[Treatment] Seeking OSCAR input

[KeepingItSimple]

After nearly a month of nightly APAP use, I wonder if the number of CAs (or anything else) that I'm seeing are of concern. Overall, my AHI has improved vastly from 97.9 during my sleep study to consistently under 5 thought not by much. I had no CAs recorded at that time though. I'd appreciate input from the wise members of this forum. Thank you.

[Dormeo]

Are you feeling better during the day? Do you think you sleep pretty soundly at night? It's helpful to know the answers to those questions.

I would not say I have wisdom, but a few things do strike me as I look at this chart. First, your leak graph is awesome -- way to go!

Second, the number of CAs you're seeing isn't a big cause for concern. Using the machine may be washing out just enough CO2 to reduce your "breath-now" trigger point a tiny bit. This often resolves on its own with time.

An additional possibility is that the CAs follow little arousals. Arousal breathing tends to be heavier -- you can see it in the flow rate -- and that washes out CO2 (see above). In this scenario, it would be the arousals rather than the CAs themselves that might be preventing you from achieving the best possible sleep. You can zoom in on events to see what happens just before and after them, if you're curious.

There is a hint of clustering in your obstructive events and flow limitations. This may indicate that you sometimes tuck your chin down toward your chest, which creates a bit of a narrowing of your airway. Try using a fairly flat and firm pillow to see whether that helps, and try to notice whether you tend to curl up in a ball if you sleep on your sides. A different approach is to use a soft cervical collar to keep your chin up, but let's not load you down with more gear unless it's clear you need it.

Finally, you would probably do well to raise your minimum to 7. This will give you your full EPR pressure-drop of 3 from the get-go (the machine can't go lower than 4), and it may head off a few FLs or OAs. I can see a possibility that you might want to make further increases in your minimum down the road, but one step at a time.

[Gideon]

simple change, increase min to 7 as Dormeo said, give the EPR room to work.

[KeepingItSimple]

Thank you for your input! Here are a few responses.

Yes! I feel way better during the day. And to think I didn’t even know I snored 3 months ago, much less that I have severe OSA. The biggest difference is resolution of a lifetime of major depression. After decades of meds, therapists, and psychiatrists (and a divorce), treatment for OSA brought the depression into complete remission and all general anxiety is gone with it. I feel better than I have in all 66 years of my life! Between better sleep and depression relief I’ve discovered energy, concentration, motivation, and wide ranging interests. I’m tackling projects I could only dream about even six months ago.

I started using a soft cervical collar about 2 weeks ago. I’m using a Caldera Releaf and it’s comfortable without allowing my chin to tuck. Bonus: my neck also feels better in the morning!

I’ve read the advice to set minimum pressure to 7 so as to get the most benefit from EPR but I see my pulmonologist this week and I suspect he will adjust my pressure all the way around. I trust him—he’s the doctor who urged me to have a PSG done just to be thorough in his diagnosis of a 2+-yearlong gut-wrenching chronic cough (atypical asthma). If he surprises me and doesn’t make any adjustments, then I’ll make some myself.

Overall, I am going to buy a backup power supply because I will never be without my APAP again. I can’t even take a quick nap without it now. I took to my APAP like a duck to water. After my sleep study I was determined, before I ever got the machine, that I was going to find a way to live with it every single night. I read everything I could find about potential pitfalls and possible solutions so I felt prepared to cope with most typical issues. It turned out to be quite easy to adjust to it. I couldn’t be more grateful for the change it has brought to my life.