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New user seeking guidance optimizing settings
#1
New user seeking guidance optimizing settings
Hi folks, 

I'm a late 30s female who has struggled with sleep for over a decade. In the past few years, fatigue, ability to stay asleep, and executive functions have worsened. Fairly active and healthy weight. Slightly deviated septum.

After jumping through more hoops than I care to recall at the moment, I have an auto cpap. No easy feat! As soon as SD card arrives (another case of DME insisting not included), I'll start using OSCAR. My polysomnogram showed the following:

SLEEP PARAMETERS
Total sleep time: 400.1 minutes
Sleep latency: 26.5 minutes
REM latency: 243.5 minutes
Sleep stage distribution: N1 14.5%, N2 75.7%, N3 3%, REM 6.3%
Total arousal index: 29.7/hr
Apnea-hypopnea arousal index: 12.1/hr
Snore arousal index: 5.7/hr
Limb movement arousal index: 0.1/hr
Spontaneous arousal index: 11.7/hr

RESPIRATORY PARAMETERS
Obstructive apnea events: 2 Hypopnea events: 36 
Mixed apnea events: 1 AHI: 7.6/hr
Central events: 12 
RERA events: 81 (index = 12.1/hr)
Baseline oxyhemoglobin saturation: 99%
Mean oxygen saturation throughout study: 97%
Lowest oxyhemoglobin saturation: 93%

DIAGNOSIS
Mild OSA

Re diagnosis, any thoughts? I've read a lot about UARS, though, I certainly don't have the data or experience to form a strong argument about the matter. No one I've seen has ever mentioned UARS, at least not to me. I'd never heard of UARS until joining this forum. 

Re auto CPAP settings, any suggestions based on sleep study? For the past week I've used pressure range 5-18 and EPR 3. Took me 3-4 nights to adjust to wearing mask. Now that I'm fairly comfortable with mask and showing minimal leaks, shouldn't I start to feel a little more rested? I felt slightly more rested maybe 1-2 days at most. I know it's hard to advise without OSCAR data. Maybe I should bite the bullet and stick with current settings until I have a few nights of OSCAR data...

Any and all guidance appreciated! This forum is a lifesaver.

K
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#2
RE: New user seeking guidance optimizing settings
A minimum of 7 will allow EPR to work at the lower pressure. EPR lowers exhale pressure by 3 from the inhale pressure. Since the lowest pressure your machine will deliver is 4 EPR will only lower pressure by 1 at a setting of 5. Also, 5 may be starving you for air. That's assuming your machine is at 5 for any length of time . We won't know until we see OSCAR data. Even if the therapy is working well it may take a little longer before you feel more rested. It's good that you feel comfortable with the mask. Often that's a major challenge when first starting.
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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 user seeking guidance optimizing settings
While not a lot, thus the Mild in the diagnosis, about 1/3 of your events are central.  

Obstructive apnea events: 2 Hypopnea events: 36 (AHIo= 7.6-2.4= 5.2)Your Obstructive AHI is 5.2)
Mixed apnea events: 1 AHI: 7.6/hr
Central events: 12 (7.6/3= 2.4 CAI)
RERA events: 81 (index = 12.1/hr)
(RDI = AHI + RERAs = 7.6 + 12.1 = 19.7)  The RDI pushes you up to Moderate AHI.

So yes, looks like Mild UARS.  Most doctors do not recognize UARS as something to be treated, but the treatment is the same as for RERAs, (EPAP pressure for OA events, and PS/EPR for the rest of the obstructive.

I agree with the min Pressure of 7 but with the central apneas I'd like to take a more cautious approach to the EPR as higher values of EPR can, not always, result in an increase of central apnea events.  I too want you to be at EPR=3, fulltime, to treat your hypopnea and RERAs, but let's start at EPR = 1, fulltime.  
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#4
RE: New user seeking guidance optimizing settings
Welcome to Apnea Board,

Yep with the Centrals we'll probably need to play the "Avoid CA Game". Gideon has a good plan to trial. Try it and post OSCAR and tell us how you feel after using.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: New user seeking guidance optimizing settings
*Sigh* What a frustrating and exhausting past couple of weeks, not to mention this is my second attempt at posting an update. I'm sure my first one more complete, but I'm trying to practice not allowing perfection to get in the way of good (and done). 

