Newly diagnosed - on a DreamStation - need review of data

[matsarge]

Good morning. I was diagnosed back in March 2019 and I've been on the DreamStation Auto Cpap for the last 45 days. For the most part, it seems to be helping a lot. During my testing (in a sleep lab), my AHI was around 37 and with the machine, I've been at around 4.5 AHI over the last 45 days. 

All that said, I feel like it can be better. My deep sleep is still nowhere close to what it needs to be. I have two main things that track sleep: 1) Oura ring - which can break sleep down into Rem/Light/Deep and 2) I have a Sleep Number bed which tracks via Sleep IQ. On average, I'm getting about 30 mins of deep sleep a night, with the majority being light sleep (around 60% most nights). My average heart rate is around 56-57 every night. 

The doctor set the machine to the default (4-20 cmH2O), 30 min ramp at 4, flex on and at 2) and I'm pretty sure it can be updated to something better. Based on the Sleepyhead (now Oscar) data, over the last 30 days, my average pressure is 6 and my 95% pressure is 9.  

I've been trying a couple of different things over the last 3 nights, with mixed results. I've attached 3 days of data so I'm hoping that someone who's more seasoned at this type of data could review and let me know what they see. Here is the mask info - I've been using the Philips Wisp (old version given to me by my doctor). Here's the "problem" with that mask. On one side, I get the best AHI numbers with it but, the masks are S/M and L. The S/M is just a little too tight and uncomfortable (I'm constantly waking up and adjusting it) and the large is too loose and it shifts which causes leaks and my AHI to climb. On Friday, I went and picked up two new masks at my local CPAP store, the new DreamWisp and the ResMed F30. The new DreamWisp has small, medium, and large masks and the medium fits perfect. The bad news is that the medium connector seems to be just a tad too small (it's shifting toward the front of my head as I sleep) and I have a large connector on order. The F30 is very comfortable but it appears that it had a sealing issue last night. I can see it on Oscar, but the Philips DreamMapper app showed 100% mask fit with no large leak time. I know that 3 days (one of each type of mask) is a terrible sample size but it's the best place to start without 45 days of screenshots.

5/2- normal setting using the Wisp (old version).
5/3- normal setting using the new DreamWisp. (you will see a cluster of apnea's between about 6:55 am and 7:30 am - I was awake with the mask on).
5/4 - setting adjusted to (6-14 cmH20), flex at 1 and using the F30. (the cluster between 6 and 6:20 - I had woken up and was going back to sleep).


Thanks for taking the time to read through all that, I know it's a bunch of info for a first post and I really appreciate any insight. Disclaimer - I'm a doctoral student so I'm very interested in the data and determining what it is telling me, and how to use it to best treat my condition. 

[attachment=11737][attachment=11738][attachment=11739]

[ajack]

I would try min pressure 8 and review. 1cm below your average 95% of 9
OSCAR is reading your card. I would trust the leak rate, as you know some of it needs fixing.

[matsarge]

Here's some additional data to help. In my original sleep study (not the CPAP titration study), the following was noted. NREM AHI was 33, REM AHI was 40.3. Supine AHI was 92.1 and Lateral AHI was 26 on my left side and 44 on my right side. I tend to fall asleep on my back and end up on my left side, I try not to sleep on my right side. Based on other posts and feedback, I'm wondering if I need to get a cervical collar to help.

[Dormeo]

It certainly can’t hurt to try a collar. Soft cervical collars are widely available and inexpensive. The Dr. Dakota collar is more rigid, and pricier, but works well for some. 

These kinds of adjuncts to therapy are quite idiosyncratic, so if you can afford to experiment, that’s a good way to go.

[matsarge]

Good morning. Here is an additional screenshot with last night's data. It was a better night than the previous 3, and more in-line with my average. 

Settings were at 6-20, the only difference was the use of a cervical collar.

[Gideon]

A lot of Flow Limitations and RERAs. On your machine we need to increase your min pressure so bump your min pressure by 1 to 7. Don't be surprised by seeing additional increases recommended.

[matsarge]

Thank you. I was thinking the same thing about raising it to 7. When I look back at the historical data, I have nights very similar to what you see in terms of those events and having those clumped together when I'm falling asleep and when the machine is at a lower pressure. 

I have the Opti-Start turned on. Is there any benefit to that long term given that I'm raising the pressure to an amount that is higher than what Opti-Start is defaulting to (currently 6)? Or will that fix itself over time as Opti-Start seeing a new value to use?

Also, is there any benefit to the ramp function after the first few days of use? I didn't have any issues getting adjusted to the CPAP and I don't use the ramp function at all. I'm thinking about turning the time value down to zero and the pressure to whatever I have the min. set at.

[matsarge]

Well, I increased it to 7 and had an increase in AHI from the night below. Mostly hypopneas (as usual) but I got to bed later than usual and was more restless than the night before. I don't think it was an issue with tolerating the increase in min given I'm running at 9 on 95% of the time. If I take out the periods of time that I know I was awake with the mask on (between 1:55 and 2:40 and 6:10 to 6:40), my AHI is more like 4.8 last night.

Any insight is appreciated. I'm wondering if I should stay at 7 for a bit and see how it levels out or bump it to 8. Flex is at 2 with the OptiStart turned on.

[Gideon]

On ramp. Most experienced users do not use a ramp.
You recognize that one night does not make a trend and that night to night variations are normal, great.

If that was me I'd bump min to 8 and if nothing unusual comes up give it abt 3 days before changes.

[matsarge]

Thanks for the input. Agreed, one night does not a trend make.

Like any good researcher, I'm trying to limit to changing of too many variables at once.  I've been using the same mask for the last 2 nights and only changing the min. pressure. I will use the same mask tonight. I'll run it at 8 for the next 3 days and see how it goes.