Unrefreshed sleep with cpap. Epiglottis collapse.

[stathisf]

           
22 Male , unrefreshed sleep after 2 years of using cpap. Latest sleep study shows 5 AHI with 15 RDI. Some adjustments have helped a bit lately. OSCAR data attached, have no idea how to interpret them or if I have taken the correct screenshots.. any help is much appreciated. 

My AHI was initially 15. I have gotten a DISE which showed epiglottis and tongue based collapse. Got a surgery for that without noticing any improvement in sleep quality but AHI has fallen to 5. Also I have allergic rhinitis and feel like my nose is clogged a lot but anthistamiens make me feel sh*t. My doctor insisted on keeping my pressures on 4 min and 10 max but that wasnt helping so I went into the settings myself and bumped it up to 10 min 15 max and this helped. Also I am playing around with EPR. It was set on EPR 3 but then switched it off and felt like it helped also. 

 What can you conclude based on the oscar data because I dont know how to read them whatsoever. Any help is appreciated.. I also have high blood pressure, 150/100 which I think is caused by my bad sleep quality (i am always tired, cant do many sports for long and have black circles under my eyes). My sleep doc says its unlikely that the high blood pressure is caused by my sleep apnea since my AHI is only 5 (even though I have 15 RDI..). I also have my sleep studies in case someone wants to see them. 
 
And just in case all that wasn't enough, I recently got diagnosed with celiac disease around 1 year ago so I am on a gluten free diet but not sure if I am being careful enough. Could that be affecting my sleep apnea? Not sure. 

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         More screenshots:

[gainerfull]

Have you considered sticking to an earlier bed time and keeping the mask on full time?

It looks like you're testing & tuning the settings even in the same night but I can't tell if you have any method to the madness because its all over the place. It takes a couple of nights for your body to adjust to the pressure settings.

Have you considered trying constant pressure? If you're open to it, commit to yourself that you'll go to bed before 10pm every night for 7 days, change your settings to constant pressure @ 12cmH20 and turn EPR to as high as you feel comfortable - I use EPR @ 2.

Your success criteria first & foremost if waking up feeling rested followed by almost no obstructive events (light blue). Next you'll want to see your 95% flow limit at 0.00 and keep your leaks as close to 0.00 as well.

Good luck

[stathisf]

Thank you for your suggestions, what about humidification? Should I use it or not?

[Sleeprider]

It’s going to take some zoomed screenshots to understand what leads to events. We really need to see the flow rate at 3-4 minutes of resolution to see what is happening in the airway during arousal and events to guide you on possible settings or other changes. My impression is that you have periods of high flow limitation as well as some central events. It’s going to take some detective work to identify what is disrupting sleep or leading to events. EPR in moderation may be helpful, but let’s ge a closer look at the problem.

[stathisf]

            Hi there sleeprider, 

Here are some screenshots of the charts you requested showing the flow rate zoomed in. I hope these help you in understanding what is going on. I see a lot of CAs also some obstructive apneas and hypopneas.

[Gideon]

Your 3 zoomed examples are IMHO arousals that disturbed your sleep and resulted of your holding your breath. This is normal. Everyone does it.

You can evaluate your sleep hygiene which never hurts though. These are clear Airway events, no obstruction, so nothing is collapsing here on any of these.

Id kep your EPR at 3 as that looks like it is helping.