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[Treatment] Help optimizing my AHI and sleep quality
#1
Help optimizing my AHI and sleep quality
Hello everyone,

I have been using my APAP machine for about 2 years. After reading through many posts here, I would appreciate some help, as I am not entirely sure if my current approach is correct.

At the meeting with the sleep doctor at the time, I was not supposed to have any therapy at first. I fought hard for it, as I suspected at the time that I might be suffering from UARS or mild sleep apnea. I already knew that I snored heavily from recordings with the SnoreLab app. Fortunately, I finally got the treatment.

Back to today:
The original setting was 4 - 9 APAP, no EPR, ramp 15 minutes. However, since I often suffered from aerophagia, I reduced the maximum pressure relatively quickly to 7.4. I tried a higher pressure from time to time, but always reduced it again due to the stomach pain.

Recently I started using OSCAR as I had the impression that my sleep quality was not optimal despite sufficient duration. I then adjusted the pressure slightly and also activated EPR as I had read that it could help against aerophagia.

My goal would be to further reduce the existing apnea and reduce the AHI. The last two days and overall statistics are attached. Thanks for any help!

Best regards

Daniel


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#2
RE: Help optimizing my AHI and sleep quality
Are you feeling sleepy during the day, or less sharp and resilient that you think you should be?

You say you're getting enough sleep, but I'm doubtful. Most people need AT LEAST seven hours of ACTUAL sleep, and you're rarely getting even that minimum.

Your AHI features some CAs and some OAs. I'm going to bet the CAs are just pauses between breaths after deeper breathing, e.g., a sigh or an arousal. I wouldn't worry about those. It'd be nice if you could reduce the number of OAs you're experiencing. You're also seeing some snoring and flow limitations, which also point to some airway issues.

Raising your EPR to 3 might help some with the FLs. But to reduce the number of OAs, you'd need to raise your minimum pressure and possibly your maximum as well. The trick is to try doing this without causing aerophagia, which creates painful air in your belly.

So as a first step, I'd suggest raising your EPR to 3 while keeping your min at 7 and your max at 9. Let's see what that does. Depending on the outcome, we might then want to increase your min and max very slowly, looking for the sweet spot where you get fewer airway problems but without creating stomach problems. One nice thing about your machine is that you can do this in tiny, .2 increments.
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#3
RE: Help optimizing my AHI and sleep quality
You would also do better if you turned your ramp off. You get virtually no therapy during ramp.
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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#4
RE: Help optimizing my AHI and sleep quality
Thank you very much for your fast replies to my post!

(07-02-2024, 03:14 PM)Dormeo Wrote: Are you feeling sleepy during the day, or less sharp and resilient that you think you should be? [...]

I don't feel properly rested when I wake up. I often sleep without wearing the mask for 1 to 3 hours after waking up. During the day, I only feel really awake when I drink coffee.

(07-02-2024, 03:14 PM)Dormeo Wrote: [...] Your AHI features some CAs and some OAs. I'm going to bet the CAs are just pauses between breaths after deeper breathing, e.g., a sigh or an arousal. I wouldn't worry about those. It'd be nice if you could reduce the number of OAs you're experiencing. You're also seeing some snoring and flow limitations, which also point to some airway issues. [...]

Would it be helpful if I create more screenshots showing the events in more detail? Or alternatively an export of one day, if this is possible with OSCAR?

(07-02-2024, 03:56 PM)Deborah K. Wrote: You would also do better if you turned your ramp off.  You get virtually no therapy during ramp.

I deactivated the ramp for the last night. I was worried at first that it would make it harder for me to fall asleep, but it worked. I have attached a screenshot of my flow from the evening before, where I think you can clearly see the problems with the ramp. So that's clearly great advice!


I have attached a screenshot of last night. Unfortunately, the AHI is a bit higher (related to CAs I guess). I've raised EPR to 3 and disabled the ramp.

Looking forward to further valuable help!


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#5
RE: Help optimizing my AHI and sleep quality
With the increased EPR, you had a nice reduction in FLs and a bit less snoring.  Your OA index is a little lower, which may have nothing to do with the change in settings but is still good to see.  

