[CPAP] Help with OSCAR data

[removable mike]

Hi everyone,

I have been on CPAP (ResMed AirSense 10 Auto) for the last 5 years.  I wear a full face mask (ResMed F20).  My untreated AHI was 90 as of 2016.  My pressure prescription is for 4-13 cmH2O.  I have EPR set at 3 full time.

My AHI with CPAP is usually under 2 (and often under 1).  Even so, I still really don't sleep all that well (an app called AutoSleep pulls information from my Apple Watch that usually shows that I have very little to no REM sleep).  I would like to understand what problems if any, may be apparent from my OSCAR data so that I can try to improve my sleep while on CPAP (my data from last night is attached).  Can anyone who understands this data help?

I've tried mouth guards (ZQuiet - hated it) and mouth tape (doesn't help) as adjuncts to CPAP therapy to improve my sleep.  I also have a cervical neck pillow arriving today (we'll see!).

I will be seeing a sleep pulmonologist on November 11.  It has been 5 years since I've had a sleep study (at home), so it is probably time for another one.  I am also interested in having a drug induced sleep endoscopy so that the anatomical cause of my sleep apnea can be identified and potentially treated (I'm open to surgery, if available).  Any advice that you may have about topics to discuss with the doctor in light of my data would be most welcome.

[staceyburke]

Welcome to the board, there are a lot of knowledgeable people here that can answer questions and help.

I see a couple of things that would improve your therapy.

first let me explain the basics of pressures and EPR.  The min pressure is the inhale and exhale pressure.  EPR (exhale pressure relief) subtracts from the min pressure to make it easier to exhale and ALSO help with flow limits and hypopnea.  So it is an important part of your therapy.

The absolute lowest pressure the cpap machine can go is 4.  Your min is 4 and you have your EPR at 3.  It is doing nothing for you set up this way.  Min 4 - EPR 3 just can't be done because the machine can not go below 4.

I would suggest the following setting
Min 7
EPR 3

That would give you inhale at 7 exhale at 4.  It will help keep the pressures steady (your pressures look like mountain ranges) and help yout your hypopnea and flow limits that are high.

give it a try tonight and post tomorrow, tell us how this feels compared to the other setting.

[Gideon]

Welcome to the forum.

two things
Set Min pressure = 7 to take full advantage of EPR as described above.
Turn Ramp off. At these pressures there should not be any need for a ramp.

[quiescence at last]

I will be getting an airsense 11 autoset very soon as a replacement for my current machine under recall. so, this could be me, soon. in that vein, if this were my night and it were typical, then I would do the following:

make sure my minimum exhale pressure is going to be about 5.9 (like near the med. EPAP).
set my algorithm to "Autoset for Her". It raises and lowers in smaller bits, slightly slower to react, but way slow to reduce the pressures, so should be much less spikey.

If I keep the EPR set as 3, the start pressure should be 5.9+3=8.9. Setting would then show Min 8.9 Max 13.

my own preference is to have EPR at 2 because that is what I am used to. Then I could get away with Min 7.9 Max 13.

I have ramp setting on my System One one, but it only does this if I press the button. And, I rarely use it.

QAL

[staceyburke]

quiescence at last  That is not how EPR works. See my first post in this thread

[quiescence at last]

i think we were saying the same thing. but, if not, no big deal.  that is what i would do.  OP may not even want to make their own adjustments.

QAL

[Jeff8356]

Looked to me like you were saying the same thing, just in different ways.

A minimum pressure of 7 with an EPR of 3 would give you a pressure of 4 on exhale.

[removable mike]

Last night I changed the settings from 7-13 cmH2O with EPR set at 3.  Didn't sleep terribly well, unfortunately.  Here are the results.  My pressure levels are still all over the place!

[Gideon]

Set your min pressure=10
Max=15
Try that and repost

[removable mike]

Here are the results of my change to 10-15 cmH2O with EPR 3 last night.  Per the AutoSleep app, it looks like my waking up during the night coincided with the pressure spikes shown on the OSCAR graphs.  My sleep was not great but it did improve somewhat after I put on a cervical neck pillow at around 4 am.