[Diagnosis] Need help deciphering sleep study & CPAP report

[cyrial]

Hi all,

I am semi-new to the apnea / CPAP world, and would love your help.

I'm in my mid-30s, have struggled with obesity since childhood. Depression, anxiety, brain fog, slow cognitive processing have plagued me for decades. 3 years ago I saw a sleep specialist who had me take a home test. The results are below:

I was told that my sleep apnea was mild and that CPAP wasn't necessarily indicated. Nevertheless, in a desperate attempt to hopefully address my cognitive issues, I pushed for CPAP. I was put on APAP set at 4 - 20. I could not tolerate it and eventually stowed the machine away in my closet.

Just this last week on a call with a new colleague, I found myself being unable to string together a coherent thought, rambling on and on in circles, my mind scattered in a million different directions but oddly blank at the same time. Deeply embarrassed, I went on the nth online journey to see what could be the issue. My weight is certainly the elephant in the room, but I know many others around my size who are at least minimally lucid in thought. Something else must be going on.

I eventually circled back to the home study I did a few years ago and decided to take my sleep seriously once and for all. After some sleuthing, I found that instead of apnea, I may instead have UARS. In any case, I pulled my machine back out and have begun using it again, making sure to import the data into OSCAR. Below is the latest import.

I have no idea where to begin deciphering this and so am looking for help on taking actionable steps towards making sense of this and better sleep overall. Any guidance you could provide would be hugely appreciated.

[Gideon]

Welcome to the forum.

First a Red Flag, a big one.
In February of 2021 Philips issued two Class one recalls, the worst level, of basically EVERY pap machine they made. One for off gassing cancerogenic compounds which were in haled, the other for the sound deadening foam disintegrating and the particles entering your lungs. This IS still a big deal.

Next for what you need this isn't nearly the right machine for you. Yesterday there are things we can do that will make things better for you but with your UARS typically the best treatment is the application of a differential pressure between inhale and exhale. The APAP you should be using would be the ResMed AutoSet. Or a BiLevel such a as ResMeds VAuto.

A setting of 4-20 is rarely a good setting for anyone. It is a lazy setting much of the medical community uses because they believe an APAP will determine your optimum settings, it will not.

You can get an online "antibacterial filter" to catch any particles, I doubt that after 3 years there is much off gassing left to be done.

I would set a min pressure of 7 to maximize the pressure differential I mentioned above and enable flex to do the same. This differential is variable, depending on part on how hard you breathe and rarely goes over 2.

Post results from OSCAR and then we can review and adjust.

[cyrial]

Thanks so much for this insight. Had no idea about the recall... just submitted a request to have it replaced.

Do you strongly suggest getting a ResMed – ie. is the DreamStation wholly unequipped to address my issue? I will likely be paying full price as I want to avoid getting mired in the process of seeing a sleep specialist, so want to ensure that the cost is justified.

I'll set min pressure to 7 for now along with flex pressure and will report back.

[cyrial]

Made the following changes last night:
-Set minimum pressure to 7
-Put Flex level to 3
-Changed from C-Flex to A-Flex

Increased pressure took some time to get used to. I believe I woke up in the middle of the night and pulled the mask off, which is why you see the big gap in data. No appreciable difference in how I felt waking up.

Would love any insights any of you have on next steps.

[cyrial]

Would be grateful if someone could help me out with insights from my OSCAR reports. I can’t gauge the severity of disturbances.

[Crimson Nape]

First, you can turn off the VS2 parameter.  It will report things like the ribs of the hose dragging across the edge of a table.  Its reporting kind'a clouds up the graph, too.  I would try tightening your pressure to a minimum to 10 cm minimum and a 12 cm maximum.  This seems to be where you are running on pressure.  This will also prevent over pressuring on those bad nights.  By constraining the pressure may also help to reduce or eliminate any micro arousals during the night.

Please keep us posted.

- Red

[cyrial]

Thanks all for the guidance so far. I tightened the limit to 8-12 and that seems to have made an improvement. Reports are attached, with the second zoomed in on flow rate during an OA event.

AHI is lowest it's been at 1.35. Would have been lower without what seems to be a positional apnea cluster. Woke up feeling a little tired, but I'm still less than a week into this, so will take time. I've started taking Flonase right before bed, which I think is having a positive effect. I find myself turning over my sides a few times per night. Not sure if this is normal or an indication of apnea / arousal.

Except for that positional cluster, max pressure seemed to stay under 12, so will keep it there. I'm still seeing apnea events, so am thinking about increasing min pressure to 9 up from 8, which is where min pressure keeps bouncing up to for most of the night. (Can someone explain this sawtooth pattern between 8 and 9?).

To summarize: Tighten range to 9 – 12. Keep EPR at 3.

Thoughts? Thanks!

[Crimson Nape]

Those little saw teeth are part of Philips' algorithm. Your CPAP periodically will increase pressure to see if it may help. That's a good idea to bump it up to 9. . . it couldn't hurt.

As low as your AHI is now, comfort will start being a bigger consideration.

- Red

[cyrial]

Makes sense, will bump up to 9 then. Really appreciate the help!

[cyrial]

Trying to make sense of my flow rate graph a little better...

Are the waves that come after the green line a sign of palatal prolapse? Seems as if expiration suddenly collapses to 0.

If not, what could this be? Should this be addressed, and if so, how?