Finally 2 full nights with CPAP - still sleepy - OSCAR analysis?

[Oscer? I Ardly Know Er]

Hi folks! Two nights of OSCAR data attached. I've been trying out the AirTouch N30i and can finally tolerate it all night (I'm historically a combo front/side/back sleeper so it's been a tricky process).

Despite wearing the CPAP all night, I'm still waking up tired. I'm trying to wean off of my oral appliance (grinding issues) but I still feel better overall with the oral appliance than the CPAP. Any tips / what I should focus on next?

Thanks everyone and sleep well!

[Old Steve]

Welcome to the forum.


Your minimum pressure should be raised, 4cm is way too low for an adult.  A good starting point is at 7cm minimum pressure.  You are having a number of Central Apneas (CA), these can be caused by treatment and should go away in time.  Although, if you had several on your sleep study let us know or post your sleep study with your name redacted.  CPAP machines will not treat Central Apneas.   Anyway, try the 7cm for a couple of nights, then post some more charts.  Either I or someone else on the forum should be able to help.

[jdougc]

Keep using the oral appliance (grinding issues). I still use mine.

[Oscer? I Ardly Know Er]

OK after a couple of weeks of running with a minimum pressure of 7, I'm feeling substantially better. Not sure if that's from getting more nights of decent sleep or what. I'm decently refreshed but still doesn't feel like 100%. I'm getting kind of tired of putting on / taking off the mask though - the N30i is surprisingly comfortable for my mixed-front-back-side sleep habit but I still long for the days of just hitting the pillow and falling asleep.

I'd love to hear y'all's take and I have a few specific questions:


1. should I be concerned about the continued prevalence of CAs? I attached my sleep study report. Is it the pAHIc (2.9 for all night) the relevant number here?
2. Occasionally I've been waking up feeling uncomfortably bloated and with lots of gas and burps. I'm thinking this is a CPAP side effect somehow - pressure too high maybe?
3. Also, I'm curious about the details of what happens during a CA - why does the flow rate graph go all wobbly? At some point I remember waking up feeling like the machine wasn't giving me enough air but it was just kind of 'vibrating' the pressure level. I included one screenshot of this - it's the wide one.

Thanks again for all the awesome support.

[Deborah K.]

Your sleep study shows a low percentage of CAs, which are mostly treatment-emergent and will lessen as time passes.  Don't worry about them.

If you feel you still need ramp, raise the ramp pressure to 6. Your median pressure is almost 10, so I suggest raising your minimum pressure to 8 for now.  You will probably need to go higher later.

Try those and see how you sleep and feel, then report in with Oscar again.

[jdougc]

Your zoomed in chart shows a very long flow limitation, an airway restriction, not a full obstruction.
Can you repost the full nights chart showing the flow limitation chart also? Use F12 or Fn F12 for a mac to make a screen capture. You may have to resize some chart heights to fit all 5 charts:
1.Events
2.Flow rate
3.Pressure
4.Leak rate
5.Flow limitations 
The statistics and device settings on the left side should be fully visible.

In addition to raising the ramp pressure, change the ramp from auto to 5-10 minutes if ramp is still needed.

Try lowering the maximum pressure to 11 cm, since it is flow limitations driving most of your pressure increases. 
Minimizing the wild pressure swings might lower your CAs and help with the "feeling uncomfortably bloated".

See how you feel and post a few charts.

[Oscer? I Ardly Know Er]

ok so is this right, I'll:
* lower max pressure to 11
* raise minimum pressure to 8 - why is this, again? From the charts does it look like I'm still having OAs at the lower pressures, or something?
* raise minimum ramp to 6 and length to 5-10 mins and/or try without it
* try that for a while and post some more charts

I've also attached a taller screenshot for May 27 so you can take a look at it.

Y'all are the best!

[jdougc]

**raise minimum pressure to 8 is to deal with the flow limitations, since EPR the real tool for dealing with flow limitations is already maxed out.


** * lower max pressure to 11. The tighter pressure range can sometimes lower CAs.
The higher ramp pressure might help also.

[Oscer? I Ardly Know Er]

OK here's where I am right now. Anecdotally, I've felt more alert when I initially wake up, but I'm still feeling low energy / sleepy on and off through the day.


In this screenshot from last night, I'm noticing a lot of CAs clustered at the end of the night.

Thoughts?

[Deborah K.]

You need to raise your pressure settings.  Your median pressure is between almost 10 to over 10, so you need to raise your low pressure setting to at least 9.  You are hitting your high-pressure setting far too often, so you need to raise it to 13 or 14.

So, set your range to 9 to 13 or 14, and see how it goes. Otherwise, you are not getting the treatment you need.