[Treatment] AHI looks okay, still feeling exhausted throughout the day

[Ragoo32]

Hello new user here, I've been on CPAP therapy for about three months now consistently. My sleep specialist started me out at 5-15 pressure APAP which did nothing. Through trial and error I got it to 7-9 then 9-11. Maybe feeling like I'm sensitive to the pressure changes I'm now trying the CPAP setting at 9.4 pressure which has been helping but I get a lot of RERA's ever so often which is confusing. I'll send some some attachments from the last couple of nights and I'm fairly new to OSCAR so please tell me if I need to set it up a certain way for you guys.                 

- Airsense 10 Autoset 
- PAP Mode: CPAP
- Sleeping Position: Side 
- Soft Cervical Collar 
- Taking antidepressants at night, one to help for sleep

[OpalRose]

What was your median and 95% pressure readings when you used the auto mode?  

Although, I think you would do better on the auto setting, if you're sensitive to pressure changes, then stay in Cpap mode.

Your 95% Flow Limitation reading is excessive.  It should be under .10, preferably <.05.   Flow limitation can be very disruptive to sleep.  In order to help with FL, Hypopnea and Reras, you should be utilizing EPR.  

Try these adjustments:  

Set pressure to 10cm  (This may help with Obstructive apnea.)
Set EPR to 3 (This will help you breathe out against pressure, but more importantly, tackle the FL, Hypopnea and Reras.)

Although, at this point, I'm not concerned about the CA's as this may just be treatment emergent and will lessen in time.
Plus, taking an antidepressant may contribute to CA's.

[PeaceLoveAndPizza]

This is a common confusion for many of us. AHI is an indicator of a very specific set of conditions that are monitored, it is not an indication of quality sleep. Quality sleep is a much more complex equation to solve, with AHI being one of many things to consider.

[Ragoo32]

Hello OpalRose, my 95% pressure readings on auto were sitting around 10.5-10.8. I will try out these settings tonight and let you know what happens. Thank you!

[OpalRose]

Ok, that's a good guess on my part in choosing 10cm. Try it, and we'll see how it goes.

[Ragoo32]

    Just wanted to follow up with last nights OSCAR data. Looks like the hyponeas got worse with EPR set to 3. Let me know your thoughts, thank you.

[Ragoo32]

Hello, I just wanted to send some zoomed in shots of last night. Reminder pressure is set at 10cm with EPR at 3. [attachment=65970][attachment=65971]

[OpalRose]

What you're experiencing is called Positional Apnea.  You can read obout it here:

https://www.apneaboard.com/wiki/index.ph...onal_Apnea

Compare your chart with the before and after in the link.

The clumping together of apnea indicates that you're cutting off your air due to the way or position you are sleeping.
I did notice the clumping in your prior chart, but wanted to see if a pressure adjustment would help.  Usually, it won't with positional apnea.  

If you sleep on your back, be sure that you are using one pillow, supportive but not too tall vs. using two pillows.  Pillows that are too tall can cause your head to tilt forward cutting off your air.  

If you sleep on your side, be sure you're not tucking your chin or sleeping curled up as in a fetal position.  

Some folk here use a soft cervical collar which can help keep your head and neck aligned.  Working on the Positional Apnea needs to be a priority before considering any more pressure adjustments.

[Phaleronic]

Hi Rangoo32,

You're having many Hypopneas and OA events still at this pressure and with EPR on at 3 fulltime you need to raise pressure tonight, to clear these events out, please raise your cpap pressure to 13cm, a 3cm increase should help. I know you stated that you're sensitive to pressure changes, but since it's cpap pressure you need the increase and should get used to quickly (I did).

[Ragoo32]

Hello OpalRose, thank you for the suggestions. I will raise my pressure to 13cm tonight. Should I still keep my EPR set to 3 still? I’ve been sleeping with a soft cervical collar and I do catch myself lying on my back. My chin still likes to tuck in apparently lol.