[Treatment] Therapy is helping, but only a little - good AHI numbers, bad sleep

[tiredsleeper]

Changed my mask to f40, got my settings changed a little bit by sleep doc, and I started to sleep a lot longer - feeling a little bit better, but still very tired and feeling sleepy during the day. Should I be worried about the level of CA events that I have during therapy? I've repeated the sleep test and no central apnea has come up, also we've tried ASV and it was absolutely terrible to sleep in (felt 10x worse than cpap in the morning).

[Dormeo]

I don't think the CA indexes you're seeing are worrisome. If you zoom in on them, it's likely you'll see arousal breathing right before most of them. (Arousal breathing is deeper and messier-looking than asleep breathing.) If that's what's happening, then it's the arousals, rather than the CAs, that are contributing to unrestful sleep.

Your flow limitation graph is fairly active. For some people, FLs don't diminish the quality of sleep; for others, they do. Normally the way to deal with FLs is to introduce EPR, but EPR can exacerbate CAs.

Higher pressures can also exacerbate CAs. I see you're now using a fixed pressure of 11.4. This controls your OAs quite well. I wonder whether you'd do as well with your CAs if you used a lower pressure.

I know you tried EPR of 3 earlier and felt it wasn't helpful. But you might consider trying some EPR again. If you want to try that, I'd suggest using an EPR of just 1 to start with, leaving your pressure where it is. The EPR will drop your pressure when you exhale, but I'm hoping you'd still see good control of your OAs with maybe fewer FLs and no increase in CAs.

If you want to give that a try, I'd recommend sticking with it for at least three nights before trying to evaluate the change -- unless for some reason it's a disaster.