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[Treatment] Zzyzx - Looking for Tips
#1
Zzyzx - Looking for Tips
Greetings,

I was diagnosed with sleep apnea on May 5th. I had two sleep studies, but I only managed around 11 minutes of sleep during the first one. I had been on Ambien in the past, but had stopped it because while it helped me sleep more, it left me even tireder during the day. My doctor put me back on it and I slept for basically all of the study.

My AHI for the second study was 15.3. Due to COVID, the place where I did my sleep study is not currently doing titration, so I got prescribed APAP at 5-20 cmH2O and ended up getting an AirSense 10. I have a lot of issues with allergies and my nose clogging up, so my current mask is AirFit F30i. I am still having issues with being quite tired, but I'm also working on getting my depression treated as well, so I am still hopeful.

I have attached my study results and the summary chart and graphs from OSCAR, but if you need more information, please let me know. Since the limit is 3 attachments, I have put more in Imgur: https://imgur.com/a/RKHSMcj

Thanks in advance,
Zzyzx


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#2
RE: Started APAP on 5/14, Looking for Tips
From your sleep study majority of apnea happened in supine position (on back). The apnea appeared to happen in clusters as well which can indicate positional apnea which is often caused by chin tucking. In your case it doesn't appear to be a severe issue on your OSCAR data so just trying to make sure your pillows aren't too thick etc is a good start, if you are seeing periods of repetitive obstructive apnea that is a sign you may have to do more to treat positional apnea (like try a cervical collar).

On your Oscar data see how the pressure increases, then decreases to about 7 and then increases again? That is an indicator that your minimum pressure is too low and what is happening is the machine is responding to disturbed breathing and increasing pressure but each time the pressure drops again you have disturbed breathing again. To try and improve this you want to increase your min pressure, in your case I would increase it to 7 cm. Try that out for a few nights and see how that compares.
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#3
RE: Started APAP on 5/14, Looking for Tips
Hi and welcome.

Good lord, you had the vast majority of your apneas while on your back - for all of a quarter of an hour! You have just barely moderate apnea but you have an AHI of 83 on your back.

I would suggest bumping up your minimum pressure to 8, your maximum down to 15 (though that can maybe come down a little, you rarely go above 12 by the look of it) and try setting your EPR to 3.

Most of those events seem to be starting at the lower pressures although they may well be positional as well, considering how significant your supine events were, and the extra EPR may help with the hypopneas and flow limits. But hopefully, these settings will do the trick to start with. If not, then the positional issues (chin tucking, basically) may extend to other positions, albeit not as profoundly!
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#4
RE: Started APAP on 5/14, Looking for Tips
(06-22-2021, 03:54 PM)Geer1 Wrote: From your sleep study majority of apnea happened in supine position (on back).
Yeah, I've never slept well on my back. I've always slept almost exclusively on my sides. I am surprised that I even slept supine at all during the study, though it was only for 13 minutes. I usually sleep with a small pillow between my knees, which I couldn't have for the sleep study, so that could've been part of it.

(06-22-2021, 03:54 PM)Geer1 Wrote: To try and improve this you want to increase your min pressure, in your case I would increase it to 7 cm. Try that out for a few nights and see how that compares.
I will give that a shot. I appreciate your help!

(06-22-2021, 03:58 PM)Ratchick Wrote: I would suggest bumping up your minimum pressure to 8, your maximum down to 15 (though that can maybe come down a little, you rarely go above 12 by the look of it) and try setting your EPR to 3.
Since Geer1 says 7 and you say 8, I'll go ahead and try the 8/15 with 3 EPR for now. I can always turn it back down a bit if it bothers me a bit. I appreciate the assistance from both of you.
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#5
RE: Started APAP on 5/14, Looking for Tips
Hopefully with the EPR upped to 3, the pressure you're breathing out against would be the same as it was for a pressure of 7 and EPR of 2. So as long as you're comfortable with the pressure breathing in, you should hopefully be good to go.
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#6
RE: Started APAP on 5/14, Looking for Tips
Either 7 or 8 will work. 7 with EPR of 2 is effectively the same as 8 with EPR of 3 that Ratchick recommended. EPAP is the most important value for obstructive apnea and pressure - EPR = EPAP.

If you see higher numbers of centrals then try dropping back to EPR of 2. EPR helps overcome flow restrictions but it can make centrals worse, you have had the odd centrals (both in OSCAR and mixed apnea in sleep study) but not bad so EPR of 3 might be helpful.
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#7
RE: Started APAP on 5/14, Looking for Tips
As an update for those who were kind enough to give some advice, here is what my sleep looked last night after the adjustments. Let me know what you think and thanks again.


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#8
RE: Started APAP on 5/14, Looking for Tips
You accidentally turned EPR off rather than increasing it to 3.

The increased pressure may have helped a bit but it will drop a bit when you turn EPR back on.

The cluster of apnea might be positional apnea. Yours isn't bad if that is the case but worth paying attention to pillow thickness etc to try and avoid your chin tucking towards chest.
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#9
RE: Started APAP on 5/14, Looking for Tips
Seconded. Try it again with EPR turned on this time and see how you do. It does seem like those remaining events might be positional, but let's see how it looks after another night and the EPR.
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#10
RE: Started APAP on 5/14, Looking for Tips
Sorry, there was a few days I didn't sleep very well in there, but I think it was mostly because my allergies were acting up. And then, for some reason, my machine didn't record the full stats for the 1st-3rd for some reason. I don't know if I need to find a specific SD card or what, but here are the results from last night.


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