any thoughts?

[mgm84]

Hi all. So I've been using a CPAP since early 2018. Was a very loud snorer, but it seemed to help on that front. I also used to be a bit heavier, but have lost some weight and stay fairly active, running around 15-20 miles a week. 

Problem is, I'm still tired and I feel it's been worse lately. I saw my PCP, who is looking into some other things, but I'm wondering if anything can be gleaned from my sleep reports. I just found out about uploading data from the SD card, so here are my last few nights. Nothing seems crazy high, but I noticed that I barely have any obstructive events. Not sure what the significance of RERA is, but they seem to keep showing up too. I deal with a pretty high level of anxiety too, which sometimes makes falling asleep difficult (and occasionally have those weird moments where I'll shoot up gasping for air as I start to drift off). I'm still trying to figure things out, so let me know if any other info would be helpful, thanks!

[Sleeprider]

Welcome to Apnea Board. Your Airsense 10 Autoset is set to a range of 5-10 pressure with EPR at 1. Your pressure rises on flow limitations which is basically airway restriction or or partial obstruction that reduces flow, increases respiratory effort and gives rise to respiratory effort related arousals (RERA) and hypopnea. Your solution is at hand. Increase the minimum pressure to 8.0, increase EPR to 3 and increase maximum pressure to 12.0. This will make breathing easier, reduce arousals and hypopnea, and should feel pretty darn good.

If you're using Ramp, turn it off. That big boost in pressure immediately after ramp ends is no accident, it's the result of insufficient therapy pressure.

[Gideon]

Sleeprider, you are reading my thoughts. The charts says min of 8, boost the max a bit and with the underlying flow limits increase EPR to 3

[mgm84]

Wow, thank you both! Consensus seems like a good thing, so I just tweaked my settings and will report back.

[mgm84]

Ok, gave it a shot. Had some trouble falling asleep with the pressure increase (which I'm guessing is why there are so many CAs at the start?) and it looks like I had some issues with leaking there too. Willing to keep trying though!

[Ratchick]

Yeah, the CAs at the very start are almost certainly "sleep-wake junk" while you're falling asleep. I'm sure the others will be around soon to give you some more advice.

[OpalRose]

Agree with Ratchick,
The CA's showing at the start of therapy are what we call SWJ (sleep wake junk).  Nothing to worry about.

Sleep-Wake-Junk - Clusters of apnea and hypopnea events concentrated mainly around periods of sleep-wake transition. In general Sleep-wake-junk (SWJ) is not regarded as "real" since they do not occur during periods of sleep, but may be during semi-awake periods or "dozing".

The Hypopneas came down quite nicely with the pressure changes.  

As far as the leaking, the spikes on the leak graph suggest mask movement.  Very minor... maybe turning over in sleep.  

I would say hold steady with these settings for a couple days.

[SarcasticDave94]

OK yep a consensus. Those CA appeared near the beginning of the sleep session, was just after editing settings, where CA weren't present hardly beforehand, SWJ as in Sleep wake junk.

Part 2 or the rest of the story, the rest of the night seemed to have a lessening of events, but Flow Limits are still present at .25. You could likely stay at this pressure set and see what trends you make, with the possibility that the Max pressure may need to be bumped up later.

So besides a slight delay in sleep onset, how was the remainder? Feel better, worse, same? Did it result in better sleep? Those answers help decide if it was effective.

[mgm84]

Much appreciated all. And yeah, feel like I was struggling to fall asleep at the start there.

Overall I feel…about the same I think? I wasn’t expecting a revelation right away, but I’m up for sticking with these settings for a bit. Let’s see what tonight brings.

[SarcasticDave94]

OK sounds good. Let's see what tomorrow brings