Low AHI, horrible sleep, OSCAR data

[apneaHero]

Hello, 30m, diagnosed with moderate sleep apnea (AHI 30) few months ago, on CPAP machine for about 4 months now.

My AHI scores are low now - always around AHI 1. But my sleep is rarely any good. I wake up feeling totally exhausted and sleepy and I am struggling through my work shift (6 hours a day) and barely make it home at afternoons. I do not know what could be wrong. Here is data from my OSCAR from last night, which was terrible. The closeup is from one of the areas where there are lot of the RERA flags. I will appreciate any help. If any more data are needed I am happy to provide. Thank you very much.


   

   

   

[Sleeprider]

There are a large number of RERA events (respiratory event related arousal) which would ruin anyone's sleep. This is caused by a partial obstruction called flow limitation, and can easily be seen by zooming in on the flow rate graph as a pronounced flattening or plateau in the peak inspiratory flow rate. This is clearly seen in the zoomed image you provided where the inspiration is completely flattened out. We also see in your statistics that inspiration time is longer than expiration time and this represents a great deal of effort being expended to suck in a volume of air past the obstruction. The machine is properly at the peak set pressure during this episode.

There are a couple things that can be done with this. First, I suspect that you have some aspect of what we call positional apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea I don't think this obstruction or flow limitation is present throughout the night, and the degree of flow limitation is going to be proportional to your pressure. Since you seem to breathe relatively freely at times, this kind of obstruction is often caused by chin-tucking or your sleep position which has bent or kinked your airway making breathing more difficult. Some people can resolve this by being aware of the problem and using thinner pillows or avoiding positions that make it worse, while many other members here have opted for a soft cervical collar. http://www.apneaboard.com/wiki/index.php...cal_Collar

I would suggest you increase pressure to a minimum pressure of 8.0, maximum pressure of 14 and not use the softPAP pressure algorithm. Change to Standard. If you can add more expiratory pressure relief (i.e. pressure support), that may prove helpful.

[apneaHero]

Thank you so much Sleeprider.

I did the chin tuck test and yes - when I take my chin to my chest I have big trouble breathing.
So I did lower my pillows (I had quite high pillows) and also tried to be not chin tucked (also hugged pillow in front of my chest and under my chin so that I do not tend to bend my head down - DIY version until I get the collar).

I adjusted the settings as you described - min 8, max 14.

You also said to turn off softPAP. I think you might be mistaken as you also told to add EPR. On my Lowenstein machine softPAP function means EPR. softPAP on 0 means inhale and exhale pressure is the same. softPAP 2 (that is maximum value) means there is pressure relief of 2 units on exhales. So I left it on 2. As far as I know this function does nothing else.

My tonights sleep was maybe a little bit better but not quite as good as I would desire to feel quite rested.

I am providing screenshots of the tonights sleep (zoomed out and zoomed in on the RERA parts). There is still a lot of RERA flags. Though the inspiratory rate maybe looks better than yesterday?

I am providing this for you to reevaluate if the settings change and my attention to prevent chin tuck did any change or if I need any other considerations. Also I plan to buy the collar but I figured there are more size, so I first have to determine the right one for me.

Thank you for everyting.

   

   

[Sleeprider]

Thanks for the referesher on the SoftPAP terminology. Obviously we want to maximize that, and use a standard auto algorithm. Resmed machines have a soft option which was the source of my confusion. The RERA index has not improved with slightly higher pressure, and obviously the Prisma responds to flow limitation very differently than the Resmed which would have gone straight to the maximum pressure with that much flow limit. There are a number of reviews on the forum of different collars and generally, it is important to get enough height to support the chin, and size to avoid a very tight fit. http://www.apneaboard.com/forums/Forum-O...ct-Reviews

[acerlogic]

Hello apneaHero,

You posted results from two nights. Did you have softPap turned ON on both of them?

[apneaHero]

I still did not get the collar. But I tried different sleep mattress, which I had at home, I experimented with different pillows. I also thought I have quite congested nose, so I tried taking nasal spray. Below I am posting the best night so far (in terms of how well rested I felt). Its still all RERAs. But the inhale pressure is maxxed at 14. Should I try upping it a little bit more? If so how much? Any other ideas?

Thank you.


   

   

   

[Sleeprider]

Please give us a zoomed image of the flow rate at a resolution of 3-minutes.

[apneaHero]

Yes, thank you. Here are two screenshots of approx 3 minutes windows in the problematic phases.

   

   

Also here is in comparison three minutes from another days from little deep sleep phase I managed to find. Looks totally different:

   

[Sleeprider]

What are the chances of getting a bilevel machine in the Czech Republic? That looks just awful, and the only thing that might help is higher pressure and more pressure relief or pressure support. That flow chart is extreme for inspiratory flow limitation. Most doctors should recognize it, and in combination with your ongoing symptoms, the best solution is pressure support.

[apneaHero]

Thank you for the validation and a direction to take!

Sad thing is my sleep study doctor when I have check ins with her only looks at summaries of my treatment from the prisma cloud service - only thing she looks at (and sees in her printed reports) are compliance and average AHI number. She is also little rough and mostly focused on patients compliance but I will consider presenting to her the Oscar data myself like I did here. I am afraid she will get mad that I was changing the "admin" settings on my machine, but I need to take courage, after all its about MY quality of sleep (and life) and that is all that matters to me.

While googling I found this BIPAP machine available in my Country - I think it might be theoretically possible purchase it on my own eventually even without the doctor and coverage by insurance - if nothing else works out. https://www.szo.cz/cs/lekarske-pristroje...-cubebipap 

Another think I found out in my Prisma machine is that there are two modes for the APAP therapy. My machine is currently set to "std", but there is also "dyn" mode which is said to react more aggresively to flow restrictions. Would you suggest I try to switch it on?


Here is excerpt from some documentation on it I found online. Am I the UARS patient as it refers to?
   

I know my best bet probably would be to really deal with it with my doctor, I just need to muster up my courage for the uncomfortable confontation.

Thank you for everything so far sleepRider. Even thought my issue is no resolved yet, the support I am getting here is meaning very much to me.