New CPAP User, Trying to Reduce CA's

[ubersteiny]

Hi there, I've been using CPAP (APAP) for 11 days now and I'm trying to reign in my CA events. I tried discussing it with my Sleep Clinician and he has never heard of OSCAR before and wasn't really interested in hearing about the data and only is using the myAir data he receives via cloud. The fact that my average AHI on treatment is under 5 now he thinks there's nothing more that needs to be done.

I've been noticing lots of CA events and I only had a couple during my sleep study, which leads me to believe they're treatment-emergent. I've tried reducing my EPR from 3 to 2 and then to 1 and have noticed no real reduction in my AHI, which is 3-4 on treatment. I even tried no ramp last night as well. Any thoughts on what I should be trying/changing?

Stats:
Male, 31
Untreated AHI: 12.8
Sleep on my side 90% of the time

CPAP Stats:
ResMed AirSense 10, APAP mode.
Pressure: 7-16 epr 1(starting Rx was 6-16, epr 3)


Additionally, 2 nights ago I had an OA event that lasted for over a minute, not sure if that's something I should be concerned about? The pressure rose and eventually got me out of it, but I'm surprised it took that long and that the pressure didn't rise faster (my response is set to standard).

Thanks!

Attachments are an overview of last nights sleep, a detail view of last night around a cluster of CA's, and then the 3rd is over my minute long OA.

[SarcasticDave94]

I would be concerned over a 1 minute OA. It points to pressures that are too low or positional apnea.

On the CA, make sure Ramp is off and if EPR is on, turn it down 1 number and see if CA diminish.

[ubersteiny]

I would be concerned over a 1 minute OA. It points to pressures that are too low or positional apnea.

On the CA, make sure Ramp is off and if EPR is on, turn it down 1 number and see if CA diminish.

Thanks for the reply!

Those screenshots are with a min 7 pressure, epr 1 and ramp off already. Guess I could try epr off if 1 was insufficient to combat CA's.

[Gideon]

CA's can't be combated with your machine, only avoided.
Zoom 1. Most of those look idiopathic/ unknown cause, toward the end CO2 induced or possible Treatment-Emergent.
Zoom 2. I see arousal with you doing a good amount of holding your breath, could be tossing.

[ubersteiny]

CA's can't be combated with your machine, only avoided.
Zoom 1.  Most of those look idiopathic/ unknown cause, toward the end CO2 induced or possible Treatment-Emergent.
Zoom 2. I see arousal with you doing a good amount of holding your breath, could be tossing.

Thanks for the response.

So if most of my CA's are of an unknown origin, I won't be able to avoid them with my current equipment?

And for zoom 2 with the long OA, I would still be holding my breath there even though it's classified as an obstruction?

[Gideon]

You likely tossed, you certainly could toss onto a 100% positional apnea, but I don't think so.

[SarcasticDave94]

As for your sleep therapist and accepting 5 AHI as good enough, start giving a list of symptoms and complaints on not well rested state, discomfort, etc.

[ubersteiny]

As for your sleep therapist and accepting 5 AHI as good enough, start giving a list of symptoms and complaints on not well rested state, discomfort, etc.

I'll try that thanks.

Should I be worried about my median tidal volume? It's in the 300's, and using the minimum tidal volume calculation of 6ml/kg I should be ~560ml (I'm 94.5 kg).

[ubersteiny]

Have another question regarding masks. I see that I should be keeping it in this thread vs. starting another.

I have the P30i and I've been starting to get irritated nostrils and also I have 1 nostril thats always 90% blocked so I'm effectively breathing out of 1 nostril only.

Is there a mask that would suit me better? I quite like the line from ResMed that connects at the top of the head.

I like the F30i on paper but I just don't know I need a FFM if I'm not a mouth breather (at least I don't think I am).

[SarcasticDave94]

Mouth breathing via that F30i full face gives the advantage to compensate through mouth breathing when you need that. It does mean you might get dry mouth. But with full face, mouth breathing isn't breaking your PAP circuit, but mouth breathing combined with nasal or pillows masks will break circuit.