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CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct? - Printable Version

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CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct? - Sleeper44345 - 08-06-2023

Would greatly appreciate anyone’s advice from looking at my data, on
  1. If you think I actually have SDB/UARS?
  2. If so, are there any settings I should change on my CPAP?
Please feel free to ask any follow up question, and I’ll answer promptly.
Thank you in advance!


Details
35 yr/o Male. 6’0”. 135lbs. Canada

Situation/Main Symptoms
  • A decade of complaining about excessive daytime fatigue. In the last 9 months, has escalated in severity and has me desperate for relief.
  • Wake up feel unrefreshed. Constant brain fog / concentration issues. Exhausted from very light exercise.
    • Have maybe 2-3 hours of productivity each day before I can’t concentrate or find energy for my work or personal life.
  • Suspected UARS due to thousands of flow limitation events each night, and moderate RDI but low AHI. (Varies from study to study, and positionally)
At Home Test Results
AHI anywhere from 1.8 to 8 depending on the test, and sleep position.
RDI anywhere from 5.1 to 20 depending on the test and position
(Note: I’m waiting for a PSG sleep clinic appointment to get booked, hopefully in a couple of months)

At home Sleep Test Results which will be attached in a new reply below

OSCAR Data 
Have been using a Resmed 10 Autoset for about a month, but without any relief or improvement in symptoms.

My OSCAR reports from the last 3 nights attached.

Other Attempts
Note: I’ve already tried most other (non-surgical) tips recommended on the forums/reddits, without relief. (i.e. allergy/environment management, best practice sleep hygiene tips, diet, positional sleep backpack device, mouth taping, acid reflux precautions, etc)

I’ve also done all the blood tests/blood work, which have all come back normal.

Will be seeing a rheumatologist soon as well, but am thinking this is more likely to be sleep related. 



Again, thank you in advance for your suggestions on 
  1. If you think I actually have SDB/UARS?
  2. If so, are there any settings I should change on my CPAP
Replying here with my at home sleep study results attached (post 1 of 2)

RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct? - Sleeper44345 - 08-06-2023

Replying here with my at home sleep study results attached (post 2 of 2)

RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct? - staceyburke - 08-07-2023

I would move the min to 7 to fully use the EPR 3.  You till have quite a few flow limits.

RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct? - Sleeper44345 - 08-07-2023

I can definitely give that a try.

Would you be able to help me understand a little bit better why moving the minimum to 7 might help with flow limitations, and their corresponding RERAs?

RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct? - staceyburke - 08-07-2023

Flow limits are apnea - the same apnea as Oa and H events.  The only difference between them is the duration and amount of obstruction.  I have how each is classified in my signature at the bottom of the post.  


To lower the flow limits EPR is used.  Resmed has EPR settings of 1, 2 or 3.  The lowest any cpap can go is 4.  The EPR (exhale pressure relief) is subtracted from the min and is the exhale pressure.  So for example Min 5 and a EPR 3 would give and exhale pressure of 4 because it is the lowest the cpap can go.  If you set the min 7 and a EPR 3 you would again have an exhale of 4 and the change of pressure helps lower flow limits.   Min - EPR = exhale pressure

RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct? - Sleeper44345 - 08-07-2023

Ah, I understand now. Thank you!

RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct? - Sleeper44345 - 08-07-2023

I recognize it may take a few days to see any results, but just as a follow up, I wanted to post the results from OCSAR last night after increasing the min pressure to 7.

[attachment=52966]

Results looks about the same to me, with lots of flow limitations still

Symptoms wise, today has been as bad as it usually is for fatigue and unrefreshing sleep.

I'm curious if anyone sees anything in the data, or has any other suggestions or advice for me?

Since it seems to be inspiratory flow limitation based on the waveform, should I try cranking up the minimum pressure again to force more air through, or possible reduce the max pressure to prevent so much difficulty in exhalation?
[attachment=52967]

Thanks in advance!

RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct? - pholynyk - 08-07-2023

Your flow limitations are actually not too bad. We don't get concerned unless the 95% are over 0.10 - yours are 0.06 and 0.07 - so, nothing to worry about; using EPR of 3 has got them controlled.

>>>I recognize it may take a few days to see any results, <<<

Hah! It took six months for me to go from "Not too bad..." to "Pretty good, thanks!"

It takes a while to get over the years of sleep deprivation, so don't expect miracles.

RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct? - Sleeper44345 - 08-07-2023

Ah, thank you! That gives me hope to keep going with this.

RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct? - Dire - 08-08-2023

What you planning on doing after seeing all the advice you got