Request for Optimizing CPAP Therapy

[Sleepyboi99]

Hello everyone, 

I am 26 year old male that was diagnosed with mild obstructive sleep apnea in September 2024. I had a sleep study done due to never feeling rested even after getting plenty of sleep, frequent morning headaches, and also feeling generally fatigued throughout the day. the study showed an overall REI/AHI of 8.5 with the lowest oxygen saturation at 91%. Although I was diagnosed at the end of last year, I believe this an issue that I've been experiencing for many years even before. 

I have been using a CPAP since November 2024 which has helped somewhat but nowhere near as much as I had hoped. In the last 90 days, my average AHI was 5.02, but given that I am using a CPAP, I would really like to get that number below 5 into the normal range, especially since I am still experiencing the symptoms described above. I was hoping to get some advice or suggestions based on my OSCAR sleep data (started looking at this data this week). My major area of concern is central apneas which seems to make up the majority of my events as well as my frequent number of wakings each night (typically 1-3 times a night). Happy to provide any additional information aside from the information listed below as well: 

• Underwent radiofrequency turbinate reduction on 3/7/25 due to enlarged turbinates (3-4+ on the left/2-3+ on the right) - healing well with minimal congestion
  
• Back sleeper (as a life long back sleeper, I find it very difficult to sleep on my side) 
  
• 5'8", 155 lbs (workout x6 a week)
  

[Deborah K.]

I see a couple of things to work on.

Did you have a lot of CAs in your sleep study? If you don't know, post a redacted copy of the study. Ask your doctor's office for a copy if you don't have one. They must provide it if you ask.

Change your pressure range to 7 to 13. That will provide better therapy. We can then see how you do and advise accordingly.

Again, welcome, and best wishes for great therapy and comfort!

[Sleepyboi99]

Attached you'll find the results from my sleep study. Looking back, I did have a lot of CAs, but the majority were Hs. 

Would you still recommend the pressure change to 13?

[ejbpesca]

I am curious about your pressure graph.  At EPR 3 I would expect to see two separate lines, one red and one green, across the entire graph.  Maybe someone will reply with an explanation of why your pressure graph is a single green line and then a single red line.

[SarcasticDave94]

How did they diagnose you with mild Obstructive Apnea with a zero under Obstructive Apnea? Oh, and they skipped the Central Apnea count of 24 events.

Maybe you'd do better with the VAuto if CA were somewhat low. Any idea what your CA statistics show you've had? If the CA are a real problem, then ASV can treat these CA.

With the Central Apnea present and Obstructive Apnea zero, this is predominant Central Apnea, the Hypopnea excluded.

[Sleepyboi99]

I believe this may because this was the first night I tried with EPR off, and it didn't feel comfortable, so I turned it back on in the middle of the night. Last night, however, I tried turning it back off and managed to sleep the night with it off.

[Sleepyboi99]

My assumption is my sleep doctor included the hypopneas in the diagnosis which were higher than the central apneas to come to the mild OSA conclusion. 

I'm actually using a ResMed AirSense 11 which doesn't have the VAuto/ASV functionality. Currently, on the APAP mode with my machine.

Could you elaborate on what kind of CA statistics you are looking for?

[SarcasticDave94]

One issue there is with EPR 3 full time is that it conflicts with min pressure 5. The EPR 3 cannot drop 3 from 5 to give an effective exhale pressure 2. For EPR 3 to actually work always, min pressure needs to be 7.

[Sleepyboi99]

I see. Would leaving EPR off be more ideal?

[SarcasticDave94]

For your own info, the reason min 5 and EPR 3 can't work well, the CPAP minimum is 4. There are a few ResMed bilevel that go down to 3, but typical adults will feel air starved possibly at or below min 6.

You'll possibly want to experiment with the EPR levels to see what gives you overall best therapy. I don't know what effect EPR will be on your CA, if any. It may affect feel and FL may increase.