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What are realistic goals?
#1
What are realistic goals?
Good morning everyone,
I apologize for the influx of posts over the past few days. My doctor has been little to no help and I feel a bit alone in this process. Long story short I was diagnosed with mild sleep apnea with an AHI=6 and RDI=9 on an at home sleep test. 

A CPAP provider set up a Phillips Dreamstation at my house and set the range of pressure from 4-11. My results have yet to get me to an AHI below 3. Average results in 3-4 range. I bumped the minimum up to 6, but it kept my AHI around 3.8. Are these acceptable results? I always see people on the sub talking about AHI from 0.5 to 1 and I can’t seem to get there. Just wondering what is realistic. 

Thank you!
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#2
RE: What are realistic goals?
It would help if you could provide the specific Dreamstation model (is it an auto machine?), and download OSCAR and post some screenshots of your data.
Caveats: I'm just a patient, with no medical training.
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#3
RE: What are realistic goals?
I included my OSCAR report from 3 night ago with min at 4 and max at 11. I also included my OSCAR report from 2 nights ago, min at 6 and max at 11.


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#4
RE: What are realistic goals?
Here is last nights OSCAR report


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#5
RE: What are realistic goals?
It looks like you raising the min pressure to 6 was wise.

A lot of your events are "clear airway" events, which are common with newbies. It can take your body and mind time (weeks/months) to adjust to PAP therapy, and then for you to sleep more smoothly, and for the CAs to resolve.
Caveats: I'm just a patient, with no medical training.
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#6
RE: What are realistic goals?
Patience, I can’t help with adjustment but I can relate to your situation. For me, my sleep study was AHI of 7 and on CPAP it immediately jumped to 12. It took time for my body to adjust to the new “Monster” on my face.
CPAP is a journey like “The Wizard of Oz”. It’s a long slow journey. You will face many problems and pick up many friends along the way. Just because you reach the poppies, it doesn’t mean you are in Kansas. 
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#7
RE: What are realistic goals?
@Rcgop what are you at now?
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#8
RE: What are realistic goals?
I would suggest moving your bottom number up 1 more.  And try turning OFF the A flex.  For some it helps to turn it off to get rid of centrals.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
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#9
RE: What are realistic goals?
The 2 OSCAR charts are telling a few things to me. The lower pressure earlier chart had lower CA but Obstructive/OA maybe Hypopnea as well were getting past the CPAP due to low pressures. It's an inherent characteristic of Philips Respironics machines. They respond slowly and in order to reduce events, pressures must be around your 95% pressure number. In this earlier chart that is 7.5; so you can see 4 is definitely too low. Then the latter chart shows a pressure setting increase, and Obstructive goes down some, but Central/CA goes up. A typical see-saw issue.

OK, me personally, I think 4 as a pressure will be too low and uncomfortable. It'll set up a feeling of air starvation. I would suggest you consider things this way, the charts tells us what is going on with events and such, but the other half of the story needs to come from you in answering "how do you feel?" and this can be a during or after therapy on how it affects you.

I think the first setup is not good again for the possible air starvation it may bring. The second one is a bit better, but swapping a lower event count of one for another. I think preference ought to be on building more on the latter direction, we should focus on tweaking that version. Typical therapy actions to address Obstructive based events is to raise pressure. For Central based events, therapy pressures should be low and with minimal pressure swings. These oppose each other in most cases.

I think for now maybe pressures from the latter chart but reduce Flex to 1 or off to address the increased CA. Likely Flex could be added back after you've gotten used to therapy. One last consideration, if you have the chance to swap the DreamStation for the ResMed AirSense 10 AutoSet, you'd be a lot happier with your therapy.
Dave

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#10
RE: What are realistic goals?
Flex settings are really personal. What works for one person may be distressing to another. For me, I never could get used to AFlex. I'd always have a bad night. Just didn't agree with me. When I changed to CFLex things got significantly better. Consider changing either the setting level or type of Flex. It might help.
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