Now, down to business. On May 3, BEFORE the long-awaited SD card arrived, I experimented with the following settings: fulltime EPR 1 and (later the same night) 2, min pressure 7, and max pressure 18. 
(05-03-2021, 02:11 PM)Gideon Wrote: I agree with the min Pressure of 7 but with the central apneas I'd like to take a more cautious approach to the EPR as higher values of EPR can, not always, result in an increase of central apnea events.  I too want you to be at EPR=3, fulltime, to treat your hypopnea and RERAs, but let's start at EPR = 1, fulltime.  
Unfortunately, it did not go well. I felt like I was drowning in air. The following day, I had trouble taking full breaths. Probably anxiety. The next day I returned to fulltime EPR 3, min pressure 5, and max pressure 18. 

The SD card arrived May 8! Dancing I've attached screenshots of OSCAR data from three sessions, May 8, 10, and 12. I'll add two more sessions, May 14 and 17, in a second post. Please ignore the first 30-60 minutes of each session, when I'm still awake. 

I have so many questions but I'm having trouble turning thoughts into cohesive sentences today. I'm sure I'm forgetting something. Maybe I should attach a closeup? Maybe I'm forgetting to include an important detail or two (or nine)? Yeah, I'm really tired. 

Thoughts? Questions? Please? Thank you!


   
   
   

Two additional screenshots, May 14 and 17.

   
   
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#6
RE: New user seeking guidance optimizing settings
I still would like to see
EPR=1 and mAx =12
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#7
RE: New user seeking guidance optimizing settings
Here's a few things I am seeing:

Minimum pressure is still too low. If you want the benefit of EPR, you need to increase minimum pressure. If you want EPR 1, you'll need 5 min, EPR 2 needs min 6, EPR 3 needs 7+.

Your EPR is 3 and helping create Central Apnea/CA. You need to try off, 1 or 2 EPR or CA aren't avoided.

Your Ramp needs to be changed, off is preferred to help reduce CA and that you'd have more time in actual therapy. Ramp's duration there's not much therapy. So for you, you're losing 45 minutes every startup. And it's forcing min pressure of 4, EPR cancelled out there I'd think.

Finally I'm seeing Obstructive clusters. This is where you're kinking your neck like the garden hose, the more severe the kink the more restricted it becomes. You need to see how many pillows you're using, or something else is causing your head to tilt and kinking the neck.

On not tolerating the pressure, try filling a glass with water, then use a straw to blow bubbles. There's a measurement but I always forget it.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: New user seeking guidance optimizing settings
(05-20-2021, 07:32 PM)Gideon Wrote: I still would like to see
EPR=1 and mAx =12

Thank you, Gideon! For min pressure, do you recommend the highest I can tolerate? Thus far, that'd be 5. Also, turn off ramp, correct?
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#9
RE: New user seeking guidance optimizing settings
(05-20-2021, 07:36 PM)SarcasticDave94 Wrote: Here's a few things I am seeing:

Minimum pressure is still too low. If you want the benefit of EPR, you need to increase minimum pressure. If you want EPR 1, you'll need 5 min, EPR 2 needs min 6, EPR 3 needs 7+.

Your EPR is 3 and helping create Central Apnea/CA. You need to try off, 1 or 2 EPR or CA aren't avoided.

Your Ramp needs to be changed, off is preferred to help reduce CA and that you'd have more time in actual therapy. Ramp's duration there's not much therapy. So for you, you're losing 45 minutes every startup. And it's forcing min pressure of 4, EPR cancelled out there I'd think.

Finally I'm seeing Obstructive clusters. This is where you're kinking your neck like the garden hose, the more severe the kink the more restricted it becomes. You need to see how many pillows you're using, or something else is causing your head to tilt and kinking the neck.

On not tolerating the pressure, try filling a glass with water, then use a straw to blow bubbles. There's a measurement but I always forget it.

Thanks for your insight, Dave, especially the garden hose neck. I'll modify settings, see how things go over the next 1-2 nights, and report back.
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#10
RE: New user seeking guidance optimizing settings
I need you to use the recommended settings for 1 night then post the charts.
I assure you, unless you have some exotic pulmonary disease the pressure is not the problem. If you had one most likely you would be in an ICU somewhere. Seeing a full night where I'm not trying to guess what the EPR is at a particular part of the chart will help.

I want EPR initially at 1 because you had a lot of CA and it should be very safe.

Pressures of 4 and 5 are considered pediatric pressures. And please tell me if you have any trouble at all blowing bubbles in a tall glass of water.

Tell us why you are having pressure troubles, you are not allowed to use the word pressure other than to state the pressure you tried. Blowing is often mistaken for pressure. That is a whole set of solutions than pressure does. ⁶c
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