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Steveq Therapy Thread
#1
Steveq Therapy Thread
Hi Everyone --

This is a really great forum and I've learned a lot reading through the wiki and threads. I'm looking for some advice on how to approach PAP therapy given the results of sleep tests. 

In July 2024, had an initial test done (Type 3 HSAT) with AHI = 5.0, however, my sleep doctor noted a lot of presumed arousals associated with flow limited breathing (no EEG data). 

More recently, having lost an additional 30 pounds, had a repeat test done with full PSG. Overall, my AHI decreased to 0.8 overall, but 6.8 in REM sleep. Including RERAs however, my RDI was 4.2 overall but 18.1 in REM. These RERAs were consistent patterns of worsening flow limited breaths terminated with EEG arousal, pulse spike, and recovery breathing. 

In between the tests I was prescribed a CPAP (AirSense 10) to trial however was unable to fall asleep with it as I found the device to remove any sleepiness drive I had when putting it on at night, likely due to the discomfort with the forced air, among other things. I was able to use the device during the day with no issues. Since I was starting to build a mental association of using the PAP --> insomnia, I stopped. In the past I treated insomnia successfully with CBT-I, and one of the core tenets was to only try and sleep when the sleepiness drive is present, which I found using PAP to remove completely. 

However, I'd like to give it a another go as I'm still experiencing unrefreshing sleep. A few initial questions I was hoping to get the input of some of you from:

1. From reading the wiki page on titration, the suggestion would be to try and raise EPAP to prevent apneas/hypopneas, and then IPAP to address flow limitations. With the AirSense 10 I only have the EPR to work with, but I'm curious if this recommendation holds given that essentially I have no apnea/hypopnea. Should I just start e.g. at 7cm with EPR = 3?
2. I found the forced air even at low pressures to be quite stimulating causing insomnia, however it appears that during REM sleep with muscle relaxation I would need support. Does anyone have suggestions on how to minimize this feeling?

Let me know if I haven't been clear on anything, trying my best to wrap my head around everything.

Thanks!
steveq
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