As you say, you had an increase in CAs.  The little cluster near the beginning of the night may have been transitional CAs.  The neurochemical controls for breathing are different when we're awake and when we're asleep, and sometimes CAs occur during the hand-off from the one system to the other.  It's nothing to worry about.  Bracketing that, your CA index was about the same, so again, I'd say don't worry about it.

You can learn to spot arousals followed by CAs.  During an arousal, breathing tends to be deeper and the flow rate tends to look messier.  I've attached two views of a CA followed by arousal breathing.

My advice would be to stick with these settings for at least three more days.  You'll see some variation from night to night; that's natural.  After that, try min 7.2 and max 9.2 to see how that goes.  Keep us posted!


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#6
RE: Help optimizing my AHI and sleep quality
There might be something else that is contributing to your aerophagia outside of pressure, such as reflux, mouth breathing, recovery breaths, etc.

Are all 788 days of therapy yours? If you still have CAs after that much usage, you may need to consider alternative settings, or they could just be recovery / post-arousal type events. If that's the case, then you do likely need to adjust your pressure settings in some way. Bilevel could help might be able to permit you to have a lower average pressure by using PS. Using a MAD together with PAP may also yield results. I think it's important to verify that you're breathing properly through your nose first, and then go from there. Secondly, to verify what those CAs are.
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#7
RE: Help optimizing my AHI and sleep quality
(07-03-2024, 03:20 PM)CPAPfriend Wrote: Are all 788 days of therapy yours? If you still have CAs after that much usage, you may need to consider alternative settings, or they could just be recovery / post-arousal type events. If that's the case, then you do likely need to adjust your pressure settings in some way. Bilevel could help might be able to permit you to have a lower average pressure by using PS. Using a MAD together with PAP may also yield results. I think it's important to verify that you're breathing properly through your nose first, and then go from there. Secondly, to verify what those CAs are.

Thank you for your suggestions and support. Yes, I did the therapy for a total of 788 days.

Regarding the CAs: Would detail views of my CAs or OAs assist in further analysis? Also, how can I ensure exclusive nasal breathing?

Should I consult my sleep specialist again? I'm concerned about receiving adequate attention with an AHI under 5.

By the way, I have subscribed to your YouTube channel and will click through the videos after the next hopefully great night of sleep!
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#8
RE: Help optimizing my AHI and sleep quality
Dahaupt, I think it'd be very beneficial if you could learn how to identify post-arousal CAs yourself. Maybe you could scroll through and find one or two that you think are post-arousal CAs and post them, so we can see whether we'd agree. Be sure to include all the key graphs in the snippet, not just the flow-rate (as in my examples).

As to whether you need further help from your sleep specialist, this partly depends on whether most/all of your CAs are post-arousal, so let's get that figured out.
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#9
RE: Help optimizing my AHI and sleep quality
Hey Dormeo, I've selected 3 CAs of last night (AHI 3.71: OA 2.06 / CA 1.44 / H 0.21). 

This night I've started to increase the pressure by .2 (7.2-9.2).


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#10
RE: Help optimizing my AHI and sleep quality
In two of them, your breathing was a tiny bit shallow and then you took a single deeper breath -- something like a sigh. After that you exhaled and paused before you inhaled again. It looks to me as though your sleep was undisturbed both before and after CA. I'm not sure I'd say these even represent arousals; if they do, they were very brief.

In the third snippet, you had some flow-limited breathing, then inhaled in two stages, then held your breath, then exhaled, then paused your breathing. Taken as a whole, that's an arousal. You may have held your breath as you changed position in bed.

All in all, I think these CAs are just not a problem for you. It's good you're getting the hang of interpreting your flow rate. One thing that will help is for you to learn what normal asleep breathing looks like for you.

(By the way, breathing can be flow limited but not marked in the FL graph. That's because the algorithms pick up only some FLs. The general mark of flow-limited breathing is that the top of the inhalation curve is flattened, dented, or shows plateaus/peaks.)
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