Optimization assistance

[DocButNotSleepDoc]

Hello all,

I am new to CPAP in the past few months and have been struggling to get things optimized. 

38M, 5'7", weight fluctuates from 170s to 180s, been a heavy snorer for 10+ years, otherwise healthy. About 4 years ago my wife "asked" me to stop snoring so loudly. At the time I decided to try a mandibular advancement device that my dentist fit for me and I had complete resolution of my snoring. No sleep study was done. Cut forward to April 2024 and my mouth guard broke. I do nothing, until my wife "asked" me to get a new mouth guard and made me an appointment. This time the dentist recommended I get a sleep study. I completed the home sleep study that night, and the following week received my results. Severe obstructive sleep apnea with central sleep apnea observed. Now at this point I start to think about and realize that I am tired all the time, have headaches every day, never wake up rested, and wonder why I haven't considered taking care of this sooner. During the initial sleep clinic consult, we agree to start with CPAP and see what happens. 

I was given the ResMed AirSense 10 AutoSet machine, and started with the P10 mask and medium cushion, set at 5-20 cmH20, EPR 3, auto ramp time. I struggled a lot to balance comfort and low leaks, and continued to feel like sh*t, and my AHI scores were 10-18. At the follow up appointment with sleep clinic, they noted that I was about 50/50 obstructive and central apneas, so they were going to change my pressure settings to 11-13 cmH2O and wanted me to get an in-lab sleep study for definitive diagnosis. 

In the time that I am waiting for the lab study, I am tinkering with masks trying to do my best to get the fit right, eventually settling on the F&P Evora full. I followed the advice here about mask fitting and was able to get my leaks down, but still having AHI scores 10-15. I read a post that recommended turning off EPR to see if that helps. I try it and immediately my AHI scores are cut in half, now 5-10. I am still working on tweaking the fit, but I am at a point where I have a mask that I feel is actually working as intended. 

My in-lab PSG shows severe OSA with no significant central apnea, and no deep (NREM 3-4) sleep. What brings me here today is that I am still hovering around AHI of 5, still no deep sleep, and still with daytime symptoms. I'm looking for advice on how to take my CPAP settings into my own hands with my OSCAR data. I have posted my lab sleep study, and OSCAR data from last night as this is pretty consistent. I appreciate any and all advice, and apologize for my longwinded post.  

Sleep Study
   
   

Oscar 
   

[G. Szabo]

I ssuggest the follwing settings:
pressure minium: 12.6 cm
Pressure maximum: 16 cm
EPR: 1  


It is expected that with this setting you will have lower flow limit which should be decrease along with the OAs and Hs. Your CAs might increase for a while. But eventually you might want to increase the EPR to 3. 

Would you mind posting the outcome? You might need some more adjustments.

[DocButNotSleepDoc]

Thank you for the recommendations, G. Szabo! I am late in posting updated data because I was suffering from a head cold and didn't want that to skew the data. As you can see there have been improvements! Of note, during this time, my sleep clinic recommended that I do CPAP at 13 cmH20. I tried this for 2 nights and the results were poor, so I went back to the APAP 12.6-16. Also, I seem to do better with EPR at 0. I appreciate any further insights anyone has to offer and I appreciate all your help.

   

[SarcasticDave94]

Just note that most of your events were Hypopnea with 19 Central Apnea, and 1 Obstructive Apnea, zero Mixed.

Hypopnea weren't separated into Central vs Obstructive, typical. You do have some susceptibility to the Central based events. Now they didn't see that CA are significant, and they might not be, but that possibility is there.