[CPAP] deonfromdallas Therapy Thread

[deonfromdallas]

Greetings everyone and thank you for this amazing Sleep Apnea resource. 

Background
I’ve probably had Sleep Apnea for years but in the last few years, I have attempted to address the issue.  I was diagnosed with Moderate Sleep Apnea in 2019.  In 2020, I lost 64lbs and Sleep Apnea went away.  

Unfortunately, I gained 40lbs back and the Sleep Apnea has returned (Mild).  I have lost about 20lbs and plan to be re-tested when I lose roughly another 25lbs. 
In the meantime, and going in assuming that Sleep Apnea will not go away after the weight loss, I have started CPAP Therapy. 

Also, I have suffered from Insomnia since 2018 and it continues to be a problem.  I am not sure if the awakenings, typically around 2-3 AM are due to Sleep Apnea or Insomnia. 
I just received my APAP machine this past Thursday (2023-07-13) and I just got an SD card yesterday, so I only have 1 night from OSCAR (the past days are summaries).  The APAP machine settings are based upon an in-lab Titration Study I did after the Home Sleep Study confirmed I had Sleep Apnea. 


Goal 
Since I started using the CPAP machine, I still have early morning awakenings and even if I manage to sleep 4-5 hours straight due to being exhausted, I am still tired and have similar symptoms that I had before starting CPAP.  

I wanted to post some OSCAR data to see if there are any red flags or obvious changes, I can make to increase my chances of successful therapy I.e. just feel rested and increased energy levels. I didn't get much sleep last night, even though I was extremely tired, so there isn't a lot of data.

I have spent quite a bit of time reading through the forums and hopefully my chart organization is correct (based on the apneaboard.com wiki).  I have a follow-up appointment with my Sleep Doctor today at 11:45 AM CDT. 

Also, I am happy to share any information that is needed.  I do have some questions about Ramp but I will post my question later based upon feedback. 
 
Equipment: 
APAP Machine: ResMed AirSense 11 
Mask: F&P Evora Full

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I wanted to also mention that last night, I attempted to sleep on my side (which is how I normally sleep).  Since getting the CPAP machine, I have been elevating the head of the Sleep Number bed and basically sleeping on my back because it feels a little easier.

[Sleeprider]

Therapy is satisfactory from the point of view of AHI, but you have highly variable pressure at current settings and a considerable remaining flow limitation that can lead to arousals. A simple solution is to use a starting pressure of 7.0 with EPR 3. That will give you a starting pressure of 7/4 (inhale/exhale) and will reduce flow limits and stabilize pressure. Residual events appear to be obstructive and these settings will help to resolve that. I think there may be some positional obstruction, which may become worse with an elevated head position or extra pillows that can lead to chin tucking. Our Positional apnea article describes the mechanisms, and I'll let you draw your own conclusions. I get there because I see flow limits are generally well-treated, but you seem to gradually slip into increasing flow limits (chin-tucking or airway restriction) leading to events like the RERA at 00:15 and the cluster of hypopnea we see at 01:55. Optionally increase maximum pressure to 10.0. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[deonfromdallas]

Sleeprider, thank you for the quick response and detailed information.  To make sure I understand:

* Starting Pressure = Minimum Pressure?  And should go from 5 to 7
* EPR should go from 2 to 3

I'll make those 2 changes first, post another chart and then see if I need to increase the Maximum Pressure from 9 to 10.

Also, I know you didn't specifically mention Ramp?  Do I leave this setting unchanged for now?

I have read many posts here (and a Youtube video) that seem to not like this setting.  During the in-lab study, I felt like I was suffocating, claustrophobic and hard to breathe out.  My DME told me that they probably didn't have Ramp on.  At home, I don't have this feeling, which is why I would be guarded about changing it but I would like an opinion on it.

[Sleeprider]

Mode: Autoset
Minimum Pressure: 7.0
Maximum Pressure: 10.0
EPR: On Full Time
EPR setting 2
Ramp Off

[deonfromdallas]

Thanks Sleeprider!

Quick question, what is the difference between Mode=Autoset vs Mode=APAP?

I have tried to research this setting but I have not been able to find any documentation.

[deonfromdallas]

Disregard, I looked at the actual machine setings.

[deonfromdallas]

Posting new OSCAR data after making the suggested changes.  Looks like I had no OAs but have CAs which I have never had on any of the 4 sleep studies I have done over the last 2-3 years.

Should I revert the settings?

[deonfromdallas]

Edit: For some of the leaks, I was awake, making adjustments.  When I got into bed and I believe I woke up 1 time (I think around 1 AM) and made an adjustment.  Not sure about the other leaks.

I found the below sizing guide and it seems to indicate that I should be wearing a large, as opposed to the Small-Medium I was given
https://assets-global.website-files.com/...20Face.pdf

I've had to start putting band-aids on both sides of the bottom corners due to mask irritation and some have bled, although not last night.

[Sleeprider]

Let's not freak out about a brief pause in breathing once every two hours. It is not unusual at all for someone experiencing pressure support for the first time to have a few clear apnea events, and normally these diminish as you adapt. These come from the unaccustomed better ventilation, and I encourage you to focus on how you actually feel today and slept last night. Some things to consider. You had a longer continuous session with more stable pressure and a lower overall AHI, no RERA and a reduction of flow limits from 0.07 to 0.00 and marginally higher minute vent. Compare the charts in this thread, and there is no question the most recent is the best. CA events from over-ventilation are simply pauses of breathing as your body equalizes the CO2 balance it is accustomed to and at these levels is both harmless and normal.

[deonfromdallas]

Thanks you Sleeprider as always for the feedback!

I am still somewhat tired (and the feeling that the brain and eyes are pulsating), so maybe this will fade as treatment continues.  Based on what I have read on this forum and other SA resources, it may take a while (weeks, months) to feel better.

Going from Min Pressure of 4 to 7 i.e. no Ramp will take a bit of adjustment but since I have re-instituted Sleep Restriction Therapy, along with a pretty strong workout routine, I don't go to bed when until I am tired and this probably helped me not pay too much attention to the pressure change.

How big of a deal do you think the leaks are?  I can probably explain 2 of them because I was purposely move the mask around because it irritates the bottom corners of my nose.