johnnygz - Therapy Thread

[johnnygz]

Hi all!

This forum has been super helpful as I dive into my sleep apnea journey. I recently got an at home sleep study done a few months after a turbinate reduction (trouble breathing through my nose). I got the sleep study because people have mentioned I have some interesting snores and shallow breathing when I sleep. The study showed roughly 15 AHI and 27 RDI and I appear to be fairly consistent in events and snoring on my sides and on my back (images attached). So I very recently started with a CPAP machine and would love some help analyzing my data since I still feel pretty drowsy/sleepy during the day with a decent amount of brain fog. Also, I'm 35 years old, 6'2" and about 195 pounds (~12% body fat so not overweight or out of shape).

I am using a ResMed Airsense 11 with a pressure of 8-20 and EPR set at 3. Based on some research into a recent night of OSCAR data, it appears that my flow limitations are all over the place and I stop breathing for 8-12 seconds at a time (which are classified as OAs) with some CAs and RERAs sprinkled in. I'm considering bumping my minimum pressure up by 1 but my machine seems to be auto adjusting pretty aggressively within my settings, so not sure that is the right move. I would love any insight into the data and how I can further improve my sleep.

Thanks so much!

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Adding the other sleep study screenshots.

[gainerfull]

Hi Johnny,

1. You'll want to address your leak rate, if you're using a full face mask then you'll want to consider tightening it. This is reducing your therapy efficacy and likely waking you up.
2. Turn off ramp
3. I agree, you need more pressure - I'd probably bump your minimum 2cmH20 and ideally get you on a constant pressure once we get your events under control.

[johnnygz]

Hi Johnny,

1. You'll want to address your leak rate, if you're using a full face mask then you'll want to consider tightening it. This is reducing your therapy efficacy and likely waking you up.
2. Turn off ramp
3. I agree, you need more pressure - I'd probably bump your minimum 2cmH20 and ideally get you on a constant pressure once we get your events under control.

Thanks mate, I will make these adjustments tonight and report back. I'm still getting used to the whole set up and not really consistently sleeping with the mask on for the entire night, the leaks, as you said, are probably waking me up and causing issues since I end up feeling worse.

[johnnygz]

Following up with settings changed.

1. Ramp disable
2. Min pressure increased from 8cmH20 to 10cmH20.
3. Mask fit adjustments

I still had quite a few events and fairly poor sleep. Looks like my RERA and CAs increased with the increase in pressure. But the mask change limited my leaks to one large leak it looked like. Added some zoomed in screenshots as well. Not sure what my next steps should be other than just continuing on.

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Another zoom in screenshot

[Crimson Nape]

Your Flow Limits are driving up your pressure. Why not try putting a cap on it, and set a maximum pressure of 12cm. This will allow a 2cm pressure change to reduce pressure induced arousals. It isn't a complete fix, but at least you might keep some restful sleep. We'll revisit your pressures again.

- Red

[johnnygz]

Thanks so much! Will try it out tonight!

[johnnygz]

Last night I made a few adjustments.

1. Max pressure was set to 12cmH20 (10-12 range)
   
2. I used a lower profile, firmer pillow.
   

I'm actually pretty happy with the length of sleep, I only woke up once to use the bathroom and kept the mask on most of the night. Leaks seem to be more under control. According to some of the prevailing forum wisdom, the cluster of OAs and Hs point to positional apnea. I do have a soft cervical collar that I ordered just in case so I will try it out tonight! Other than that the main issue appears to be my CA events, which potentially can be helped with reducing EPR? Are those things that I would just need to live with or are there other steps I can take for this.

Would appreciate any insight, thanks so much!

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Add more zoomed in OSCAR screenshots

[Crimson Nape]

Most of your events look to be positional.  As far as the CAs, I would give it some time to see if your body adapts to a lower CO₂ saturation.  It's not like you're having them all night long.

Now, the BIG question, How do you feel?

- Red

[johnnygz]

Honestly, not that much different from before I started using the machine. I think that is partially due to sleeping less and just not being acclimated to machine, I just seem to wake up early and take longer to fall asleep. I'll try out the cervical collar tonight and maybe push the pressure up one since my median is pretty much 11 and my 90s are 12. Thanks for the help! Will report back.

[ivorpetkov]

Johnnygz, I'm following your case carefully, because largely resembles ours.