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jaedaen's therapy thread - Printable Version

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jaedaen's therapy thread - jaedaen - 06-07-2022

Hello, friends.

I finally got my first CPAP machine yesterday and have a night of OSCAR data here. I did a sleep lab a few months ago and, as it turns out, I have extremely severe sleep apnea at 136.4 AHI untreated, all obstructive. Blood oxygen levels bottomed out at 81%. My AHI went down to just over 2 at a fixed pressure of 12 in the second half of the night.  I was genuinely surprised that it was this high, since I seem to manage ok for the most part without it. All partners that I've ever had have told me that I stop breathing periodically during sleep and I figured that I should eventually get it taken care of, despite an initial reticence to using a CPAP machine. I'm glad I did, given the severity. The symptoms seemed mild to me, but I guess this is just that old 'tough it out' mentality that I learned from my parents.

Though my AHI could be lower still, I've got to tell you, I feel absolutely amazing this morning. I am never wide awake at 7am, and usually sleep a few more hours at least. I suppose that this is to be expected when going down from 136 to just under 5. I was excited to look at the OSCAR data too, being a bit of a data nerd myself.

So, I've lurked here for a bit before making a user here, and I think I have some potential adjustments for myself. I am new though, so I hope the forum veterans will keep me on the right track here:

First of all, yes, I am using ramp. I tried initially turning it off, but it's like a jet engine on my face. My ears popped, and overall it was quite unpleasant. 12 cm is pretty high for a completely new person to all of this. I'm sure I'll get more used to it over time, but for now, the ramp stays on. Maybe I'll change the ramp minimum pressure slowly over time.

I see a bit flow limiting here, maybe it would be wise to try an EPR of 1? I'm not really a fan of making significant changes all at once, I'm more in the slow and steady camp.

Also, maybe most importantly, I'm seeing some chin tucking at the beginning of the night here. I'll keep an eye on that over next few nights, I'm really not looking forward to a potential brace. Maybe I could remove some buckwheat hulls from my pillow to flatten it out a bit. At least there are only 2 clusters of these that I can see. 

I see more than 0 centrals which differs from my sleep lab, but then again, I did read here that a few centrals that are treatment emergent are totally normal, so I'm not really worried about those, as they will likely clear up.

Also, there are a few times where the pressure does max out at 15 (outside of those positional clusters) but just barely... what do you all think about raising maximum pressure just slightly up to 16? I don't want to potentially increase flow limits, but we do have some EPR headroom since this night it was at 0.

Did I miss anything here? Am I flat out wrong in any instances? Talking nonsense? Admittedly, I am not too worried about tweaks at the moment given how good I feel in general this morning, but it never hurts to dial it in more.

Those mask leak spikes I think are due to me scratching my face. I have a full face mask since I breathe through my mouth at night, but maybe if I find the full face mask too restrictive over time, I can consider a nasal pillow with a chin strap to keep my mouth closed.

By the way, I think it's really cool to help people read these charts and it's something that is clearly quite valuable to the sleep apnea community at large, so thanks! Thanks to the OSCAR devs as well.

RE: jaedaen's therapy thread - Sleeprider - 06-07-2022

Looks like a good start to your therapy. Your Airsense 11 has a feature called EPR (exhale pressure relief) that makes it act like a bilevel machine with up to 3-cm of pressure difference between inhale and exhale (IPAP/EPAP) pressure. This feature is more than just comfort, it also reduces inspiratory flow limitation, which is the result of airway resistance, and this makes therapy more comfortable. It is the flow limitation that drives pressure on an Autoset, so using EPR full time at a setting of 2 or 3 will help to stabilize pressure and increase your comfort.

Your obstructive events are a consequence of using ramp which starts you at a pressure insufficient to prevent obstructive apnea. If you cannot start out at your minimum therapy pressure of 12.0 (with EPR 12/9), you must increase the starting ramp pressure into a more effective range. My recommendation is that your turn off ramp, but increasing pressure to what you tolerate will help as you adapt to this new therapy.

RE: jaedaen's therapy thread - jaedaen - 06-07-2022

I appreciate your response very much, Sleeprider. It makes sense to recommend EPR in this case, given when I've read.

I'm surprised by your analysis that ramp is causing the obstructive clusters there, but it is true that the first one started just after the pressure ramped up to maximum. Adjusting to higher pressure would certainly be preferable to a collar. What I don't understand is why we would see these obstructive clusters just after the ramp up to max pressure, and not before. Perhaps someone could enlighten me as to why, if they have the time?

Thanks again!

RE: jaedaen's therapy thread - Sleeprider - 06-07-2022

Jadaen, the alternative theory for the apnea clusters, is "positional apnea" from chin-tucking. Equally likely, but I was waiting to see of the pattern repeated. http://www.apneaboard.com/wiki/index.php/Optimizing_therapy#Positional_Apnea

RE: jaedaen's therapy thread - jaedaen - 06-08-2022

OK, I have added an EPR of 2 and changed the ramp minimum pressure to 7 to not limit the effectiveness of the EPR during the ramp. Seems like the charts rolled some earlier awake testing in to last night, so I have zoomed in to the actual sleeping portion. The EPR is pretty comfortable, and I'm a big fan of it.

Well, looks like those obstructive clusters are gone, so that's great news. Hopefully they stay gone. The AHI claims to be 4.88 on the oscar charts, but if you look at the AHI reading on top of the flow rate chart there, you'll see it is marked as 2.47. What's the deal with that? A bug? Related somehow to how the session technically goes all the way back to 1pm yesterday? Totally unrelated? For what it's worth, the front of the machine reported it at a 2.5, so I'm going to take that as the real AHI.

I still see some flow limit issues, but it's better than yesterday. I see fewer peaks over 0.20 (I read in the wiki that this is where it needs to be addressed). I'll probably try EPR 3 tonight with a minimum ramp of 8 and see where that gets me, in an attempt to further fix these flow limit issues. I will try to keep dialing up the minimum ramp pressure gradually here until I eventually turn it off. It's a good compliance tool though early on. 

I still feel very awake and I have a lot of energy this morning compared to normal, so that's always good.

I do have a question: I notice that the pressure is not increasing even above 14 this night, whereas last night it barely touched 15. I assume this is related to the EPR setting, in that the pressure didn't have to increase as much due to fewer flow limit issues? Well, that and the lack of obstructive clusters, I had only one obstructive event all night!

RE: jaedaen's therapy thread - Sleeprider - 06-08-2022

I'll point out your flow limit has dropped from 0.13 to 0.05, and your pressure is lower, which should have you feeling great. I'm not too concerned for the moment with the AHI. Looks like everything is hypopnea. We may move to EPR 3, but no rush. Looks much better to me.