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[Treatment] Optimizing my "treated" apnea
#1
Quick summary (someday I'll post my full story in the success stories thread):
  • Originally diagnosed with severe OSA, which is now moderate (~20 AHI in my most recent sleep study, last year)
  • Using xPAP for eight years; one year on this machine
  • Have been on full face masks ever my first sleep study where I had problems with mouth breathing - I've read there are ways around this, but I seem to tolerate the FFMs well
  • Average AHI of 2.60 for the last 6 months. Compliance/usage hasn't been ideal, it turns out newborns and consistent therapy don't mix, but working on improving that now that the baby sleeps through the night in his own room
I had my one-year follow-up with my sleep doc where he basically said "these are great results, just keep using it" which I realize is clinically correct, but not very useful, and my quest to optimize various aspects of my life led me to discover SleepyHead and then this forum, both of which have been amazing. I recently tweaked my settings based on what I've read, mainly lowering EPR to try to cut down on my quantity of Clear Airway events.

Mostly looking for advice on optimizing my therapy. I feel I get decent sleep, and can definitely tell the therapy makes a difference... but I'd like to get great sleep, if it's possible, and I'm not sure what to make of my data.

Links to my last two nights are below. Note I got up before the crack of dawn without an alarm both nights - I think I slept a bit longer last night with the machine off, which I try to avoid - both nights the real out-of-bed time was around 4:30am. This is partly due to my weird schedule (very early morning exercise) but lately it is happening more frequently and I don't need an alarm.

Tuesday night: https://imgur.com/NVfyE1t
Wednesday night: https://imgur.com/Y5T1EUA
Sleep study results from 2016: https://imgur.com/dlPMfS5

Thanks in advance, and thanks to everyone who's contributed to the exceptional resources on here.
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#2
First glance: increase your maximum pressure. Start with just 14 and wait a week to see if that does it. You are tapping that upper limit far too often.
Next increase your minimum pressure to 10, maybe 9.5.
PaulaO2
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#3
Hi eternal,
WELCOME! to the forum.!
Good luck as you continue CPAP therapy and also with getting it optimized.
trish6hundred
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#4
(10-12-2017, 03:18 PM)PaulaO2 Wrote: First glance: increase your maximum pressure. Start with just 14 and wait a week to see if that does it. You are tapping that upper limit far too often.
Next increase your minimum pressure to 10, maybe 9.5.

Thanks - I'll try just the maximum pressure bump for tonight and the minimum pressure bump later on.

I do see what you are saying, especially on Tuesday night where I was consistently running into the pressure ceiling for about a 1.5 hour period.

(10-12-2017, 04:15 PM)trish6hundred Wrote: Hi eternal,
WELCOME! to the forum.!
Good luck as you continue CPAP therapy and also with getting it optimized.

Thank you!
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#5
I think bumping your minimum pressure up is going to be the key. I would use the 30 day median pressure as a guide, and the suggestions above look about right.
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#6
Thanks Sleeprider.

Would it be better to try only the maximum pressure bump for now and wait to see results, or increase both ends of the range at once?
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#7
If I had to choose, I would rather see you increase the minimum pressure than the maximum. At 9-13 your median pressure is over 11.0. Although you reach your maximum pressure, I think that is mainly a function of being at too low of a minimum pressure. Your pressure is swinging by 4 cm with current settings, and I think you will find it less disruptive if you simply increase minimum pressure by 1.0. That said, your event rate is fine, and your pressure increases are driven by flow limitations. This may not be that important and we have often suggested limiting maximum pressure that is increased only for flow limits. The more important question is, are you feeling good and reasonably rested. You have been doing this for a year, so you're in a pretty good position to answer that. If you feel good, nothing is needed.
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#8
(10-12-2017, 08:05 PM)Sleeprider Wrote: If I had to choose, I would rather see you increase the minimum pressure than the maximum.  At 9-13 your median pressure is over 11.0.  Although you reach your maximum pressure, I think that is mainly a function of being at too low of a minimum pressure.  Your pressure is swinging by 4 cm with current settings, and I think you will find it less disruptive if you simply increase minimum pressure by 1.0.  That said, your event rate is fine, and your pressure increases are driven by flow limitations.  This may not be that important and we have often suggested limiting maximum pressure that is increased only for flow limits.  The more important question is, are you feeling good and reasonably rested.  You have been doing this for a year, so you're in a pretty good position to answer that.  If you feel good, nothing is needed.

Thanks and your point is well taken. I did increase the minimum pressure to 10 after your post and now I plan to leave it alone and just take regular notes on how I'm feeling day-to-day (which I didn't do before).

Lately I do feel pretty good, particularly in the last week. Hitting 7 hours a night very consistently and rarely going back to sleep without the therapy which I believe has been a source of problems in the past.
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