[Treatment] New User Seeks Guidance

[Sleeper396]

I don't know why it couldn't be accurate. There's one night of good stats. A few more and you'd have a trend. Until then your trend is more like the one with AHI if 3.x, with some scattered event flags.

Did you sleep well on that night of .26 AHI?

I did sleep well, except earlier in the evening, perhaps because I felt too warm.  I’ll look for a further trend.  Thanks, Dave.

[SarcasticDave94]

OK good and congrats.

[Sleeper396]

Good morning..  I have a "time at pressure" question relating to CA's. The Oscar chart, as I hover over the "time at pressure" graphs, says that the majority of my CA's are taking place at lowest pressure settings -- mostly between 8 and 8.6 cmH2O. I went back and examined a few weeks of data, and this seems to be the case every night. There are almost never CA's at higher pressures and only CA's at the lowest pressure levels (in the 8 cmH20 range - below 9 cmH20, with the majority taking place at 8 cmH20). Even discounting the apparent SWJ, when they occur, this seems to be the case every night for CA's that are not related to SWJ. The recorded pressure is always in the 8 range, or there about. (For the last 30 days, my average pressure was 9.5, and my 95% pressure was 12.9).  

I was under the impression that CA's are more likely to occur at higher pressures. Is it showing this way because the algorithm lowers my pressure when it encounters CA's, or is it possible that in my case, CA's are occurring mostly at lower pressures, and that my low pressure should be increased -- since none of my CA's appear linked to higher pressures on the Oscar graph? Sleeprider has previously indicated that I "might benefit from a narrower range of pressures."

My AHI for the last 30 days is 3.3, but apnea events are 2.32 index (approx. 70% of all events). I have been on APAP therapy now for approximately 80 days. I have a doctor appointment in one week to review my progress. I don't expect much from the doctor, since I have been doing everything myself. The only question will be whether I push for an ASV (ResMed AirCurve 10 ASV) -- given a 30 day CA index of 2.32, with a total AHI of 3.3. I am prepared to say that I am still having difficulty sleeping and staying asleep, and that my nocturia could be better. My CA's appear to be the culprit. Any further suggestions regarding minimum pressure setting being bumped up, and my upcoming sleep doctor's appt, would be appreciated.

[SarcasticDave94]

It's possible the CA experienced are the issue to blame not feeling the best well rested state. The problem with trying to get them to agree to go on the getting seen path is the low treated CA levels. But the ASV is likely the right therapy answer. You'll need to have a lot of subjective evidence with a lot of "I'm not feeling well rested" type of complaints.

[Sleeper396]

Thanks, Dave. I will try.

[SarcasticDave94]

BTW a bit more info... The AutoSet algorithm is programmed to do nothing for or against CA.

[Sleeper396]

Understood.  So I must determine if the CA's are low enough so as not to jeopardize my treatment, or do I absolutely need an ASV to enhance treatment.  In your opinion, could the ASV be too complex for my lower level of CA's?  Or am I safe moving in that direction and trying to force the ASV?

[SarcasticDave94]

I think it depends on a few factors. What trends are the CA producing, the up and down aspect still charts a trend or tendency. Consider the level of poor therapy that CA brings to you. Would you feel better and would therapy be better if there were almost zero CA to deal with? You need to place some sort of tangible value on CA that you deal with, these CA cause such and such, robbing well rested state, something. You feel like X now, but you believe if CA were gone, you would feel like Y. Is Y a lot better than the X you're at now? You'd have to decide, and if you conclude yes I will be better off, then you need to make ASV happen.

[Sleeper396]

I think it depends on a few factors. What trends are the CA producing, the up and down aspect still charts a trend or tendency. Consider the level of poor therapy that CA brings to you. Would you feel better and would therapy be better if there were almost zero CA to deal with? You need to place some sort of tangible value on CA that you deal with, these CA cause such and such, robbing well rested state, something. You feel like X now, but you believe if CA were gone, you would feel like Y. Is Y a lot better than the X you're at now? You'd have to decide, and if you conclude yes I will be better off, then you need to make ASV happen.

Good advice, as usual.  Thanks, Dave.

[Sleeper396]

I thought that I was making great headway until the last few weeks. Sleep sessions are terribly short - interrupted by need to pee (not quite as bad as pre-APAP days, but still bad -- 3-4 times in a night).  While my AHI has moved below 2, my sleep is terribly interrupted. I do not see that CA's are waking me up, as Oscar is showing my wakeups even with limited, to almost no CA's just prior to the wakeups. Great advisors on this board have suggested that I move in the direction of an ASV, but I am feeling that the "need to pee" wakeups are not necessarily CA-related (see Oscar for last night).  Just checking back for an update/opinion.  I have been advised to increase my minimum pressure from current 8.2 to 9 or 10 with EPR added.  Started that process but did not see results. I may try it again this evening. I am just asking for an expert reality check as you can see a problem from my posted Oscar results last night. Am I missing anything? Should I still work towards an ASV machine, even though my CA index for the last 30 days is only 1.6 (on a total 30 day AHI of just over 2). Both indices are still moving down further over the last week, despite my broken sleep -- 4 times per night (1.5 hours each sleep session). I see a urologist and am treated for enlarged prostate (BPH), but otherwise have no other urological problems other than nighttime peeing. My desats are fine, as I check them periodically.  Feeling very frustrated!