New diagnosis and new to CPAP

[obstructiveindividual]

Hi all

30 year old male, BMI 28
Years of unrefreshing sleep, daytime sleepiness
Initially told "too young", "wrong body type" for sleep apnoea

Recently diagnosed with mild-moderate obstructive sleep apnoea average AHI 12/hr but 20/hr during REM sleep

Currently 3 weeks into CPAP. Have been trying to educate myself as best as possible

Current issues
- ongoing fatigue
- aerophagia whilst increasing minimum pressure (my understanding is to roughly target at 2mm H20 below average), burping whilst trying to get to sleep, gassy following morning

Goals
- daytime energy ASAP. Really affecting work, social life

Current settings
- mode autoset
- pressure 7 to 13
- ramp off
- response soft
- EPR ramp only level 1
- smartstart off

Have attached a recent OSCAR upload - have started using this in the last week
Looking forward to some insight - the forum has already been a wealth of knowledge

Thanks in advance

[CPAPfriend]

Enable EPR full-time at 1cm. Go to 2cm if the results are in the right direction, then 3cm. Your events are resolved, by and large, and the therapeutic response to your residual flow limitation is to enable / increase pressure support (EPR in your case). Also worth trialing, though make these changes one at a time and give them as much time to gather their own data as you can tolerate, but also worth trying is setting your pressure to fixed about 2cm below 95th or ~8cm.

As noted by you, your apnea is worse during REM, which is in line with your persisting daytime symptoms and the pattern of flow limit in your readout. You're likely getting kicked out of REM excessively.

[obstructiveindividual]

Thank you that's really helpful

Do you mind breaking down what you mean a little further - are you saying it might be at this point my own response to the pressure that is kicking me out of REM rather than obstruction itself? And therefore EPR support might help keep me asleep more reliably?

Am still trying to wrap my head around some of the concepts and jargon haha

Thanks

[Deborah K.]

I suggest you raise your minimum pressure to 7 and set your EPR to full-time use set at 3.  If you can, turn off ramp, but if you feel you need it, set it for 10 minutes at the most.  These changes should improve your therapy and your comfort.  Try it, tell us how you feel tomorrow, and post another chart.  Good luck!  

[obstructiveindividual]

Thanks both

I have started moving towards the recommendations

Last night I set my minimum pressure to 7.8cm H20 and EPR to 1
Have attached chart

Nil major differences re daytime energy, may be coincidence but did remember a couple of dreams which is rare for me!

Tonight I plan to increase minimum pressure to 8.0cm H20 and EPR to 2

Thank you

[obstructiveindividual]

Have further increased as planned
Appears I had another apnoea last night - does increasing the EPR often mean that the pressures will need further increasing? Presumable my expiratory PAP will now be slightly lower
Unless there are new suggestions based on last nights info I will continue increasing my EPR to 3

Thanks all!

[Melman]

With a minimum pressure of 7 or higher you will get the maximum respiratory pressure reduction of 3. A further increase in minimum pressure is not required in your case to maximize the benefit of EPR.

[obstructiveindividual]

Thank you

I have now made it to a pressure min of 8cm H2O and an EPR of 3
Am still feeling groggy in the morning and tired during the daytime


I know for some people it can take a while for things to start feeling better but would be grateful for some opinions on my OSCAR charts and any identifiable issues or PAP tweaks to be made

I have been reading about UARS and am also interested to know whether my REM sleep looks any better - are both of these things able to be interpreted from OCAR?

Thanks for everyone's help so far

[Deborah K.]

Your most recent chart looks better. Do you feel any better?

[obstructiveindividual]

Honestly haven't noticed any changes yet. Still feeling groggy in the morning and low energy during the day
I understand it can take a while to start feeling better - is that true even after the settings are optimised?

Also noticed am still having a couple of apnoeas - is it realistic to aim for zero or is it ok to have a couple throughout a whole night?

Thank you