[CPAP] Help Tuning CPAP w/ oscar data

[Deborah K.]

I disagree with lowering the pressure. It's more important to have proper therapy than to worry about the high CAs. Once we know what is causing them, high CAs in the study or treatment-emergent CAs, then we can determine how to proceed.

[Exitor]

My sleep study recorded 0 central apneas.  Speaking with my provider previously it seems that any central apneas I experience are treatment emergent.  The sleep study I did is also recent, performed 2/28.

[jdougc]

The obstructive events were 1.58, which is pretty decent.
The rest of the events were CAs which might be made worse with the pressure swings caused more by the few flow limits events.
That is why I suggested a tighter pressure range. This has helped a few people in the past.

[jdougc]

I am not a fan of APAP for all people. 
ResMed will raise the pressure after an event, but instead of staying at that pressure, it will drop it for comfort until the next event and raise it then drop again, over and over all night long.
Our bodies don't typically do well with pressure swings, and CAs can be a consequence.
You could raise you minimum to 8.0 and lower your maximum to 9.0 which is above your 99.5%
Raising your minimum might increase your CAs for a few nights though, as your body gets used to this pressure increase.
Good luck.

[Exitor]

Gotcha.  I'm willing to try different settings as I haven't been getting help otherwise.  I appreciate you both helping, really.  I'll report back to see if a tighter pressure band helps.  I forgot to try the full mask setting w/ nasal pillows last night so I'll add that too.

[jdougc]

I found that full face setting gentler, the machine is not trying to overcome the "extra resistance" of nasal pillows.
I even tried a larger pillow size last night after someone here suggested that the pillow tips wouldn't go as deep into my nostrils.
I was leery and expecting leaks, so it too longer for me to fall asleep.
My leaks may have been the best ever and my nose felt pretty good.
I bought a cheap large on Amazon, probably not durable.

[Exitor]

Well events went down but are still there.  It looks like for part of the night I was bumping up against the 9 cm limit.  Makes me wonder if I should shift it a bit.

   

[jdougc]

How did you feel when you woke up? Were you rested?
Did you wake up through the night?
This info is as important, more so than the numbers.

If you were to raise the pressure, the CAs would probably increase.
The rise in your pressure is mostly due to the Flow Limits, which may need addressed eventually.
Toss the few CAS as your were falling asleep and waking up.
Try raising your minimum pressure a little closer to your maximum, try 8.4 cm of pressure for a few nights

You can scroll though your flow rate and look at the CA events and see what is happening before. Did you have a sigh/ big breath?

Most of your CAs are happening during the ragged breathing of deep or REM sleep

[Exitor]

When I wake up I feel like it takes time for me to "boot".  Kind of like having a hard drive as opposed to an SSD for a computer.  The speed for me to gather myself is slower, a grogginess.  Even when sleeping, it feels like I could wake any moment.  Last night I don't remember waking up but I wake up every night at least once, even if to turn on my other side.

I can try tightening the pressure range more tonight.  I guess I'm trying to find my "ideal" pressure by changing the values this way.

Not sure if you can answer this but is it possible that my (at home) sleep study "missed" recording central apneas?  During the study I woke up then went back to sleep.  So is it possible that an OSA event woke me up and so I never get into deep sleep where all the centrals occur?

My curiosity is pushing me to investigate a MAD through a sleep dentist to see how much relief that would give but I'm not giving on CPAP just yet.  Attached a zoomed version here.

   

[jdougc]

The home test might have missed short duration CAs.
Normally they don't miss 10 seconds events, but I am not experienced with home studies.

During the night, we have "micro"arousals, where we would not remember stirring. Can't really eliminate them, but we hope to minimize the detrimental effect on our sleep.

I would look for bigger breaths before the CAs in your flow rate graph. Your mind might have said your O2 sats are fine or high, no need to breath for a few seconds. 
Hopefully a more experienced person can add their knowledge.