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New user seeking guidance optimizing settings
#1
New user seeking guidance optimizing settings
Hi folks, 

I'm a late 30s female who has struggled with sleep for over a decade. In the past few years, fatigue, ability to stay asleep, and executive functions have worsened. Fairly active and healthy weight. Slightly deviated septum.

After jumping through more hoops than I care to recall at the moment, I have an auto cpap. No easy feat! As soon as SD card arrives (another case of DME insisting not included), I'll start using OSCAR. My polysomnogram showed the following:

SLEEP PARAMETERS
Total sleep time: 400.1 minutes
Sleep latency: 26.5 minutes
REM latency: 243.5 minutes
Sleep stage distribution: N1 14.5%, N2 75.7%, N3 3%, REM 6.3%
Total arousal index: 29.7/hr
Apnea-hypopnea arousal index: 12.1/hr
Snore arousal index: 5.7/hr
Limb movement arousal index: 0.1/hr
Spontaneous arousal index: 11.7/hr

RESPIRATORY PARAMETERS
Obstructive apnea events: 2 Hypopnea events: 36 
Mixed apnea events: 1 AHI: 7.6/hr
Central events: 12 
RERA events: 81 (index = 12.1/hr)
Baseline oxyhemoglobin saturation: 99%
Mean oxygen saturation throughout study: 97%
Lowest oxyhemoglobin saturation: 93%

DIAGNOSIS
Mild OSA

Re diagnosis, any thoughts? I've read a lot about UARS, though, I certainly don't have the data or experience to form a strong argument about the matter. No one I've seen has ever mentioned UARS, at least not to me. I'd never heard of UARS until joining this forum. 

Re auto CPAP settings, any suggestions based on sleep study? For the past week I've used pressure range 5-18 and EPR 3. Took me 3-4 nights to adjust to wearing mask. Now that I'm fairly comfortable with mask and showing minimal leaks, shouldn't I start to feel a little more rested? I felt slightly more rested maybe 1-2 days at most. I know it's hard to advise without OSCAR data. Maybe I should bite the bullet and stick with current settings until I have a few nights of OSCAR data...

Any and all guidance appreciated! This forum is a lifesaver.

K
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#2
RE: New user seeking guidance optimizing settings
A minimum of 7 will allow EPR to work at the lower pressure. EPR lowers exhale pressure by 3 from the inhale pressure. Since the lowest pressure your machine will deliver is 4 EPR will only lower pressure by 1 at a setting of 5. Also, 5 may be starving you for air. That's assuming your machine is at 5 for any length of time . We won't know until we see OSCAR data. Even if the therapy is working well it may take a little longer before you feel more rested. It's good that you feel comfortable with the mask. Often that's a major challenge when first starting.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

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#3
RE: New user seeking guidance optimizing settings
While not a lot, thus the Mild in the diagnosis, about 1/3 of your events are central.  

Obstructive apnea events: 2 Hypopnea events: 36 (AHIo= 7.6-2.4= 5.2)Your Obstructive AHI is 5.2)
Mixed apnea events: 1 AHI: 7.6/hr
Central events: 12 (7.6/3= 2.4 CAI)
RERA events: 81 (index = 12.1/hr)
(RDI = AHI + RERAs = 7.6 + 12.1 = 19.7)  The RDI pushes you up to Moderate AHI.

So yes, looks like Mild UARS.  Most doctors do not recognize UARS as something to be treated, but the treatment is the same as for RERAs, (EPAP pressure for OA events, and PS/EPR for the rest of the obstructive.

I agree with the min Pressure of 7 but with the central apneas I'd like to take a more cautious approach to the EPR as higher values of EPR can, not always, result in an increase of central apnea events.  I too want you to be at EPR=3, fulltime, to treat your hypopnea and RERAs, but let's start at EPR = 1, fulltime.  
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#4
RE: New user seeking guidance optimizing settings
Welcome to Apnea Board,

Yep with the Centrals we'll probably need to play the "Avoid CA Game". Gideon has a good plan to trial. Try it and post OSCAR and tell us how you feel after using.
Dave

OSCAR
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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