xiaopigu - Help with CPAP Settings

[xiaopigu]

Hi everyone,

I am needing help with titration! I  got diagnosed with mild OSA at the end of June this year, with an AHI of 8.0 and a respiratory disturbance index of 14.8. I got sent a Luna G3 which I used from the 1st of July until the 17th of July, when I was able to swap for a resmed 11. My doctor prescribed a range of 4-20, which I did on the first night and had a terrible experience with aerophagia and a CAI of 5.8 with an AHI of 8.8. I was concerned about it, and asked in r/cpap and was suggested to lower the range to 6-8. I did that and eventually settled on 4-7 after a few days, and my AHI remained around 2-3.

After I swapped for my resmed 11, it was preset to the doctor's px of 4-20, and so the night of 7/18 I had an AHI of 8.0, with a CAI over 6. "No problem," I thought, I would just set it back to 4-7 like I did on the Luna G3. So imagine my surprise when I woke up today and saw an AHI of 6.62 and CAI of 5.18. Is this normal? Is there anything I can do to tweak my pressure settings? Unfortunately on the 18th I didn't have my SD card in, and so I will put the Luna G3 data for  July 1-17 below, and Oscar data for July 19th[attachment=67238]. I would appreciate any advice!!!

Luna G3
July 1 (start date)
AHI: 8.8 / Pressure: 5.5 / P95: 6.0 / CAI: 5.8
July 2 
AHI: 5.8 / Pressure: 6.0 / P95: 6.5 / CAI: 4.6
July 3
AHI: 6.4 / Pressure: 6.0 / P95: 6.5 / CAI: 4.6
July 4
AHI: 2.4 / Pressure: 6.0 / P95: 7.0 / CAI: 2.0
July 5
AHI: 1.0 / Pressure: 5.0 / P95: 7.0 / CAI: 0.4
July 6
AHI: 2.2 / Pressure: 5.0 / P95: 7.0 / CAI: 1.6
July 7
AHI: 2.0 / Pressure: 5.5 / P95: 7.0 / CAI: 1.4
July 8
AHI: 3.4 / Pressure: 5.5 / P95: 7.0 / CAI: 2.2
July 9
AHI: 3.2 / Pressure: 5.0 / P95: 7.0 / CAI: 2.2
July 10
AHI: 3.2 / Pressure: 5.0 / P95: 6.5 / CAI: 2.6
July 11
AHI: 2.6 / Pressure: 6.0 / P95: 7.0 / CAI: 1.6
July 12
AHI: 0.8 / Pressure: 6.0 / P95: 7.0 / CAI: 0.4
July 13
AHI: 1.8 / Pressure: 6.0 / P95: 7.0 / CAI: 1.4
July 14
AHI: 2.2 / Pressure: 5.0 / P95: 7.0 / CAI: 1.4
July 15
AHI: 1.2 / Pressure: 6.0 / P95: 8.0 / CAI: 0.8
July 16
AHI: 4.0 / Pressure: 5.0 / P95: 6.5 / CAI: 3.6
July 17
AHI: 2.8 / Pressure: 5.5 / P95: 7.0 / CAI: 2.4

[staceyburke]

On a cpap it is hard to be sure that the centrals are all centrals.  The machine gives several small bursts of air and if the air is returned it is a Obstructive Apnea is they are not returned they are then classified as Centrals.  If you were in a sleep lab they have you hooked up to many sensors and a belt around your chest to tell which it is.
 
I see a small set of Oa that would tend to be positional apnea and I would guess quite a few of the centrals that are grouped together could be also.
 
.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

I would suggest a change in your pressures however.  You have EPR (exhale pressure relief) set for Full Time 3.  That will not do anything with the setting you are at.  The absolute lowest any cpap can go is 4.  The min is the inhale pressure and EPR is subtracted from the min for you exhale pressure.  With min of 4 there is nothing to subtract as the machine can only go to 4.  I would suggest a min of 7 (min 7 – EPR 3=4) and a max of 10.
 
Min 7
Max 10
EPR Full time set to 3

[Phaleronic]

Stacey is right to raise the pressures, if you're keeping epr on at 3 and want to get those CAs cleared I would raise min to 8.2cm set max to 15cm a bit more than the suggestion but I want to see if you need a higher limit of pressure overall.

I just saw that you are having bad aerophagia so go with the settings Stacey suggested for now.

[xiaopigu]

Thank you and Stacey for your advice, I’ll try for a few days and report back!

Do yall have any advice for how to talk to my doctor about it? I get pestered to keep the settings at 4-20 and was told to call my doctors office to get a changed prescription, and so I called but haven’t heard anything back for a couple weeks

[Phaleronic]

Sure thing xiaopigu, well you can't effectively use EPR with min pressures under 6-7cm, so you're not utilizing the machine correctly at 4cm min, you can tell your doctor that and gauge his response (I don't like sleep doctors-too many bad experiences with them personally, as well as my family members').

[xiaopigu]

Oh, the doctor prescribed low of 4 and high of 20, which I found out is a pretty standard and very generic prescription which didn’t fill me with confidence, especially after the respiratory therapist said that the doctor specially prescribed that for me after looking at my sleep study results.

[HalfAsleep]

The doctor didn't specially prescribe those pressures for you. They're the default setting of the machine. And, yes, the DME will argue that it's some kind of special prescription. We have heard that line before! Actually, it's the "lazy doctor settings".

Also, if the DME and doc see you're being compliant and your AHI is below 5, they're not going to care. Those data points are how they get paid.

[Deborah K.]

Did you have a lot of CAs in your sleep study?  If not the CAs are treatment-emergent and will lessen as time passes.

Also, you don't have to use the settings your doctor set.  They want to be in control of your therapy because they make money that way.  You can easily change the settings yourself to the settings suggested by Stacey.  You have every right to do so.  

[xiaopigu]

Good question. My sleep study (I used Lofta’s home study) just gave me an AHI of 8.0 and a Respiratory disturbance index of 14.8. I tried the settings Stacey gave last night and got an AHI of 4.8 and a CAI of 4.7. I did wear a soft cervical neck brace.

[Deborah K.]

If you have a copy of your sleep study, post a redacted copy here. If you don't have a copy, ask your doctor to give you one. They have to give it to you by US law.