Request for help reducing AHI - Oscar data provided

[TrishaTX]

Good morning!  I'm a relative newbie, started APAP in September 2020, sleep test AHI was 89.   I use a Dreamstation/w humidifier with a WISP nasal mask, pressure range 5-15.  After my initial learning curve, my AHI has been pretty consistent between 3 and 5.  The only exception was when I had COVID, it was 20+, but went right back to normal when I recovered.  Lately, it's been creeping up into the 5 to 7 range.  It's allergy season here on the Gulf Coast and I'm affected by that seasonally, but on OTC meds.  

Is there something that I can do to try to reduce my events or should I give this more time to self correct?

Oscar screen from last night is attached.

Many thanks!!

[Gideon]

Welcome to the forum, but no OSCAR screen.
Two things
Make sure your flex is not =3 as many have issues at that setting. It may be ok.
Increase your min pressure as that is the solution for most events, especially obstructive ones. 5 is usually low for PR machines which typically need more pressure to head off events. Personally, I'd start mine at 7 or 8.

[TrishaTX]

     Thank you and sorry, I'm not sure why my attachment didn't take. I've added it. Flex is at 2.

[staceyburke]

I’m sure you will get some very good guidance on this post but I would like you to look about positional apnea.

Positional apnea is when you cut off your own airway. NO PAP machine can help positional apnea. You must find a way to stop cutting off your airway. It can happen in any sleep position but more often if you sleep on your back or use tall pillows.

In those positions you “tuck your chin down to your sternum, cutting off your airway.

You can try changing your sleep position but if that doesn’t work a collar is a way to keep your airway open.

At the bottom of the post there is a link on collars. In it there are Oscar charts from people without a collar and the same people with collars. You will see some charts much mike yours.

[Dormeo]

Trisha, I agree with staceyburke about the possibility of positional problems, given the clustering we see off and on during the night. Be aware that people can also chin-tuck if they lie on their sides.

PR machines are fairly conservative about raising pressure, especially in the presence of hypopneas and flow limitations, which are milder restrictions of the airway. For that reason, I would recommend raising your minimum pressure to deal with the Hs and the FLs. I'm going to bet you'd feel comfortable trying a minimum of 9, which is where your pressure is for a fair amount of the night already.

I'd also recommend turning off the ramp so that during the early part of your night you have the full benefit of the machine.

If you're game to experiment with those changes, I'd be curious to hear how it goes and to see another chart.

By the way, you might want to turn off the VS2 flags. They don't measure anything of interest, and they kind of clutter up the landscape.

[TrishaTX]

Thanks, all - I'm going to try all of this right away!

[Sleeprider]

Trisha, I think before enrolling you in positional therapy, I'd like to see you increase your minimum pressure. The Philips machines react to obstruction, and don't do a good job of preventing it. I think you need a minimum pressure of 9.0. I know that sounds a bit extreme since you are at 5.0 now, but let me make my case. Your chart shows you start out at 5.0 cm and immediately have a lot of snores and hypopnea that brings your pressure up to 11.0. That cleans up the obstruction, and the Philips CPAP starts dropping pressure, but goes too far, and as it drops back to 6.0 you have another cluster of hypopnea and the machine is incredibly slow to respond. It finally brings you back to about 8.5 cm and you kind of limp along with sporadic snores and hypopnea. Then at about 4:30 the machine brings you back to 8.5 and only a few events are present. At 6:30 that pressure goes to 9.0 and it looks better. Looking back, I see Dormeo is on the same page.

You need a minimum pressure of 9.0. I'm not a fan of Philips Dreamstation CPAPs for this reason and others, but you can get good therapy by taking this simple step.

[TrishaTX]

Thank you.  I'll try that tonight!

[Dormeo]

Glad to know I'm on the same page as Sleeprider -- he's the best!