New user struggling with treatment

[bsroberts]

I (31M) am a new CPAP user. I've never snored, I'm fairly active, and I'm not overweight but I've been told I breath very shallowly. General daytime fatigue and sleepiness despite getting 'enough sleep' (8+hr) led me to ask my physician about a sleep study. In October I was diagnosed with moderate sleep apnea (AHI ~16) on a Virtuox at-home test. 

In January I finally got an APAP (pressure 5-20 cmH2O) and it has been pretty rough ever since. I've tried a few different masks (N30i, p30i, F30, N20, F20) and I've generally come back to the F30 for comfort and seal quality. I've been consistent in using the machine every night since receiving it, and initially I found I was feeling better - more energetic and less foggy. But after a few weeks I started to regress. I'm finding now that I'm getting AHIs in the 1-3 range on most nights but I feel as bad as I did before starting treatment. 

I've started looking at my data in OSCAR and I see a lot of Open Airway events most nights. I'm wondering if I have complex Apnea, either as a result of treatment or at baseline.

I'm looking for some advice on how to proceed - what changes could I be making to my treatment to reduce Clear Airway events or more generally improve things? I've attached two screenshots from OSCAR of representative nights - one worse one better.
       

[bsroberts]

I haven't followed up to this post in a while but I was still hoping for some advice.

Since my last post I've made some adjustments to my treatment based on the somnologist.
He advised I try CPAP for a little while and recommended a pressure of 5 cmH2O with EPR 1, based on my APAP pressure statistics and the fact that I really dont have much in the way of OAs. I've also started using a slightly more comfortable F30i mask and I've tried propping myself up with more pillows (which seems to help but, eh?)

I've played around with that pressure a bit in the past month, trying a set pressure of 5, 6, and 7, with small adjustments to EPR, but I havent found the changes to make much of a difference. Sure, I've had a few good nights (AHI 1 or below) but my AHI and sleep quality vary widely day to day.

To me, it looks like I consistently experience post-arousal central apneas - many of which arent flagged by the machine.

After almost four months I'd expected to feel better than this, but maybe I'm still getting used to my therapy?

I've included a screenshot of my most recent night from OSCAR and a link to my SleepHQ data. I'd appreciate any advice.

4-19: https://sleephq.com/public/20f658f4-3d82...ee7bd1528c
4-18: https://sleephq.com/public/d9f43145-024b...69fee36c1d
4-17: https://sleephq.com/public/caa3bd8c-1dd6...149bcd1fbb

[joeblough]

i don't know i can give any advice - my numbers and graphs look extremely similar to yours, including CA-dominated AHI and extremely low OA AHI. but i don't feel a lot better despite a couple months of treatment. instead of being deathly fatigued, these days i am headachy and dizzy. i guess it's better but still not good.

since my AHI was pretty mild i have gotten an online rx for the Bongo RX EPAP and i'm going to see how that goes. i've got a watchpat ready to go so i can wear it while using the Bongo RX and see how my numbers look with the epap.

[bsroberts]

Good luck, please follow up after you’ve had a chance to try it out! It sounds like a promising solution.

[staceyburke]

Your pressure is set to 6 fixed.  That is so low that most adults would have a hard time getting enough air.  With it being fixed your pressure can not go up even if you need it higher.  Why is it set like that, did the Dr. set it or are you just guessing at a setting?


What I would suggest your setting to be:

Min 8
Max 12
EPR full time
EPR 3

Your flow limits are high and fl are apnea.  The only difference is length of time the apnea is.  For an H or O event it must be at least 10 seconds to record as an event (O or H).  If they were 9 seconds for example they would be a flow limit.  The settings I gave you should stop most of the flow limits and not raise your pressures very much.

[bsroberts]

My doctor suggested 5 and EPR 1 a few weeks ago after reviewing my APAP data. When that didnt help very much I started raising it a little based on some other recommendations online. But maybe 6 and 7 was still too low.

I’ll try your settings and see how things go, thanks!

[Expat31]

It would be a good idea to take off the calendar so we can see all of your data when you repost.

Thanks

[bsroberts]

Removed the calenda to show my full data. 

I dont remember taking my mask off but ?‍♂️
Here's my SleepHQ from last night at the new setting: https://sleephq.com/public/04fd8970-56c6...2efcb6db48
And my OSCAR as well.

[Expat31]

With ths exception of central apneas, your graphs look pretty good, and the
recent setting changes bave borne their fruit. 

Flow imitations are  now well controlled with EPR, apart from a quick burst at the beginning of the night. 

No leaking problems either. 

In your sleep test, was there any reference to any  centrals?

You mentioned shallow  breathing, has yout lung  capacity been  checked out? Or at least a Peak Flow test performed?

I am guessing here, but, could increase your minimum pressure to say 10 to see what happens.

[staceyburke]

So now the main question is How are you feeling?  Better, worse or the same?  Was your night more or less restful?  You numbers look good. The number of central events will go down as your body adjusts to the therapy.