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Transitioning from APAP to CPAP using Oscar - sleepadventurer - 11-28-2023
Hi all!
It's awesome to be a new member of this forum! I'm excited to get to know you all.
My sleep apnea treatment journey began about 1 month ago. I had an initial AHI of 22 in my take-home sleep study (Lofta), and I ordered a Resmed autoset AirSense 11. I tried a few masks and have settled on the F30i which works well for me (got the small wide cushion which fits my face well). I have been using the machine every night for about a month. I am feeling a lot better but I think there is still room for improvement.
So,
- I am learning about transitioning from initial APAP pressure settings (4-20) to more dialed-in settings (mimicking CPAP). I have watched uncle Niko and Lefty on Youtube to try to analyze my Oscar data and adjust settings from that.
- Based on those videos and my limited knowledge of my Oscar data, I am under the impression that APAP stock settings are good to begin with, but my Oscar data shows my pressure level getting to max 13, and on average about 11.5.
- I have set my pressure to around 6-20, until last night when I set it to 11-13, trying to dial in that range so that I can get my AHI below 2.5, to 1 or 0. Unfortunately, it seemed to max out throughout the night (13) and my AHI was still 2-ish.
I have attached my last 3 nights of Oscar data.
I would love some input on if I am on the right track, and what to try next to have less Obstructive Apneas, lower AHI, and a better nights sleep!
Thank you so much in advance!!!
- Sleep Adventurer
RE: Transitioning from APAP to CPAP using Oscar - BoxcarPete - 11-28-2023
Did your sleep study track sleep state? Mine did, I had 0 events in nREM sleep, and instantly jumped to 25 AHI in REM. I say this because it's common to have clusters of positional apnea due to chin tucking, and that could be related to the way your body fully relaxes in REM sleep. It sounds hokey, but a soft cervical collar has been tried by many members here successfully, including me. I'm still working on settings myself, but I found my best night so far is with the machine somewhat tightened down on the range like you did, and with the collar on. Another thing to try would be a lower pillow if you have one. Good luck!
RE: Transitioning from APAP to CPAP using Oscar - SarcasticDave94 - 11-28-2023
Welcome to Apnea Board,
Something you may want to experiment with is adding EPR full time. Even in this 11 series, it should be a setting of 1, 2, 3 along with ramp only or full time. You'll need to be the judge which works best on the numbered setting, however you may want EPR 3 full time. And EPR numbers indicate cmH2O reduction on exhale, and cmH2O is what your pressure values are, meaning both are measured the same. EPR is a reduction while other pressures are an increase on your AutoSet.
Some members that have flow limits as you have on occasion seem to do better with EPR assisting. Flow limits are the beginning airflow reduction prior to hypopnea and full apnea.
RE: Transitioning from APAP to CPAP using Oscar - sleepadventurer - 11-28-2023
Thanks for the suggestions!
I will try EPR 3 tonight. Would you recommend keeping min 11 and max 13? It seems that it wanted to go higher than 13, so would I want to up the max to 15ish? I'm still a bit confused on how narrow to make the min/max based on past Oscar data (showing that my apnea/hypopneas require 11-13 cmH20 per event).
I am also curious - you mentioned people that have "flow limits like mine". I've never understood flow limits or how they relate to flow rates, hypopneas, and most importantly min/max settings.
Any detail around this you could provide?
Thanks!!
RE: Transitioning from APAP to CPAP using Oscar - BoxcarPete - 11-28-2023
Flow limit is a grade given by your machine to your breaths, judging them by shape, and ventilation volume compared to the previous three or five minutes. Just because your breaths are getting a bad grade doesn't tell you what questions they are getting wrong, so to speak. Check the wiki to look at how yours appear. Mine are the classic inspiratory flat tops, and tend to disappear when the machine raises pressure according to its APAP algorithm. Others have found that theirs go away with increased EPR. Do note that if you enable EPR, it will reduce your pressure when exhaling, so your pressure can drop below the threshold required to keep your airway open in some cases.
Definitely look into positional therapy though, you may need to make no changes to your setup except something to prevent chin tucking. You can test this easily by letting your chin fall down and rest against your chest. If this makes it harder to breathe, you should pick up a soft cervical collar, or use a shorter pillow, or roll up a towel under your neck. It's a cheap investment in a possible solution.
RE: Transitioning from APAP to CPAP using Oscar - Kathy14225 - 11-28-2023
Going with the previous replies I use a buckwheat pillow, they're micro beads which was suggested and it squishes up to any form so if your on your side you can position it under your chin and under your head not in front so it's not touching the mask. Very soft.
RE: Transitioning from APAP to CPAP using Oscar - PeaceLoveAndPizza - 11-28-2023
Some readings from the Wiki on flow limitations.
https://www.apneaboard.com/wiki/index.php?title=Optimizing_therapy#Flow_Limitation_Statistics_Interpretation
RE: Transitioning from APAP to CPAP using Oscar - SarcasticDave94 - 11-28-2023
Looking at info again, if we base action on the median then FL wouldn't require action.
Flow limits in general tends to appear as the limitation before transition into hypopnea or full apnea. As I recall FL is also what the ResMed keys on to begin increasing pressure, entering into combat mode against the expected event.
RE: Transitioning from APAP to CPAP using Oscar - sleepadventurer - 11-28-2023
This is great stuff, thank you everyone.
I ordered a soft cervical collar for positional therapy (great idea) and I'll consider the pillow! Tonight I'll try the EPR 3 and report back. I'm thinking about raising the max pressure from 13 to 15 (so an 11-15 pressure range) to get more pressure during the obstructive events.
@SarcasticDave - could you explain a little more what you mean by "if we base action on the median then the flow limit wouldn't require action"?
I'm starting to understand flow limit but my knowledge is still basic.
I had another thought / question: if my AHI has never gone beyond around 2.6 since I started therapy a month ago, should I just be content? Is there a purpose to keep getting in the weeds and fine tuning things? I've heard that under five is considered effective.
Thank you all again!
RE: Transitioning from APAP to CPAP using Oscar - SarcasticDave94 - 11-28-2023
Sure. If actions to combat FL were based on median FL number on Oscar, you may not require action. Actions against FL would be an increase in pressure, typically PS in bilevel.
Once you've reached AHI below 5 firstly consistently, it's about comfort and sleeping well. The overall goal to tuning the machine is to obtain less than 5 AHI along with good comfort and well rested sleep. Once you get that reasonably consistent, stop dial turning and make good OSCAR charts. There will be outliers but unless it's gone off the rails long term, adjustments really aren't needed.
Myself I was actually sleeping better at AHI 3 than zero, which I did have fairly often for a while until COPD got a bit stronger.