Sander's therapy thread

[Sander]

Hey everyone! First of all, thank you for taking the time out of your day to look at this thread and potentially help me. 

I'm a 19 year old guy that was diagnosed with sleep apnea about 6-7 months ago. My AHI during my WatchPAT test was 57 (49 OA/8 CA), so I was diagnosed with severe obstructive sleep apnea. Following that I was given a Resmed airsense 11 autoset and was put on a constant starting pressure of 8. I was able to succesfully adapt to CPAP right away and slept with it the entire first night.

I didn't have any problems getting used to CPAP, but I wasn't really getting the effects that I wanted yet. I was still incredibly tired each morning, felt groggy and had low energy levels, even after multiple weeks. This caused me to speak to people on a Dutch apnea forum, explaining my problems. They informed met that increasing the pressure may be useful. Changing the pressure didn't really do a lot in terms of the effects that I wanted. I've increased the pressure more and more overtime to hopefully feel better, but to no avail.

I've noticed that I have quite a bit of central apnea events and mostly during the last part of the night, right before I wake up. I've figured this is why I wake up feeling so tired. What could I do to improve the situation?

I've attached screenshots from OSCAR below.

[Phaleronic]

Welcome to the forum Sander

You're having some leaks throughout these charts and it looks like some clustered CA events, likely bad positioning during sleep causing the ca events and leaks to spike. For now I would turn EPR on 2 to see if this helps, as well as trying a flat pillow and if the CAs continue maybe a soft cervical collar.. Other members will chime in too I'm sure and give their advise as well (good people in here). Glad you posted a thread!

[Sander]

Thank you Phaleronic! I always like to learn the science behind facts and advice, so could you explain how EPR/PS could help me? I know it's something to with ventilation, but other than that I don't know how it works.

If EPR works good, should I try getting my doctor to prescribe me a BiPap?

Also another question, if I turn EPR to 2, would I need to increase the pressure with 2 as well?

[Deborah K.]

Turn your EPR up to 3.  You don't need to change your pressure in response to changing EPR.  

Did your doctor prescribe the Cpap setting you are using?  You can switch to Apap and set a wider level of pressure.  Your machine will only go as high as you need, so you don't have to worry about that.  If it were me I would switch to Apap with a pressure range of 9-15.  It's up to you but I think that might be more comfortable.

[Sander]

Thank you Deborah. My doctor described a constant pressure of 8,6 or something like that. I increased it myself, because I wasn't seeing the effects that I wanted. Do you think APAP will be suitable if I have quite a few CA events?

[Deborah K.]

Apap use won't affect CAs. Did you have a lot of CAs in your sleep study? If not, they are treatment-emergent and will diminish on their own as time passes.

[Sander]

I did have CA events but the majority was obstructive. 8 central events vs 49 obstructive. 

This night I slept with EPR of 2. The effects weren't really noticable yet, AHI was about the same and I felt awful like usual. Do I need to turn EPR to 3? And then, should I try increasing the fixed pressure to get the remaining obstructive events away or just try APAP?

[Deborah K.]

I say raise the EPR to 3 and switch to Apap mode with a pressure range of 9-15.  It's worth trying the change.  I think you will find it more comfortable.

[Sander]

Done! We'll see how it works, I hope it does improve the situation

[Sander]

Another day, another post! I have switched EPR to 3 and àm now using APAP mode. Unfortunately there wasn't really a change in terms of score or my feeling after waking up. During the night I did wake up with a sore throat and I noticed my AHI was 7, so I upped the pressure to 10-15. 

What can I do to further optimize my therapy?