matsodav - Therapy Thread

[matsodav]

I sought a diagnosis after struggling with sleep maintenance insomnia for a few years which contributed to lots of mental fatigue.

I've done an at-home study which gave me an AHI of ~13, was prescribed APAP pressure 5-15 but I could not get used to the mask and I fell off the wagon for months.

I've since followed up with a titration study which prescribed a set pressure of 8.0. I'm using a ResMed AirSense 11 set to CPAP mode 8.0. EPR 3. Auto humidity, no tube temp. Mask is AirFit P10. I'm using a ResMed chin strap.

I am concerned that the titration study only had ~2.5 hours of sleep data as I struggled to sleep there, with basically no REM sleep according to the notes. So wondering if a static 8.0 pressure is not doing it for me and I should go back to APAP.

I've had some good nights and some bad nights. Last night was especially bad with lots of brain fog throughout the day today (I STRUGGLED to function today). I'd like to get some insight into how my settings might be falling short preventing all nights from being "good nights".

I've attached two examples of OSCAR data. Let me know if I've done that incorrectly.

The following are notes from my original at-home study:

RECORDING INFORMATION:
Breathing Status: room air
Technical Quality: Satisfactory
Duration of Recording: 599.9 minutes
Estimated total sleep time: 7h 33m
Percent of sleep with movement: 0.9%
Estimated sleep efficiency: 99% total, 98.1% supine
 
RESPIRATORY MEASUREMENTS OF SLEEP: The average SpO2 measured 92.8% with an SpO2 nadir of 88.0%. The 3% desaturation index (ODI) measured 18.5/h and the 4% ODI measured 4.1/h.  Time spent with oxygen saturations below 89% measured 0.3 minutes (0.1% of total sleep) and time spent with oxygen saturations below 85% measured 0 minutes (0% of total sleep).  There were 94 hypopneas, 0 obstructive apneas, 1 central apneas, and 0 mixed apneas for a total of 95 events resulting in an overall AHI of 12.6/h (central apnea index of 0.1/h).  The supine AHI was 12.7/h (103.9 minutes spent in the supine position) and the non-supine AHI was 12.5/h (350 minutes spent non-supine).
 
Snore index (percentage of time spent snoring versus the total sleep time): 1.3% overall, 3.9% supine
 
Pulse: Average pulse frequency was 67.8 bpm with a minimum of 51.0 and a maximum of 109.0 bpm.
 
CONCLUSIONS:
1.  Mild obstructive sleep apnea with an overall AHI of 12.6/h.  Sleep-disordered breathing did not vary by position with a supine AHI of 12.7/h (compared to a non-supine AHI of 12.5/h).
2.  Average oxygen saturation of 92.8% with an SpO2 nadir of 88.0% that was proportional to the degree of sleep-disordered breathing.
3.  Although actigraphy is a reasonable surrogate to measure total sleep time, in the absence of EEG measurement of sleep there is potential to overestimate total sleep time using actigraphy alone and subsequently underestimate the true severity of sleep-disordered breathing.


I appreciate any insight provided. Thank you!

[PeaceLoveAndPizza]

I believe you called it correctly and need to go back to APAP, at least until we figure out what the best pressure is for you.

Try this:

Mode APAP
Min pressure 8
Max pressure 15
EPR 3 full-time
No ramp

After a few nights we can work on narrowing down the range to something more tuned for your needs.

[matsodav]

This is my first full night to report. I've unfortunately taken my mask off the other nights unknowingly. I just realized I did 14 instead of 15 max pressure so I will adjust that.

[PeaceLoveAndPizza]

it looks like things are beginning to settle in. How do you feel in the morning? From the chart things look quite grand.

I would not suggest changing anything for now, other than setting your max pressure to 10. I am a fan of minimising the pressure range for comfort.

Continue with it for another week and let’s see how things look and how you feel. If something goes off the rails, let us know.

[matsodav]

I felt extremely groggy this morning upon waking. Also worth noting I woke around 3:30a with mucus in my throat so had to remove mouth tape to clear and switched to chin strap. Anything jump out as poorly performing today? I'm tempted to try switching to an F40 to avoid mouth leaks. I've previously tried the F20 and couldn't get used to the discomfort around my nose. Also fair if you tell me I haven't given things enough time.

[PeaceLoveAndPizza]

Nothing specific stands out to me. It does look like you had some congestion by the roughness in the flow rate.

Would you be able to repost the chart and replace tidal volume with respiration rate? I think that will show it more clearly.

For now i would not suggest changing anything.

[matsodav]

Here is the same night with the added graph and then last night's data as well. What does an increase in respiration signal?

[PeaceLoveAndPizza]

I like to use the respiration rate to see how restful the night turned out. The more erratic it is typically means the sleep quality during that time period was not particularly good.

[matsodav]

From looking at those two graphs it seems that during period of spiking respiratory rate I also get some events.

[PeaceLoveAndPizza]

Your charts do not show enough events to be concerning. What we want to do is find settings that allow you a good nights rest.

Three things for you to consider.

1. Stay with the current settings for 3-4 days, then reevaluate. It is quite possibly you just need some time with them to get comfy.

2. Try incremental adjustments to the current setting by increasing max pressure by 0.2 every other night or so until things either feel better or go totally off the rails. 

3. Try a fixed pressure setup to see if the pressure changes are affecting sleep quality. If you want to go this route, try the following:

Mode CPAP
Pressure 10
EPR 3 full-time
No ramp

You may want to try option 2 for a night or two, then go to option 3 for a few nights, then back to option 1. Fine-tuning is a bit laborious as there is nothing patiently obvious to fix. Patience is required, so hang in there.