First week using CPAP, need help reading OSCAR data

[sleepymoth]

[attachment=75742][attachment=75742][attachment=75741]Hi, this is my first time posting here. I've been using CPAP for a week now and am still feeling really tired & having constant brain fog. My symptoms haven't changed much. I recorded my data last night and need some help understanding it. What changes can I make to my settings to lower my AHI? I had an initial AHI of 5 from my at-home sleep study. Thanks!

[Winter247]

Notable things to me: (1) you mostly have CA events, (2) you have a few jumps in pressure, with the first seeming high and abrupt, (3) leak rates get a bit on the high side during the pressure increases.

It seems to me as though you would benefit from titration, as your range (8.0-15.0 cmH20) is far wider than it needs to be. As your median pressure is 8.94, I suspect that you will benefit most from lowering your maximum pressure by a significant amount. I'd love if other, more knowledgeable posters weigh in on this, but my non-expert instinct would be to keep your minimum at 8.0 for now (as apnea/hypopneas/flow limitations are not high) and lower your maximum first to around 12. After trying that, you may want to slowly increase minimum pressure and decrease maximum pressure to have a much smaller range and much less abrasive jumps in pressure.

Also, unless you need EPR due to struggling to exhale, I'd recommend turning it off and trying that. Best of luck!

[sleepymoth]

Notable things to me: (1) you mostly have CA events, (2) you have a few jumps in pressure, with the first seeming high and abrupt, (3) leak rates get a bit on the high side during the pressure increases.

It seems to me as though you would benefit from titration, as your range (8.0-15.0 cmH20) is far wider than it needs to be. As your median pressure is 8.94, I suspect that you will benefit most from lowering your maximum pressure by a significant amount. I'd love if other, more knowledgeable posters weigh in on this, but my non-expert instinct would be to keep your minimum at 8.0 for now (as apnea/hypopneas/flow limitations are not high) and lower your maximum first to around 12. After trying that, you may want to slowly increase minimum pressure and decrease maximum pressure to have a much smaller range and much less abrasive jumps in pressure.

Also, unless you need EPR due to struggling to exhale, I'd recommend turning it off and trying that. Best of luck!

Thanks for the suggestions, I'll try these settings tonight and report back tomorrow.

[Winter247]

Great - I hope it went well.

[sleepymoth]

I tried turning off EPR, but couldn't exhale comfortably, so turned it back on to 1, full time. I will try decreasing my max pressure today. Do you think I have central sleep apnea due to the high CAs I'm getting?

[Winter247]

Definitely keep EPR on 1 then if exhaling is difficult. 

Do you have a copy of the summary of your sleep study? Did it indicate that you had central or complex events? 

If not, I’m confident that those CA tags are as a result of the pressure being too high. Notice how they all tend to appear after a jump in pressure? Basically, too high of pressure leads us to expel too much CO2 and, as our breathing impulse is driven by C02 levels, we stop breathing. I’ve heard that clumps of CA events can be due to sleeping position, too, but I don’t fully understand that and other, more knowledgeable posters can speak to that. 

You’re still having significant flow limitations and some RERAs, so it’s possible that the pressure needs to be raised a little. However, all of this is difficult to know because your mask leak rate is pretty high and could be contributing to issues. If I were you, I’d prioritize: (1) reducing mask leak, (2) lowering the maximum pressure a bit more, (3) raising the minimum to 9. 

It may be that the suddenness in which the PAP algorithm increases pressure is too abrupt for you - this is common for women, and your PAP has a “for her” setting which may be better for you. It makes the machine change pressure more gradually. 

No matter what you do, try to only make changes one at a time and give yourself a couple nights for each change before the next. Prioritize reducing leaks no matter what. I’d start with raising minimum to 9 or lowering maximum to 12. Then make changes in 0.2 increments per day. 

Again, there are many on this site who are more knowledgeable than me, so if anyone sees anything incorrect in what I’ve said, please weigh in!

[sleepymoth]

Thank you again for the input. My initial at-home sleep study was just a pulse ox, so I don't think it could differentiate between OAs and CAs... I've included my sleep study below. I'll try decreasing the max pressure to 12 tonight.

[sleepymoth]

Last night, I decreased max pressure to 12 and turned off EPR (exhaling with it off was actually ok this time around, probably psyched myself out the previous night). I woke up around 2:45 am and didn't go back to sleep with the CPAP. I looked at my OSCAR data this morning and saw a bunch of CAs right before I woke up. What may have caused that? I will continue decreasing max pressure in increments.

[SarcasticDave94]

Some groups of events, CA and OA, can be SWJ (sleep wake junk) if they're near the beginning or ending of a session. Yours are not, the CA ended a half hour before your session break at 3:17.

You edited down Max, which you would have needed in the prior chart. Just don't take too much away or this too can impact therapy.

And you took EPR off. This may be the right thing to avoid some CA. However, it might reduce comfort and increase flow limits.

I'm not sure of your edit timing, but you'll maybe want to base results on more than a single night. Every single night will be a bit different no matter what.