[Treatment] NightmaresOfTheBottom - Therapy Help Thread

[NightmaresOfTheBottom]

Hello everyone,

I've read through many of the posts, guides, and resources here.  This is my first post.

I was recently diagnosed with moderate obstructive sleep apnea.  I have year round allergies causing nasal congestion and enlarged turbinates.  I had a home sleep study done a few years ago that was inconclusive, and a recent in-lab sleep study that recorded an AHI of 15.2.  I've felt that I've had sleep issues my entire life - trouble falling asleep, trouble staying asleep, trouble waking up, not feeling well-rested, and daytime fatigue.  I use melatonin and occasionally Ambien to help sleep.

I got tired of waiting for my sleep doctor, DME, and insurance company to process the paperwork and get me set up with equipment, so I purchased my own ResMed AirSense 11 Autoset through Lofta.  I use a ResMed AirFit F30i full face mask.  I also use a Nonin Wrist Ox2 Bluetooth (BLE) Model 3150 oximeter and a gen 3 Oura ring (which is what initially gave me data pointing to possible sleep apnea).  I will hopefully (within the next month) receive a second AirSense 11 through insurance, at which point my current machine will become my travel/backup machine.

I've completed one full night's sleep with the machine, as well as several partial night's sleep where I ripped the mask off after a couple hours.  I've also used it while awake watching TV and reading to become familiar with it.

My settings are mode AutoSet, pressure 5-15, AutoSet response standard, ramp time auto, start pressure 4, EPR on, type full time, level 3, climate control auto, tube temp auto, mask setting full face, b/v filter off, smartstart on, smartstop off.

I have attached my redacted in-lab sleep study results, as well as OSCAR screenshots from the first full night.  I've included the oxygen and pulse information as well since I have that capability.  I felt okay when waking up after it, but not particularly well-rested.  It was not too uncomfortable to sleep with.

I'm interested to know how my results look and how I can improve the APAP treatment.  Please let me know if I should include any more information or screenshots.  

Thanks in advance for any help,
NightmaresOfTheBottom


Link to redacted sleep study:
imgur DOT com/a/8y3p45p

[NightmaresOfTheBottom]

I have also uploaded the data into SleepHQ so that it can be viewed that way in addition to the OSCAR screenshots.

https://sleephq DOT com/public/teams/share_links/df23a4ac-5e69-4615-99b6-7112b80ac0f3

[Deborah K.]

I suggest you set your starting pressure at 7.  This is a good starting point for most adults, and it allows your EPR setting to work better.  I also suggest you turn ramp off.  You get no therapy during ramp.  Try it without ramp, and if you are really uncomfortable, run it set at 5 for about 10 minutes.  You'll find you don't need it very shortly.

Again, welcome, and good luck!  

[Phaleronic]

I have also uploaded the data into SleepHQ so that it can be viewed that way in addition to the OSCAR screenshots.

https://sleephq DOT com/public/teams/share_links/df23a4ac-5e69-4615-99b6-7112b80ac0f3

I just checked your sleephq charts, turn EPR off and raise your min pressure to 8cm.  You should be able to handle that minimum pressure, but it you can't turn it on @ 1.  Your 99.5 percent pressure is 10.4 and you're having clear airway events and Obstructive Apneas, turning epr off will help these.

[NightmaresOfTheBottom]

Thanks for the responses.  Here is what I've tried since my original post, based on the replies I received.

Changes:
C1)  Decreased ramp from auto to 5 minutes.  All other settings unchanged.
One night of OSCAR are attached for this, AHI 1.54.
C2)  Increased EPR from 2 to 3.  Ramp was left at 5 minutes.  All other settings unchanged.
Two nights of OSCAR are attached for this, AHI 1.80 and 1.13.

I have also uploaded all of the data into SleepHQ (note there are two machines on there now).  Link at bottom of post.


Summary:
Overall, I have felt pretty good with the treatment so far.  I wake up well-rested and clear-headed.  It's been easy to fall asleep with the F30i mask.  Sometimes I have torn the mask off in the middle of the night, but I've made it through the whole night a few times.

My overall sleep time has decreased by 1-2 hours on average compared to sleep without APAP, but I still feel better despite less sleep.  My total REM time and average HRV have also decreased when using APAP, according to my Oura Ring.

I received a second additional APAP machine of the same make, model, and mask from a DME through insurance, and have now been using that one as my primary unit, keeping the other as my travel/backup machine.


Questions:
Q1)  What setting change should I try next?  Drop EPR from 3 to 0?  Increase minimum pressure to 7 or 8, as previously suggested?
Q2)  I have been changing only one setting at a time and collecting at least two nights of data, should I collect more nights of data before drawing conclusions or making additional changes?
Q3)  My pulse changes (47) and Sp02 changes (14) seem high to me.  Does this indicate PLMS, as mild PLMS was noted during my in-lab sleep study?  I have low iron and ferritin that I have been supplementing to attempt to increase back to normal levels.


Links:
SleepHQ data -- https://sleephq DOT com/public/teams/share_links/98bb141e-352a-40af-afa8-4c86b688727f
Lab Sleep Study -- https://imgur DOT com/a/redacted-sleep-study-8y3p45p
OSCAR screenshots -- https://imgur DOT com/a/5svr6Pj

Thanks again

[NightmaresOfTheBottom]

Side note, the DME attempted to slyly provide me with an open-box (likely used) Airsense 10. I had read through the guides on here prior to my appointment, so I was not having any of that and insisted they give me a brand new Airsense 11 instead. What a bunch of crooks.

[Old Steve]

As others have said you need to increase your minimum pressure to 8cm and then post some more charts.

[Deborah K.]

Put your EPR back to 3. It makes breathing more comfortable, and, more importantly, helps lower flow limits, which need to be as low as we can get them. Your charts show that they were lower when using 3 instead of 2.

[Dormeo]

Like Deborah K., I recommend that you raise your minimum to 7. I also recommend that you keep your EPR at 3, given your flow limitations and given the hypopneas observed during your sleep study. And though it doesn't matter a lot, you might try turning your ramp off entirely at this point. I'd suggest spending at least 3 nights with revised settings, especially given how short your intervals on the machine are. You're not getting a lot of data that way.

In SleepHQ, I can see that a fair number of your OAs as well as a fair number of your CAs are parts of arousal episodes. (The OAs might occur, e.g., as you hold your breath turning over.) This means that they are likely to decline in frequency as you start sleeping more soundly.

Your sleep study showed a lot of spontaneous arousals. Those are arousals that aren't preceded by respiratory events. These can be difficult to address, and your best bet is to do everything possible to put in place the conditions for restful sleep. More below.

Your sleep study also mentioned a vitamin D deficiency, as well as the iron deficiency. Has your doctor figured out why you're deficient in vitamin D and has he or she suggested treatment? I'd follow up on this if you haven't already; see the connection with sleep here:

https://pmc.ncbi.nlm.nih.gov/articles/PMC8912284/

Why are your times on the machine so limited? Do you sometimes take the mask off and then go back to sleep? Do you sometimes get just 6 or so hours of sleep per night?

Guidelines for restful sleep:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.