Slept fully twice in 3 months since starting CPAP for CSA

[redking2436]

Good afternoon, since starting cpap in November last year I have slept through the night only twice and am slowly losing the will to live because of it.

A bit of background:
I have had issues with daytime fatigue costing me my job and social life since 2017 and gone down many rabbit holes and treating the apneas is the last treatable route. 
I had a sleep study in 2022 during which i had the worst migraine of my life and unsure if that could have skewed the results, but it showed an AHI of 10.7 and were central in origin.
At this point my really nice Dr retired and his replacement didn't even bother to reply to letters and as I was classed as mild sleep apnea was told to keep taking modafinil which i had already told them had no effect) and basically let go of.
After waiting for another local referral and despite being told they don't deal with non-standard apneas and if it was up to him he wouldn't treat this with CPAP but they may have a machine i could borrow, i was finally sent home with a mask and a machine.


And this is where I am now, I've been trying to adapt to the machine for 3 months however at the start of the therapy I managed to dislocate both shoulders so it's only really since February I've been able to lie down without pain so haven't tried digging into the data too much, the nurse dealing with me always seems overworked and tired and any attempt i make to have a conversation hasn't progressed. 

Please would any one share their wisdom if my graphs show anything that would explain waking up constantly at night, I felt fatigued before but now it's fatigue and i can't even enjoy sleeping in between. I feel if i make a fuss and ask for help from the nurse, they will just take the machine back so it feels like walking on ice.



I have attached my oscar output hopefully correctly edited and readable, any help would be appreciated

Regards,

Redking.

[Jay51]

Welcome to ApneaBoard, Redking.  I see at times during the night your ASV going from an epap of 5 up to 22 ipap (Ps of 17).  That is a massive swing of pressure!   You have some brief spikes in mouth leaks that occur also. 


I suggest tightening this range.  Lowering the PS max would help the most.  Much lower than 18.  Try maybe 15.  Then try to keep going lower and as low as you can and still get good OSCAR charts.  

If you like epap of 5 and have no or very few OA's on your OSCAR chart, you can keep epap at 5.  You might try raising it to at least 7, since most adults feel air- starved below 7 or so epap.  

Please post subsequent charts and we can optimize and find tune more as necessary.  I have an old s9 adapt asv with both a single epep setting and ps range, and have done numerous experiments with it.

[redking2436]

Thanks for the much appreciated advice, will try and get through to the nurse to update the numbers. I complained before about waking up feeling like there was no air so she increased the PS max from 15 to 18, but I think she should have raised the PS min instead.  I know i can access clinical mode but feel it may ruffle some feathers but I am willing to do so if needed.

Added some additional days of data

[Sleeprider]

Redking, are you willing to do your own changes to settings?  My thoughts on changing pressure are very similar to Jay51.  We have found it is possible to reduce PS max a lot and still maintain efficacy.  At this point, your machine resolves all events, but the pressure changes are far too large.  I would recommend that we take you back to the default settings for ASV shown in the Resmed Clinical Titration Guideline below.  Your settings are ASV mode with EPAP 5, PS min 5.0 and PS max 18.0.  I would suggest dropping that back to ASVauto mode, EPAP min 4.0, EPAP max 7.0, PS min 3.0 and PS max 12.0.  These settings would meet your needs without the huge spikes in pressure.  Our experience shows a PS max of 12 is generally sufficient, and if we would observe the result and make any changes necessary. Considering how dysfunctional  you feel, making this change certainly cannot hurt.  In my opinion, you are better off asking for forgiveness rather than permission.  Here is how to access your clinical settings to change the mode, EPAP min, EPAP  max, PS min PS max. https://www.apneaboard.com/resmed-airsen...setup-info

The different settings have effects on your breathing, and we have to sort out what works and what doesn't. EPAP stents the airway against obstruction, and when too low will result in UA events which are obstructive. Using ASVauto, lets the machine detect obstruction automatically and increase or decrease EPAP as needed. PS min is the pressure support you feel on each breath. It is what makes inspiration easier and gives the sense of better ventilation. Your PS min is currently 5.0, which is relatively high for ASV. I am suggesting trying a lower PS min for now, and we will need your feedback to see if we need to return to 5.0 or maybe higher. PS max is what gives your device the ability to trigger or cause a breath when you have insufficient spontaneous respiratory effort. 12 cm is usually sufficient, and 15 is conservative, however 18 is very high for this purpose. Based on your respiratory statistics, your median pressure support now is 6.0, the 95% is about 10 cm and the maximum is about 15 cm. So a 12 cm PS max is probably sufficient. Our objective is to minimize pressure changes while getting the job done. It's going to be a process, based on trial and error, and hopefully you feel up to the job of making changes and providing feedback.

Summary:
Mode: ASV Auto
EPAP min: 4.0
EPAP max 7.0
PS min: 3.0
PS max: 12.0

[SarcasticDave94]

Yep. Certainly would be nice to have ASV Auto mode with the EPAP range.

[redking2436]

After having no luck even getting a call back so put the machine in airplane mode and  tried the auto asv route, i woke up and removed mask and must have fallen asleep without it so the data isn't great but it was much easier to use than before. Will try again tonight.

[Sleeprider]

With ASVauto mode, we learned the machine maintains a low EPAP pressure from 4 to 5 cm. This confirms your original use of fixed EPAP at 5.0, but the range is fine. The reduced pressure support was effective in stopping events. Your respiration rate was lower, which may suggest your respiratory needs are met with these lower pressures and you were more relaxed. I don't see a need to change from these settings until we see more data. In future graphs, please include minute vent rather than cumulative AHI.

[redking2436]

Not sure if it's the change to auto asv but I'm waking up way more often but haven't turned off the machine. Multiple times with half hour or so inbetween before finally falling asleep without the mask then waking up later and putting it back on.

Hopefully just a temporary situation.

[redking2436]

A bit more data that's hopefully useful, had one night I actually slept through on the 11th but since then its back to the broken fragmented sleep so any insights would be appreciated yet again.
It could be due to my mouth opening as i fall asleep and the mask no longer fitting, I printed off the resmed mask guide and my face is between large and medium and if my mouth opens it's definitely large but because im on a "trial" it seems they dont want me to test any masks and just seem to want me to give up :/.

[Jay51]

Great job Redking.  Very nice clean looking charts.  Enviable.  Lowering your PS max has probably helped you stay asleep longer.  You can try lowering it even further since you have no events in these charts.  Keep EPAP settings where they are.  

Sleeprider or Dave or anyone else may see other tweaks to help you sleep better, but tremendous progress!