[CPAP] New user, OSCAR interpretation for high AHI

[apt65]

Hi, I'm a pretty new user, I've been using the CPAP about a week and a half, and was initially diagnosed with OSA after an in home sleep study where my AHI was measured to be around 18. After a particularly rough start, I've finally got to the point where I can both fall asleep and stay asleep (mostly) with the mask on. I've slept a normal period of time the last three nights in a row. 

However, my AHI appears to be higher than optimal for treatment, and I'm trying to learn how to interpret these results in OSCAR. Machine is a Dreamstation and the mask is a nose mask (N20). The attached OSCAR data is similar to the other two nights I've been able to sleep through (AHI is similar and events are similar). I can post more if needed.

I appreciate any help you might be able to offer. 
   

[apt65]

I noticed I messed up a bit on the original screenshot of my oscar results so here's a new one.

[Sleepster]

The first thing I would try is adjusting the straps on your mask. It's leaking way too much. You may need to call your equipment provider to try a different mask, it's usually necessary to try different masks to find one that fits you well. When the leak rate is too high the CPAP machine can no longer maintain the pressure splint needed to stop the obstructive apneas.

[SarcasticDave94]

Welcome to Apnea Board.

Default pressure settings of 4-20 are rarely successful. These can and should be adjusted by yourself with feedback from AB members. For starters, the low number of 4 is likely to cause feelings of air starvation. I'd consider bumping it up to 6 to see how that feels. Yes, you are "allowed" to do so. In fact, I encourage you to do it yourself. You are the one using it, just do adjustments with a bit of knowledge. Lots of doctors and DMEs will tell you otherwise, but it's not true. You don't need a new script to do it, but the doc/DME do need that if they attempt setting edits.

A second reason to bump up minimum pressure is that Respironics machines are slow to respond to events. If you bring the pressure up, it will likely lower the AHI number.

Secondly, consider turning off the VS2 event flag in OSCAR settings.

Third is to get your specific machine clinical manual within the CPAP Setup Manual tab in the top banner.

[Dormeo]

Apt65, congrats on learning to sleep through the night using your machine. You do have a couple of large-leak interludes, but on the whole the leak levels look fine. (If you were using a ResMed machine, that'd be a different story.) Dave has explained why you should consider raising your minimum. Try 6, as he suggests, and post another chart. Additional increases will probably be warranted.

There's a suggestion of clustering in your obstructive events. No need to do anything about that now, but when we can see another chart, we'll want to be on the lookout for clusters. If they continue to be present, solutions can include changing your bed pillow, staying off your back, or using a soft cervical collar. But one thing at a time.

[apt65]

Great, thanks for the insight guys. I'll make the change to 6.0 as suggested and report back. Dormeo, I agree that it sounds like positional issues may be a thing for me. I tend to move around, change positions a lot during the night. I've also just recieved the manual for the machine. I appreciate all the help, it's literally a lifesaver. The doctors and DME have been less than forthright with advice so far.

[SarcasticDave94]

Let us know if things improve. And post a new OSCAR shot tomorrow. We can view how things changed for you. Include a detailed answer to "How do you feel?" as well.

[apt65]

Well, feeling a little groggy this morning (I stayed up way past my bedtime), but feel like I slept a lot more deeply last night. The results this morning seem to confirm. All in all, the change in pressure sure made things feel a lot more comfortable in general. I felt like I could fall asleep a lot easier.
   

[Gideon]

I'd like to suggest a min of 7 to help your Obstructive events and
Reduce flex to 1 or off to reduce centrals.

[Sleeprider]

I agree with Bonjour, in fact I'd bet your minimum pressure will move to 8.0, which is a very common and effective pressure that is close to your 90% pressure. You are making steady improvement, and I'm sure you will find optimizing the minimum pressure very rewarding.