continues you may need a collar. There is a link in my signature on collars. Take a look at it. 

Again your main problem are the flow limits please follow Gideon’s suggestions.

[Lovableluciferian]

I apologize for missing the flow chart.  I'm still new to all this.  I'll try to find it and post it.

[staceyburke]

Your flow chart is in the 3rd chart you posted. But the link to charts in my signature gives the ones we need to see together. All other we would ask for if needed.

[Lovableluciferian]

Also I will have to work my way up to EPR 3 because I tried it earlier on and -hated- it.  It felt like my breathing rhythm was wrong and gave me a mild choking sensation. I will start tonight with EPR of 1 and lower limit of 5.8.  I'll work up from there.

[staceyburke]

EPR only decreases the min number on exhale. For instance if you have the min 7 Epr 3 your exhale pressure is 4. Your inhale pressure is the min 7

If you set it at the min 5.8 and EPR 1 Your exhale pressure would be 4.8 and exhale is the min 5.8

That will not do much but this is your therapy, do what you wish but know what you are doing and not just change numbers.

[Lovableluciferian]

I didn't think it would improve my treatment.  I was hoping it would get me used to EPR so I could move up to the setting Gideon suggested in a week or so.  Perhaps there is a better way to get used to EPR?  I'm not changing numbers just to change them.  I'd just as soon leave it on my old settings if building up to the newly recommended settings is bad or counter productive.