chemmkl's therapy

[chemmkl]

Hi everybody,

I'm new to CPAP and would appreciate very much some feedback about my current stats. I've gone through the wiki and also through the content available at SleepHQ (fee trial, not going to pay for it) and it seems that my stats are not particularly bad (very low AHI, controlled leaks and flow limit). In particular I am looking for ways to improve my O2 stats.

Here's my backstory so far:

• My wife reported that in between snores she though that I was not breathing sometimes. I was waking up "normal" or so I thought.
  
• Purchased a O2 ring to verify and the results from the first night confirmed the suspicions: 82 drops below 4% with the lowest at 70% SpO2.
  
• Got an appointment with a respiratory physician and he ordered a sleep test at home with a ResMed ApneaLink device and the result was AHI 35 (20 apneas / 15 hypopneas per hour) and the RX was 7cmH2O with a 15 minute ramp.
  
• On the 7th of August I got a brick from the DME vendor that works with my insurance: SEFAM Ecostar basic model, literally the only data it has is compliance with therapy: number of hours running - numbers of hours using it. No remote management or SD card of any kind. It came with an EVIL Lowënstein JOYCEeasy nasal mask large size that leaks into your eyes from the ball-joint and is painful to wear if you don't want leaks. 
  
• I used the O2 ring to try and infer how I was doing with the therapy for a week. I was averaging 25 drops over 4% per night with the lowest SpO2 averaging 77%. My ViHealth "O2 score" went from 1.6/10 without CPAP to 8-9.5/10 consistently with the CPAP.
  
• Because I was hating the Lowënstein mask I ordered a ResMed Airfit N20 and also a F20 as a backup for days with nasal congestion. The N20 is so much nicer to wear, it was day and night. It did not affect my O2 results so all good.
  
• I tried the F20 full face mask just to check it out and it was a disaster, back to the same results as not using CPAP (112 drops and lowest at 70% SpO2).
  

For my second week I purchased a ResMed AirSense 10, the no-modem version since there is no DME vendor involved so that I could have data beyond the O2 Ring (I am software developer and data analyst). This is what I have done so far for my first 3 nights of full data:

1. August 16th. I set it at the original RX: CPAP mode, 7cmH2O and 15 minute ramp. The results (first attachment) were showing AHI 14 (9 OA, 5 H) so not as good as it seemed with the O2 Ring only. Not too bad leak rate or flow limit but a lot of snoring.
   
2. August 17th. I was planning to wait a week on CPAP mode and 7cmH2O to gather more data but curiosity won and I enabled APAP the next day. I set it from 5 to 20 cmH2O. The results (also attached) were really good, AHI 0.74 and the snoring greatly reduced. Leak rate doubled from about 4 liters to 8 liters but still not too bad and understandable given that the pressure instead of being constant at 7 went over 16 sometimes. Median 12 and 95% at 14.
   
3. August 18th. Based on the wiki I decided to increase the lower limit to 2cm below the median 12cmH2O I got the previous day. The results (also attached) were even better with AHI 0.43 and only 3 OA events in the whole night. Snoring greatly reduced Flow limit also seems better.
   

So my main question as I stated earlier is: if I have such low AHI why are my O2 stats still not great? Or having 96% median with 89% minimum is normal for sleeping? Anything I can do to improve the therapy? I am also curious about EPR and what impact it can have if I disable it or reduce the support. Finally, any idea why using a FF mask was so bad for the SpO2 results?


Thank you for your help in advance!