Still waking up tired

[Expat31]

Curious, you are right, it seems like no real change. Central and obstructive apneas are still stubbornly present, in spite of the fairly robust pressure increases.

Also your flow limitations are basically unchanged in spite of EPR being adjusted downwards, together with no improvement in central apnea levels. Whilst we are only looking a short selection period, I would have expected to see at least some movement, either in a positive or negative way.

You could could try increasing pressure again to see what happens, just to cover all bases, just to see if it moves the needle, but not sure if this would help. Only you can decide on how you feel.

As I am writing this, and taking into account the above, I am starting to think that your central apneas and obstructive may be an indication of complex sleep apnea. (Please read through this link).

The first thing I would do is look more closely at the central apnea events, ie a 3 minute view to see the pattern indicating this sympton. Please post this so we can review.

Other members who have experienced this phenomenon would be able to help with additional advice.

When you took your sleep study, I am assuming it was without using a CAP machine, so in these circumstances, central apnea events relating to complex sleep apnea would have not shown up.

It may be helpful if you could post your original sleep study, with of course your personal identification elements redacted. There may be some clues there that may help.

Let's take it step by step...

Thanks

[Expat31]

There is one other possibility I should have mentioned, mixed sleep apnea, let see what the zoom to get  a 3 minute view shows.

[Sleepyparrot]

Morning - here are some screenshots from last night and some zoomed in around CA and OA events - doesnt seem like much change - any additional thoughts would be appreciated.

[Expat31]

Thanks for the graphs.

Overall I see no real change, the events are still stubbornly present.

The change in EPR to 2 from 3 has again not had any real impact on flow limitations or reducing central apneas, and I think doubtful further pressure changes will help

Regarding the zooms of events, they look correct to me. For the centrals, normal flow picks up straight away after the event, without any recovery blip, with also no sudden change in pressure, as airways already open.  Also no discernable peak in flow limitation. But can't be sure with the tight scaling of the graphs.

The obstructive event looks sort of OK, as this time you see a blip in pressure as the machine tries to prise open the airway, however cannot see any discernable recovery blip in respiration.

Well that is how I am trying to interpret them, but no expert.

In conclusion, to be sure to be able to  resolve all the above issues, a seperate titration study, with the view to obtaining a suitable bi-pap machine may be required

Hopefully another member can help out, who unlike me, has personal experience on all things bipap therapy.

If there is no comeback, you may have to start a seperate thread relating to bi-pap.

[Sleepyparrot]

Thanks for your help - I reduced the EPR from 2 to 1 overnight and that reduced the CAs and AHI to under 2 - I will keep these settings for a few days if they keep coming down I may try and turn it off. My Dr seemed happy that I was below 5 so unsure how interested they will be in doing another titration but I will check

[Expat31]

The key question is how you feel. That's the best metric.

You may want to check overnight oxygen desaturation with an OSCAR supported oxymeter, just to 'leave no stone unturned'.