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Back to CPAP - Pierrec83 - 01-13-2021

Good day to all, I just discovered your great Forum.

I have been diagnosed with Sleep Apnea back in 2008, equipped with a CPAP machine for 3 years, saw another doctor who told me that my problem was more "Upper airway resistance syndrome",  switched to a NARVAL (Now resmed) Oral Appliance, renewed a few times the appliance. In 2016, as I had issues to get the appliance renewed (traveling a lot), I switched to an off-the-shelf self-adapted Oral appliance (Oniris) bought on Amazon, and renewed it several time this way.
End of 2020, I went for a new polysomnography, which I did with my Oniris oral appliance on.
They measured 15 to 20 Apnea per hour and I am now back since Dec 20th with a CPAP Resmed S10

Since close to one month, the situation has improved, and my IAH measured by the CPAP ranges between 2 and 4 per hour. I estimate, based on RESSCAN graphs, that my average apnea duration is around 20-25 seconds 
But, as it happened back in 2008-2011, I still have few pretty bad nights followed by low-energy / bad mood days.
It seems that those nights are the one when the IAH goes close to 4, and when the apnea durations are longer.
The doctors tell me that I am very lucky to be below 10, and even more below 5... and that I should not feel a difference between a night with an IAH of 2 and one with an IAH of 4. But my issue is that I really do.

So I wanted to know if some other people are/have experiencing/ed something similar , and if they have found a way to crack it.

Thanks a lot

RE: Back to CPAP - Sleeprider - 01-13-2021

Pierrec83, the Resmed Airsense 10 is capable of treating UARS and flow limitation, and that capability can be enhanced with certain settings. I see you are using a range of 5-14, which does not sound very optimized to me, and your use of EPR (exhale pressure relief) can be a game changer. You can download the free OSCAR program from the software link at the top of this page. It will provide graphs and statistics far easier to use, and more detailed than ResScan. The link in my signature show how to Organize Your Oscar Charts, and Attach Files so we can see screenshots of your results. If you really want to get a picture of what is going on, and improve your results, we can help you to minimize upper airway flow limitation and respiratory events.

RE: Back to CPAP - Gideon - 01-13-2021

Welcome to the forum.

Here we like to see about half of the AHI 5 before we call someone optimized.
UARS is all/mostly about flow limits. For that we need to see detailed views of the flow rate 2-3 minute zoomed views so the waveform of the breaths can be evaluated.
The best tool, and the preferred tool is OSCAR. Attach the full nightly screenshot in addition to zoomed charts of issue area. We can direct you from there.

Can you list the specific model you have, it's on the front. AirSense 10 is a model line, I suspect your model is AutoSet.

EPR settings can have a major impact on your therapy, what is yours set at?

RE: Back to CPAP - Pierrec83 - 01-13-2021

Thank you very much.

I have attached
-The daily report of last night - which feels like a bad one (as a screenshot). I also have it as PDF since the screenshot does not show the last graph/ snore, but cannot did not post
-A zoomed screenshot on 15 minutes flowrate
-A zoomed screenshot on 3 minutes flowrate
For the machine settings it says EPR 2 cmH2O, mode APAP, and  Pressure Settings  5-14 (it started as 5-12 Dec 20, and I increased to 5-13 Dec  29 and 5-14 Dec 30)

I hope I did it right

thanks again


RE: Back to CPAP - Gideon - 01-13-2021

2 changes,
increase min Pressure to 8
Increase EPR to 3

The irregular nature of the breaths in your 3 minute view make me think that you are tucking your chin. Not severely, but you have small clusters of OA events. This "Chin Tucking" cannot be overcome by pressure. More commonly we see episodes of many more events clustered associated with AHI in double digits. Look at the Soft Cervical collar and Positional apnea wikis in my signature. I'm not saying use a collar at this time but be aware and consider modifying a pillow.

EPR helps with Flow Limits by acting like a limited BiLevel machine. Min Pressure should NEVER be lower that 4 + EPR and frequently min pressures on less than 7 are not tolerated by adults.

RE: Back to CPAP - Sleeprider - 01-13-2021

I agree with Bonjour's assessment. The following wiki articles should be helpful to you and are worth reading.
Positional Apnea: http://www.apneaboard.com/wiki/index.php/Optimizing_therapy#Positional_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php/Soft_Cervical_Collar

RE: Back to CPAP - Pierrec83 - 01-14-2021

Thank you for all the analysism, advises and readings, very instructive and helpful
Being in Europe... I finished my night

I applied 3 changes last night :
-EPR from 2 to 3
-Low pressure from 5 to 8
Removed any pillow, just the head on the mattress

The results are :
-I feel more rested
-My AIH was 3.71 (my average since Dec 20 is 2.68) with a split Obs /Hyp / Clear airway of 2.38/ 0.53/0.79 (my average being 1.78 / 0.48/0.42)
-I did not consciously wake up, no mask removal and was woken up by the alarm
-Average night pressure was 10.7 (my average average-night-pressure is 8.35)

I will now look for a collar but it seems difficult to find here in Europe

RE: Back to CPAP - Pierrec83 - 01-15-2021

Good day to all

Some updates : 
SCC : yesterday I finally got an SCC from a medical shop. I put it on to sleep, a bit tight to avoid that my chin could still go inside down, remove any other pillow as the back part of the SCC was piling on them, .. but 2 hours after kind of falling asleep, I woke up and had to remove it as I had the feeling to suffocate with this wrapped tightly around my neck... I will need to try again as based on the readings you advise, I do believe there is something there

Discussion with my doctor : I had a follow-up appointment with my doctor, this morning. I discussed about my quest to tune the therapy, and as expected, the doctor reaction was
-you should not touch the settings, this is an expert stuf Smile
-you are below 5 IAH which is already very good
-there is no point in increasing the low pressure from its value of 5, as anyway, the machine does automatically increases to reach the necessary values. There is no point neither to increase the 14, as my records show that the pressure does not go above 13... so changing 5-14 to something else would have no effect
So talks with the doctors will definitively not get me towards tuning and optimizations...

RE: Back to CPAP - Dormeo - 01-15-2021

Well, you have the measure of the doctor! Below 5 is not "very good." It is potentially the equivalent of being poked with a stick multiple times per hour while you're trying to sleep. Bad for rest, and bad for your long-term health. Generally speaking, an AHI from 1 to 2 is good and from 0 to 1 is excellent.

You can't hurt yourself fine-tuning your settings. You wouldn't need to if your doctor were as attentive as the experts at this forum.

The machine increases pressure *in response* to events. To head off obstructive events, higher minimum pressures may be needed.

But you know all that. I'm just venting on your behalf.

RE: Back to CPAP - Sleeprider - 01-15-2021

The best collar will fit loosely and provide good support, to the back of the jaw and chin without impinging on your throat or neck. If your collar creates pressure behind the chin and to the throat, it is not the one you want. You can name the brand and model without posting a link. In truth, inexpensive SCC is just fine, and there are some reviews in the reviews forum and linked from the soft cervical collar wiki. The collar should NOT feel tight, but it should feel supportive.

Your doctor's reaction is pretty typical, but the real guidance is, do what is comfortable, and effective for you. It's easy to get caught up in the data, and that is a trap to avoid, but good therapy is what gives you the best sleep. That usually, but not always corresponds to a low event rate or AHI.