New CPAP user - almost all CSAs and some CSR

[Belladonna]

I had been snoring off the charts (according to SnoreApp) and was perpetually tired, so I had a home sleep test in February 2021. I was diagnosed with "minimal to mild OSA", with results showing AHI of only 3.5, with slightly higher RDI of 5.4. Since it seemed so mild, I opted to try a MAD (mandibular advancement device) in hopes that there was just some mild obstruction that could be corrected with it. The device did help my snoring a bit (per SnoreApp), but I still had trouble staying asleep and never feeling rested. Fast forward to this summer when I shared a hotel room with my sister who told me my snoring was insanely bad - and this was with the oral device I'd been using for years. My husband never mentioned my snoring, most likely due to him having used a CPAP for years and sleeping soundly with it. Possibly important to note that I'm a female and not overweight (5'6", 130 lbs - BMI 21). 

So I went to a sleep doctor who looked at my 2021 test results and suggested I try a CPAP, with no new sleep test needed. I received my CPAP (Resmed AirSense 11) on October 10, and have been using it ever since. I was given a P10 mask with it, which I had a lot of trouble adjusting to due to the pressure on the lower part of my nostrils. I've since started using a p30i which is much more comfortable for me. I've been tracking my CPAP reports with Oscar, and have become a bit concerned about 2 things: 1) my AHIs are 96% CA's (clear airway) - average 4.72, vs 0.19 avg OA's and 2) I've had 3 episodes of Cheyene-Stokes (though it's 0.39% of total time).

I have yet to see my sleep doctor for a follow-up, but I have an appointment in 2 weeks for this. However, on my initial visit my doctor seemed quite distracted and dismissive, so I would like to solicit the expertise of you folks so that I'm better informed when I see her. I'm not sure which screenshots to include, so here's a shot of last night's report, along with info from the Statistics tab. Current settings are "Autoset for Her" 6-18, EPR 3, ramp auto, climate auto. I have a Wellvue Sleep O2 monitor, which I've worn a few times so there are some stats from this as well. (Note that I was traveling from 11/3 - 11/23 using an AirMini, so there's a 3-week break in my usage.) 

I'd appreciate any insight you can provide!

       

[Belladonna]

I'm the author of the above post, replying to it in hopes of bumping my request for help. It's my first post and I know you folks are quite busy, so I just want to make sure it gets in the queue. Thank you!

[SarcasticDave94]

Sorry we all missed it.

What I would try is this, first if you can tolerate it, increase minimum to 7. Try it a night. Post again with the OSCAR chart, and tell us if it felt better. You have some CA and these may be just CPAP induced. As such they should get lower with time.

Increasing minimum to 7 should help EPR 3 work fully. It should also reduce Obstructive Apnea and Hypopnea.

[super7pilot]

A lot of folk who just get started on cpap (me included) deal with CA's. After I started to concentrate on slowing down my exaggerated breathing due to inhaling under pressure then suddenly having all that pressure removed was one of the reasons that CA's showed up when they weren't present on my sleep lab results. Those are called treatment emergent CA's.

So that brings up a question that needs answering. And you DO want to ask in your upcoming appointment. Did you have CSR's and or CA's in your sleep study?

I suspect not as the prescribed machine would be the airwave not the airsense to fix real CA's and CSR's. But I of course am not a doctor.

That might be why folks haven't responded and made settings suggestions.

[Deborah K.]

I suggest you turn ramp off. You don't need it anymore. During ramp you get no real therapy, and anytime you get out of bed and return, ramp starts again, robbing you of more therapy.