Still need help with cpap therapy

[weuw]

Hi !

I still have problems to get a regular good sleep. Sometimes it's okay for one or two nights, and the followings are terrible (I sleep but I am exhausted at wake up).
It was the (bad) case last night. Here are screenshots of Oscar :

   

   

   

As you can see my pressure is now at 12 and EPR 2. I saw a doctor last week who told me to try with this higher pressure. And it worked for two nights...

What is the problem with my sleep ?? Is it simply insomnia ? Numbers are not so bad.
But I really have problem with deep sleep (my watch showed only 15 minutes last night).

It is CA ? Or Flow limits ??? I added Oscar User flags on the charts because I noticed I have a lot of some.

Thanks 
Serge

[Gideon]

You are having more arousals than are being indicated. The close up of your CA events, those are you holding your breath when you toss so there they are more of an arousal flag.

The UA chart shows some awake breathing, more irregular than the other closeup .

I'd recommend increasing EPR but suspect that would increase your Central Apnea

[Sleeprider]

Increasing EPR may be worth a try to ease flow limits, and see if CA is impacted. I don't see any events that would benefit from higher pressure at this point.

[weuw]

Thanks for all, I will try EPR 3 tonight.

Regards

[weuw]

Hi there

I am currently in holidays, so I won't be able so upload Oscar charts.
My sleep continue to be very inconsistent.

All datas I have is daily report from Resmed. Last night with these settings : Pressure 11.5 EPR 3
I had an AHI of 9.6 with 90% central apnea. I cannot give you Flow limits numbers...

I got only 15 min deep sleep. I am not so exhausted because in holidays I can stay in bed longer and rest.
This week I cannot get more than 30 min deep sleep, but central apneas where less.

But I am totally despaired by CPAP titration results. It seems impossible to find a good value and stay with it.
Last months I noticed pressure 10 with 1 EPR gave me best results, but recently I saw a lot of flow limits and User flags events (short apnea) which triggered a lot of arousals.

My moral is affected. Can you try to help me ?

I thought moving Autoset pressure instead of continuous, for example 9-13 with 2 or 1 EPR ??

Many thanks
Serge

[weuw]

Don't you think auto pressure could be more adapted in my case ?

By the way, I've red that antidepressants like Sertraline could cause more apnea, and last weeks my posology was higher. I am trying to reduce it a bit.

[notam2]

I went back through your previous threads looking for more information that could be of use to help you. When you had your initial sleep study, your AHI was 27. Do you know what the breakdown of that number is i.e. OA vs CA vs H? I'm wondering whether you had any CAs before starting therapy.

I don't think more pressure will help you. However, more pressure support might help. Then again, it might not. However, if I was in your shoes I'd seriously consider obtaining a VAuto and trying min EPAP = 7; max IPAP = 12; and PS = 4. The aim of this is to treat your flow limitations and arousals. It could make your CAs worse, but I noticed a couple of your CAs immediately follow what looks like an arousal, so maybe if you treat the arousal and eliminate it the CA won't follow.

There aren't a lot of other options for you to try with your current machine, except maybe lowering your pressure a little. Something like a fixed pressure of 10 with EPR 3.

[weuw]

I really appreciate your help, and your conclusion seems very coherent.

About my initial study, duration was 7h22 with 6h total sleep, 185 arousals, 15 apnea (10 obstructives, 1 central and 4 mixed).

Next night I think I will try 10 pressure with 2 EPR then if I feel a bit better I will try 3 EPR.

Have a nice day.

[notam2]

Do you know how many hypopneas you had during the initial sleep study?

I noticed in an earlier thread that you were taking benzodiazepines. This could be responsible for your CAs. If so, there's not much that can be done with PAP machines to fix that problem.

I don't think that you need a lot of pressure to clear your obstructive events. You may even want to try a fixed pressure of 8 with EPR at 2 or 3. Preferably 3. The pressure differential will likely help you more (with arousals and flow limitations) than the overall amount of pressure.

[weuw]

Do you know how many hypopneas you had during the initial sleep study?

I noticed in an earlier thread that you were taking benzodiazepines.  This could be responsible for your CAs.  If so, there's not much that can be done with PAP machines to fix that problem.

I don't think that you need a lot of pressure to clear your obstructive events.  You may even want to try a fixed pressure of 8 with EPR at 2 or 3.  Preferably 3.  The pressure differential will likely help you more (with arousals and flow limitations) than the overall amount of pressure.

Ok thanks !! 

In my sleep study (October 2020) I had 127 hypopneas (21/h) with 74 obstructives. Is is coherent with your analyze ?

PS : When I used Autoset with 7-12 EPR 1, Oscar indicated median 9.6 and 95% 10.88.