Newly Diagnosed: CPAP Beginner Seeks Advice

[CapeCodder]

I was diagnosed with severe OSA 6 weeks ago and started CPAP therapy 2.5 weeks ago. I began using OSCAR 4 days ago.

My sleep study showed an AHI of 35.7 per hour. For the first 10 days of CPAP therapy my AHI averaged 12.51 per hour. 

Then I read here about the potential benefits of using a soft cervical collar so, on Day 11, I started wearing a Caldera Releaf Neck Rest which resulted in my average AHI decreasing to 2.38 per hour since then.

My knowledge about sleep apnea and CPAP therapy is practically non-existent, and I have gotten little advice or assistance from my pulmonologist (I also have COPD), sleep medicine doctor or DME, so I am entirely reliant on what I can learn here … and I am very grateful for any insights, advice or recommendations anyone can offer. Thank you!

Below are the results of my sleep study (I’ve tried but failed to post screenshots of the actual report) and my first 3 days of OSCAR reports:

AHI    35.7 events/hour
Nadir SaO2    84.0%
Time spent with SaO2 < 90%    47.5 minutes
Total Sleep Time    324.5 minutes
Sleep Efficiency    66.77%

Sleep Architecture: 
The study started at 09:48 PM and ended at 05:54 AM, with a sleep latency of 73.5 minutes and a REM latency of 203.5 minutes. Total sleep time was 324.5 minutes with a sleep efficiency of 66.77%. The sleep stage percentages were 5.2% N1, 63.3% N2, 13.9% N3, and 17.6% REM. The total amount of time awake was 87.5 minutes and there were 211 spontaneous arousals. Patient remained in the supine position for 166 minutes and non-supine for 245.5 minutes. 

Respiratory Measurements: 
Soft snoring was recorded during this study. There were 193 respiratory events consisting of 184 obstructive, 0 mixed, and 9 central. The average event duration was 17 seconds, and the maximum duration was 28 seconds. The AHI was 35.7 per hour of sleep and the RDI was 35.7. The AHI was 7.4 in REM sleep versus 41.7 in NREM sleep.

Oxygenation Data: 
Pulse oximetry demonstrated a mean of 94% and a nadir Sp02 of 84.0%. Saturation was above 90% for 328 minutes, between 81-89% for 47 minutes, and 80% and below for 0.0 minutes. 

EKG: 
The patient demonstrates normal sinus rhythm and a mean sleeping heart rate of 75 bpm. 

Periodic Limb Movements:
The total PLM index was 63.4 per hour of sleep. The total number of leg movements that cause arousals was 17 for a leg movement arousal index of 3.1. 

Impression: Obstructive Sleep Apnea (severe) G47.33 
This study indicates the patient has severe obstructive sleep apnea and moderate oxygen desaturation. 

           

[Gideon]

Welcome to the forum

Please set min press=7 to both improve comfort ad allow EPR to work
Set EPR2, Fulltime, same as above.

In your diagnostic study your O2 SATs said that without CPAP you should be on supplemental oxygen without question

Please purchase a pulse oximeter to verify that you do not need supplemental oxygen with CPAP. Most likely you are fine, let's verify it. Any pap machine will most likely improve your SATs sufficiently.

[CapeCodder]

Thank you.
I will set minimum pressure to 7.
“Set EPR2, Fulltime, same as above.”
Do I understand you correctly to set EPR to 2?
I check my O2 regularly, and it’s typically around 94-95% … I will continue keeping an eye on it.

[Gideon]

I check my O2 regularly, and it’s typically around 94-95% … I will continue keeping an eye on it.

To be clear, at night?  if so you're good, which is expected.

[Gideon]

And yes

Set EPR=2, Fulltime
We will see how you do and adjust.

[CapeCodder]

No, not while sleeping.

I will set minimum pressure to 7.
“Set EPR2, Fulltime, same as above.”
Do I understand you correctly to set EPR to 2?

[Gideon]

Please measure your O2 levels while sleeping with the AutoSet. over the entire night.

Your diagnostic study said your O2 was between 81-89% for 47 minutes. 5 minutes at those levels call for supplemental oxygen. This is important, even if I don't expect to see a problem. It's as simple as I know you have never had your O2 levels tracked overnight with any PAP machine.

[SarcasticDave94]

Yes, you need to set min pressure at 7 then EPR Full Time 2.

If you get a recording oximeter such as CMS 50D or F or some others, they will upload pulse oximeter data into OSCAR.

If your SpO2 levels are 94-95 in the daytime, you need to pay attention to that level. Mine are about 92-96% daytime and I've got COPD.

[CapeCodder]

In order to measure my O2 levels overnight while sleeping with the AutoSet requires additional equipment that connects to the AutoSet, right? I have no such equipment. I will have to research it and purchase it.
(Pardon my ignorance; this is all very new to me and very overwhelming.)

[SarcasticDave94]

Just like what I did last time I did it, a $128 or so CMS 50F recording pulse oximeter, the free SpO2 Assistant (I think it was called that) and then OSCAR on you PC. After sleeping, hook the CMS 50F to your PC via a USB cable, upload to the Assistant then out to OSCAR. Finally, using your SD card from your PAP, you upload that night's sleep session to OSCAR. It'll combine it from there.

Editing price, just saw this CMS 50F for $128 Amazon.