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New to APAP with low AHI
#1
New to APAP with low AHI
y gang,

I just started treatment for what was diagnosed as mild OSA (WatchPAT) but seems more like UARS with AHI 3.3 and RDI 10.9. I've gone ahead and gotten an APAP after consulting with a ENT and sleep specialist. My symptoms are daytime sleepiness, mild brain fog, sleep paralysis, & usually awake with a headache.

Luckily I've had very little issue adjusting to therapy. I can sleep full nights and the mask doesn't seem to leak excessively. Going to attach my sleep study and some preliminary data from the machine. I've only been using it for about 5 days, and just have my last night of recorded data. So far, I don’t feel much different.

Would love for someone more experienced to take a look for opinions on how I can improve my stats, especially as I started with a low AHI.

Specific questions:
  1. Is my minimum pressure too low? Seems like my machine ramps up to around 7-8 to address hypopneas and then goes back down... they reoccur, rinse and repeat. I don't have a lot of data to go off of yet though.
  2. I have EPR set to 1, full time. Is this beneficial or hurting my case? I see quite a few CA events.
  3. Should I bother messing with settings at this stage or continue adjusting to the therapy?
Thanks so much for looking. Hoping I can contribute back to the community once I've learned more.


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#2
RE: New to APAP with low AHI
The Sleep Test diagnosed you with mild sleep apnea. I didn't notice clear airways on your test, but you have a few on the chart posted. They are probably "treatment emergent" and will lessen after a while.

And yes, your minimum pressure is too low. You should strive for comfort and a pressure of 4 can cause you to feel "air starved."

Set your minimum pressure to 8cm and open up the max setting a bit to 12cm.
Set EPR to 3. Give it a few days at this setting. If you notice an increase in CA's, then lower the EPR to 2.

Repost after a couple days.
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: New to APAP with low AHI
So I had a hard time tolerating a min pressure of 8, but 7 seems to be doing the trick? Or perhaps I can work up to 8 over time.

Appears the majority of my AHI is now from clear airway events, maybe I'll turn down EPR next?


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#4
RE: New to APAP with low AHI
Clear Airways are up a little.  That's to be expected when using EPR.  But Hypopneas dropped.  
So it appears it will be a bit of a balancing act.  Using EPR 3 will keep CA's up (but may lessen in time).
By not using EPR, you may see more Hypopneas and some Flow Limitation.

You'll have to decide what you can live with or what you are most comfortable with.
Also, try to eliminate the ramp. You shouldn't need it with lower pressures.

You can leave your minimum pressure at 7 as that seems to work for you.  And move your EPR down to 2.
Stick with this for a couple days and repost.
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: New to APAP with low AHI
That's what I was thinking too. Will report back next week to see what happens! Thanks for your help so far, I really appreciate it.
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#6
RE: New to APAP with low AHI
Ok, been using 8-12cm with EPR 1 for a few weeks now... Can sleep through the night pretty consistently but still averaging around 1.75 AHI with a mix of hypopneas and CAs. Usually have more CAs than hypopneas. I'll attach a pretty typical night with these settings.

Am I starting to hit the limit of what CPAP can do for me? I am starting to feel better overall, though some days are still rough in terms of energy. I've had COVID the past few weeks which I'm sure skews how I'm feeling though.


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#7
RE: New to APAP with low AHI
Attached another night of data


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#8
RE: New to APAP with low AHI
After looking at the charts, there isn't that much difference in numbers, regardless if you use 7 or 8 minimum pressure or EPR 1 or 3. I didn't notice if you used EPR 2, but what I'm saying is try not to chase numbers.

You state that you sleep through the night pretty consistently. Sleeping good and feeling decent through the day should be your guide. And believe me, most here would tell you that each night is different.
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: New to APAP with low AHI
Makes sense! Just checking that my CA events weren't at a concerning level. Thanks again
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#10
RE: New to APAP with low AHI
I don't see anything too concerning, but keep watch on the CA's.

If they increase, you can turn EPR off and use a lower pressure. But the downside would be more FL and Hypopneas.
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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