[Pressure] Need Help with Pressure

[bhoskins]

Just to provide a little background, I've been diagnosed with Sleep Apnea for 15 years now.  I was told at the beginning (15 years ago) I had Severe Complex Sleep Apnea and it was the worst he has seen in a long time.  During the initial few years I had a few surgeries done to try to help alleviate some of the issues which it has.  Deviated Septum, Sinus Surgery and the UPPP Surgery.  On top of that I started exercising and lost 65 lbs and in the best shape of my life.  My snoring is 100% gone but I still require a machine.  I also saw a neurology doctor about CSA but they said its not central and its all OSA, so ?????

I got my most recent machine, the Resmed Air 11  Autoset around February of 2023, the pressure has always been 5-10 and my AHI has been around 7 or so, not great but functional.  Something happened in  July and I just feel worse, sleep quality has really went downhill.  Also, just to point out, I always wake up with a headache, can't remember when I haven't but since whatever happened in July those headaches are worse. 

My initial thought was open up the pressure, 5-20 and let Autoset fix it.  Not much difference as the pressure went up, I think CSA may have gotten worse.  I turned off EPR, seemed to make CSA better but CSA was still high compared to OSA, so I then tried pressure 4-8 thinking its pressure causing CSA, no luck.

I just installed the SD Card lastnight, so I only have good details of 1 night.  Installed Oscar this morning and created a forum account.

Any guidance here would be greatly appreciated.  The headaches, brain fog, naps, etc. is awful.  I have reached out to a sleep doctor but I can't be seen till the end of October and I can't wait that long, I keep calling every 2-3 days hoping someone canceled a appointment and I can get it.   Last sleep study was 2017, so I attached the summary of that as well.

[staceyburke]

You are having a lot of positional apnea.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Your sleep test showed almost all of your positional apnea was on your back!  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

I would also move the min up from 4 to 7


You have a lot of central apnea.  You had almost no central apnea in your sleep study, so ONCE you have got the positional apnea under control, I would try using EPR.  You need to set it at full time and set it at 1.  See if that helps with the flow limits AND you do not get more centrals.  IF the centrals don't increase it to 2 and again give it several days to see if the central are ok and then go to a setting of 3.  EPR will help your flow limits but it tends to increase the centrals until you get accustomed to the treatment.

[Sleeprider]

Your latest charts show clusters of obstruction typical of "positional apnea". https://www.apneaboard.com/wiki/index.ph...onal_Apnea This change in your results may have come from a change in your bedding, pillows, sleep position or weight. It's there, and a common tool used to fix it is the soft cervical collar. https://www.apneaboard.com/wiki/index.ph...cal_Collar
Based on your results, you clearly need higher pressure. Your current range of 4.0-8.0 is not adequate to treat the obstructive events. I'm going to initially suggest a minimum of 8.0 and maximum of 12.0 is more appropriate to your condition. We often use EPR to treat the flow limitations that cause the pressure to increase rapidly in an Autoset machine, and to provide a bilevel form of pressure that actually reduces flow limitation, respiratory effort related arousal (RERA), hypopnea and poor sleep. With EPR you get a lower exhale pressure and higher inhale pressure. This is effectively bilevel and it can be very beneficial, or it can also lead to increased central apnea as it increases ventilation and reduces CO2. Without knowing your tolerance for EPR, I recommend you try it.

In summary, minimum pressure 8.0, maximum pressure 12.0 EPR full-time at Setting 3.

[bhoskins]

I appreciate the feedback, the suggestions was a big help.  My OSA went down to almost nothing but my CA still seems high.  Any thoughts on the CA?

I got a CVS Brand Soft Cervical Collar & I removed some stuffing from my adjustable pillow, so great suggestions.  Too bad I can't just use the neck brace and get rid of the sleep machine  

Also, I went with the minimum pressure 8.0, maximum pressure 12.0,  EPR full-time at Setting 3 approach.

[Sleeprider]

To reduce the CA, we may need to reduce the EPR back to 2 or 1. Take your time in making the changes and let's keep track of where the intersection of comfort and efficacy seems to lie. Keep in mind that CA is common in new users (therapy onset centrals) and will often clear up as you adapt to the improved ventilation. Note your pressure only went to 10 in spite of the higher setting, so the use of EPR really dampened the changes in pressure and your 95% flow limit has dropped to 0.03 from 0.17. That is an important and significant improvement. Your overall AHI is half of what you previously posted going from over 19 to 9.2. Still too high, but CA tends to be less disruptive than the obstructive events we saw before. No clusters of OA in the new chart, so nothing further is needed, and you might even be able to omit the SCC with the pillow modifications. Really good progress with room for improvement.

[bhoskins]

EPR changed from 3 to 1 and still using the Soft Cervical Collar.  

Numbers keep getting better with the suggested tweaks, so the help is much appreciated.  Any other suggestions to finish it off? I think I'd like to keep EPR on and not turn if off completely, unless that's the only way to take down the CA events further.   I can tell I tossed and turned a little more with EPR at 1 vs 3 but even with the tossing and turning, I feel much better today.

[bhoskins]

Looks like I finally hit some good settings, these numbers are the best I've seen in the 10+ years I've been using a CPAP machine, so that's great and ridiculous all at the same time. I've gotten more help from this forum than I have from my doctor.

Should I be content with my results since its below 5 (for the first time in 10+ years of cpap)  or should I try to tweak to get my AHI as low as possible? If I did anything, would I tweak the Min pressure up a smidge more? 

EPR 3 to 1
Min Pressure 8 to 9
Mas Pressure still at 12
Using Soft Cervical Collar