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Help with Optimizing Settings - sleepykaizer - 11-26-2024
Hello, all,
I've been lurking for the last two weeks or so; I was diagnosed with moderate obstructive sleep apnea from an at-home Lofta test. (I've attached screenshots of the raw data for your convenience). Diagnosed with moderate sleep apnea, AHI 15, RDI 24, O2 nadir of 90. Initial recommendation was 4-20cm of pressure, but as I've heard that's more or less a lazy doctor's prescribed range, and pretty much what everyone starts off with, I started trying to self-titrate.
Attached are my last three days of trying out CPAP. (I've actually had it for a few days prior, but those days were so fragmented that they don't give a good idea of a full night's sleep). I'm trying to be optimistic-- even 6 AHI on CPAP is better than 15 without it-- but I can't help but be nervous that I'm heading in the wrong direction. When I turned the pressure up, I ended up getting more AHI, although my flow limit graph definitely improved. When I turned it back down, flow limit got worse and AHI stayed more or less the same.
Is it possible I'm just spinning the dial too much and not allowing myself to get used to certain settings? Should I go back to low and hang out there for a few days to see what happens? Any advice is greatly appreciated.
A note: last night, I did a little test by sleeping half the night with my cervical collar and apnea backpack on, then half off. The sleep I got with it on was definitely better so I'll be sticking to my collar and backpack from here on out.
ANOTHER note (bear with me): I've also just been diagnosed with LPR (possibly GERD, too). If anyone has any experience on managing apnea with LPR, I'd love to hear it.
RE: Help with Optimizing Settings - Deborah K. - 11-26-2024
You would sleep better with a pressure range of 9 to 15. This is because your median pressure is sometimes as high as 10, and you are bumping up against your high-pressure settings.
Keep your EPR setting at 3. Otherwise, your flow limits get very high.
You are having some Positional Apnea. This shows on your charts when Os and/or Hs are clumped together. No setting will fix this. It happens when your chin is tucked toward your chest. It causes reduced airflow much like a kinked hose results in reduced water flow. Some solve this with a flatter pillow. Most solve it by sleeping in a soft cervical collar. Most drugstores carry a few and Amazon carries lots of them. Lots like the Caldera Releaf Collar because it is quite comfortable, but they do not go high enough for some. Others like the Valpeau collars and others. I solved it by sleeping on a fairly low pillow that has a raised edge in front that keeps my head tipped back a little. It works perfectly for me.
Do you know if you had a lot of CAs in your sleep study? If you don't know would you please post a redacted copy of your sleep study?
Again, welcome, and good luck with your new therapy!
RE: Help with Optimizing Settings - sleepykaizer - 11-26-2024
Thank you for your response! I'll try the settings you've recommended for the next few nights and see what kind of results I get. I've been using my cervical pillow and sleep apnea backpack on and off, but I'll try to get better used to them.
To answer your question, I only had one marked central on my sleep study, so it doesn't seem statistically significant. I kind of suspect that the CA events I'm seeing might be treatment-emergent centrals so I'm trying not to stress that too much.
Attached are the results from my sleep study.
RE: Help with Optimizing Settings - sleepykaizer - 11-29-2024
Okay, here are the results from the last three days with 9-15cm pressure, EPR 3, no ramp. I've been using my cervical collar and positional backpack 100% of the time, so I don't think these are positional, but who knows? Frustratingly, it looks like I took my mask off on Tuesday and Wednesday night (I remember waking up, taking it off, then immediately putting it back on... guess I wasn't as immediate as I thought lol), but last night was 100% compliant. Wednesday was my worst night of the three, and it looks to be because I woke up multiple times.
My takeaways so far:
1) I'm definitely having some kind of weird wake-sleep junk or transitional apneas immediately after/during drifting off to sleep. A mix of centrals and obstructionals. Given that only one central appeared in my sleep study, I feel a fair bit of confidence that these centrals are treatment emergent. I will keep an eye on them. On Thursday, I fell asleep once and stayed asleep all night (thank you, Thanksgiving dinner), and only had one of those major clusters at the beginning of the night-- there were other apneic events, but more spread out.
2) I have chunks of time where I'm relatively apnea free. Up to an hour and half. I'm not sure if this lines up with sleep cycles or not.
3) Anecdotal evidence: I feel better with CPAP than without it, no question about it. It's not a dramatic change but I'm yawning less (still there, though) and feeling slightly more energy. No heavy eyelids. Hoping this continues to improve.
What do you guys think? My pressure graph feels like a mountain range, which is a little concerning. Should I stay the course with my current settings and see if I continue to improve, or make any adjustments?
Thanks for your time!
RE: Help with Optimizing Settings - Deborah K. - 11-29-2024
I suggest raising your pressure range to 11 to 16. This should improve things for you. Unless the pressure changes wake you, I would not worry about the mountain range. Your CAs are definitely treatment-emergent and will lessen as time passes. Ignore them. Post again with charts in a few more days so we can see how things are going. You are doing great!
Even with EPR at 3 your flow limits are pretty high. It might be that you would do better with a ResMed AirCurve 10 Vauto instead of an Autoset. Much later in my therapy, I was advised of the same thing. With Sleeprider's (and other people's) help, I was able to get a Vauto prescribed. Because it was a different type of pap machine my insurance covered it. There's a long thread about my journey to get the new machine by talking my regular (not sleep specialist) doctor into prescribing it. In case you are interested, here's a link to the thread:
https://www.apneaboard.com/forums/Thread-Flow-Limits-How-to-Upgrade-CPAP-to-Bilevel?highlight=flow+limits+bilevel
RE: Help with Optimizing Settings - sleepykaizer - 11-29-2024
Thank you for the advice, I'll make the changes and come back in a few days with more data.
As frustrating as it is to hear that I might need to buy a new machine (I paid for my Resmed out of pocket-- ouch!), it's also good direction. I got my APAP prescription through Lofta, so I'm not sure if they'll be any help in regards to changing the prescription to BIPAP, but I'll try them first. I'm also seeing a pulmonologist (who is the one who initially recommended I do a sleep study) and a cardiologist-- long story, but I've been having some shortness of breath issues that I think are related to LPR, and some pounding heart issues that I think are related to sleep apnea. I'll talk to both of them about my ongoing sleep therapy. If Lofta won't come through, hopefully they will, if I show them that I have room to improve with a different machine.
Thanks again for all of your help so far! TTYL
RE: Help with Optimizing Settings - Deborah K. - 11-30-2024
If you do need a bilevel, you can ask your regular doctor or even a nurse practitioner, dentist, etc. to prescribe it for you. If they agree, ask them to prescribe a ResMed AirCurve 10 Vauto and to write on the prescription that no substitution will be accepted. That's the best machine. My husband and I love ours!
There are folks on our Supplier List (in the black ribbon at the top of each page) who sell good used machines. Some folks have found real bargains this way. There's also a fellow on another board who buys and sells used machines, buying and selling them at very reasonable prices. I can tell you how to contact him if you want.
Best of luck with getting your therapy to be the best it can be!