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I like the idea of capping the pressure and think 9 is a good start. I also like the idea of switching to AutoSet instead of AutoSet for Her mode. Make sure when switching to AutoSet mode you also set the response to Standard and not Soft.
Soft response which for Her mode uses has a tendency to increase/pressure more gradually, but because of the slower responsiveness has a tendency to sometimes hit higher peaks.
Your timing and pattern of increases and FLs is consistent with apneas exasperated by REM.
Note at 5:15 to 5:45 your machine want to go higher, but couldn't because it's capped, thus the ugly FL and event cluster.
Sometimes dealing with Apnea and Aerophagia means walking a gentle line between un-optimised therapy and aerophagia.
These are what I believe your next steps should be:
Stay at 9 for a while, say two weeks. As you body adjusts, it may very well might learn to stop the air from going down the wrong tube.
Then increase the max pressure by 0.2. We are in no hurry. If the Aerophasia returns go back to previous pressure, and try again in a couple weeks.
Repeat, until max-pressure is well above where machne needs to be.
Another update: 95 nights.
Aerophagia seems to be eliminated with my current settings.
I am exhausted.
What else can I do?
Why is the AHI higher some nights?
What does it mean when the cpap is registering CSRs? Is that when I'm actually awake or partially awake?
I don't really want to increase pressure but I'm willing to if there's actually a chance I could feel better during the day.
I am also totally new to CPAP, so I may be totally off-mark here, but...
Reading this thread I see the OP had a negative in-home study, and an in-lab AHI of 7.7
After 95 nights on CPAP their AHI is way down, and the CPAP-induced aerophagia seems to have resolved. Which is great.
Except that the OP is still exhausted!
Is the goal to treat the AHI or to treat the patient? To my completely untrained eye, it seems like something is missing in this picture. (In fact I understand that in many countries the OP would not even have been offered CPAP in the first place).
I don't mean to discourage anyone, I'm just trying to understand what's going on.
1) I can't zoom in to confirm this, but it "appears" that the obstructive events are sometimes clustered. This would indicate positional apnea aka chin-tucking in which you kink your own airway. By analogy, think of a kinked garden hose. Pressure will not solve this. It may be worthwhile to try a soft cervical collar. As I recall, Gideon's signature contains a link to give you details on this.
2) Since the aero is gone, I would consider raising max to 10 because the machine seems to want to go there. if aero returns, max back to 9. It's an experiment.
Eddydee - once diagnosed with OSA (ie AHI over 5) my docs only goals for me are cpap compliance and reduced AHI.
The minute they saw AHI over 5, they consider my fatigue solved with cpap use. They won't even consider looking any further before 6 months of cpap compliance.
Multiple primary docs and a few specialists. It is incredibly frustrating.
I am meeting with a new primary doctor in a few weeks but past experiences leave me feeling a bit hopeless about ending the fatigue.
So, I'm doing my best to use and optimize my cpap treatment. Even if it's just to be able to hand that data to the docs and beg them to keep looking for answers.
I don't know if I can tolerate a c-collar. One of the other advisors thought my patterns suggested REM induced apnea - if that is the case is the c-collar beneficial?
And with an AHI already under 3, what is the potential of feeling any better by getting it a little lower?
I understand the goal is therapy optimization.
Just tired and frustrated.
@Brazen I feel for you, it must be disheartening to feel you're going down a series of rabbit holes and not being treated as a real whole person.
I really hope it works out for you fully, and CPAP will be a step in the right direction, even if not a complete solution.
@Eddydee
Thank you, I appreciate the empathy.
Treating even mild OSA makes sense, like certainly it's more restful/healthy to reduce the number of times during the night that my sleep patterns are disturbed by reduced oxygen intake.
I'm just trying to find a doctor that will consider other possible reasons for my fatigue.
So, I feel like I should preface this with a few things...
I'm a nurse and in general nurses make terrible patients, I am no exception.
I also work in Informatics so I'm all about the data.
I'm just trying to get a handle on how the CPAP is benefiting me. If I can find the benefit, I can accept wearing the dang thing.
So, a week ago I decided to try an experiment.
I was interested to learn what my AHI might be without the CPAP. (Sleep study gives only one night in a strange environment)
Since there is no way to collect that data at home without the CPAP on I figured the next best thing would be to set my CPAP at minimum pressure. 4.0 min, 4.0 max.
My average AHI for the last week is 1.68.
My average AHI for the last 30 days is 2.05. (7-9 pressure)
Why did lowering the pressure lower my AHI?
How much difference is there between room air and 4.0 pressure?
I also feel no difference in my daytime energy. (Chronic fatigue here.)
I'm attaching my OSCAR stats from my lowest AHI and highest AHI nights from the last week as well as the total stats.
