New to CPAP, again

[SarcasticDave94]

Probably the MyAir app would tell you just using CPAP gets good grades. I never found it to have meaningful analytics.

OSCAR charts are definitely the one to monitor.

You had a small amount of large leak, indicating an occasional leak issue. Keep an eye on mask seal.

Your events are a bit too high yet. Your goal is an AHI under 5. I don't see your CPAP settings, so generically here's a few things. You may want EPR full time, maybe needing EPR 1 to start due to the CA flagged. Later try EPR 2 then 3. Probably separate nights each to find which felt better and lower events. This may add to CA, possibly that adding CA but reducing the other stuff.

Also you may want to begin increasing pressure slowly to 8 to see if that helps reduce all events, keeping CA separate from the rest. So said because CA are opposite type treatment actions in most cases, than would be the rest of the events.

[Grogu]

Thanks @SarcasticDave94

Right now I have my ERP setting on 3 fulltime and must say that I'm really loving that setting. My main "issue" last time on CPAP was that I felt like I couldn't exhale and that there was so much forceful pressure coming in that I felt like I was suffocating. I would just rip off the mask most nights, so 3 feels good, but if it's causing issues, I can definitely change it.

My other setting right now are:
Range: 7 to 16
Ramp: 15 (going to eliminate this over the next week)
Auto heat and auto humidity

Do you think I should change the range to something like 8 to 13? Would that make a difference with the AHI?

I also see that there is a wiki here on getting a good face seal. I'm definitely going to look into that tonight before I go to bed.

Thanks again!

[SarcasticDave94]

You can do it that way, with pressures. As in moving both Min and Max up. They only need to go up enough to lower your events.

[Deborah K.]

You have Positional Apnea.  PA cannot be fixed with a setting change.  You can see PA on your chart where you see obstructives and hypopneas clustered together.  This is caused by dropping your chin toward your chest.  It hinders airflow the same way a kinked hose hinders water flow.  Some people can correct this by sleeping on a flatter pillow, but most need to wear a soft cervical collar.  Most drugstores carry a few and Amazon carries loads of them.  Lots of us like the Caldera Releaf Collar, available on Amazon, because it is very comfortable, but for men with long necks that may not work.  Lots like the Velpeau collars, which probably would work too, and they have higher sizes.  Getting the PA under control will drop your AHI.

You can stay with 7 to 16 pressure if you like, but I suggest you change to 9 to 14 because your median pressure is a bit over 9 and you don't need pressure as high as 16.

As to EPR, it's up to you.  I think EPR 3 is good because it's more comfortable and, more importantly, it lowers flow limits, which are good to get as low as you can.  The CAs may go up a little, but I think keeping the flow limits down is more important.  Dave has been around longer than me, so I suggest you try what each of us has suggested as to EPR and see what works better for you.

[Grogu]

Thanks Deborah K!

I'm going to read more up on positional apnea and look into a collar.    Could the positional apnea have anything to do with sleep position?   The only reason I ask is that I noticed in my titration report that I have double the events when I'm on my side.

For tonight I'm going to change the pressure to 9  to 14 as you suggest and keep the ERP at 3.   I really like being able to exhale.  In a few days if the AHI if unchanged, maybe I'll try ERP on 2.   I'm also going to try to sleep on my back tonight and see what happens.  

Thanks again!

[Deborah K.]

Yes, positional apnea can be worse depending on sleeping position.  Some do better on their sides, but many tip their chins even worse on their sides, especially if they sleep in a fetal position, which I'm guessing you do.

I sleep on my back on a pretty flat pillow that tips my head back slightly. That solves PA for me.  Maybe regular back sleeping will solve it for you.  I hope so!

[Grogu]

I probably had the best sleep last night that I've had in months, followed by the worst sleep 

I woke up at 2:30 am due to some knee pain and was off my CPAP until about 3:45 and then wore the machine while awake until about 6 am.   The second time period AHI was 11, but I was tossing and turning and had lots of leaks going on, it was a hot mess.  

I've attached the OSCAR report from the good part of the night (4.5 hours) and I'm super excited.   My AHI was .67 and I feel pretty good today.   I have been increasing minimum pressure all week and last night I had it on 9 to 13.  I've also been focusing on side sleeping (which I usually do anyways), but thought that might help with some positional apneas.  

So, I'm wondering if based on the attached, if I should increase minimum pressure to 10 and keep max at 13 (or maybe even reduce to 12).   I've been watching some videos online about CPAP versus APAP and I'm starting to believe what several popular YouTubers say about having a too low minimum pressure could result in undetected events and interupted sleep.  Some of these YouTubers promote the idea that CPAP is better than APAP.   My thought is that the lower limit of the APAP range is probably the more critical.   

Although, with 9 to 13, the first 4.5 hours of my sleep last night were pretty good, so I'm not sure if it's worth raising to 10.    The only reason I would think that 10 might be better is that 95% is @ 9.48.