miltpalacio - therapy thread

[miltpalacio]

I was diagnosed with moderate sleep apnea (AHI 19.8) via an at home Lofta sleep study ~6 weeks ago. I have been using my CPAP every night since while experimenting with settings and mask types.
 
I am still feeling tired / unrested when I wake up in the morning.
 
I consistently have AHI around 5 and it is almost entirely CA events. I have OA events <0.5 on most nights (and often 0.0…)
 
I have also noticed a consistent pattern where the first half of my night has low pressure, low leaks and low number of events. Around 2-3am I see my CA events spike (along with pressure and leaks).
 
Any help with my settings or therapy would be greatly appreciated!! Thank you!

[OpalRose]

Did you experience CA's on your Lofta sleep test?  If not, this could just be treatment emergent and will lessen in time.

Also, the CA's could be a direct result of the leaks.  Notice how the pressure rises at the same time to try and compensate.
I think if you continue to try and fix the leaks, you might see your numbers lower.

https://www.apneaboard.com/wiki/index.ph..._Jeffy1958

A slight adjustment in your pressure range plus the use of EPR will help lessen the flow limitation and Hypopnea.

Try this:

Minimum pressure set at 9cm.
Maximum pressure set at 12cm.
EPR set at 2.

[ejbpesca]

Here are some items you may want to consider for your therapy:

1. How did you arrive at Min 7 pressure?  Was that prescribed by your sleep study?  If you have no presscibed pressure, 7 is a starting place.  Raising it a bit at a time can help reveal an optimum Min setting.  CAs may emerge as pressure changes are made then fade with time.

2. Run the mask fit test.  With mask on move your head a bit, twitch you mouth and nose to see if a seal is kept.  If not adjust the straps until it is.

3. Monitor the Med pressure under Statistics.  It can be the best Min setting.  It will change with time and you are not far from it by using 7.

4. You Max is 10.  It is pegging out at the top of the graph and would go higher if allowed.  You may want to give it head room to do so.  Once an effective minimum is established, the Max can be lowered.

5. EPR is off.  It may be worth a try for comfort.  It too may cause CAs at first.

6. The last two hours or so had higher Flow Limitations that raised pressure and showed erratic breath waves.  The CAs in this section may have been brought on by the higher pressure.  This happens to me often, sending my AHI higher than I would like.  For me, it is caused by sleeping on my back.  I roll to my back, Flow Limitations goes high, pressure rises to 18, large leaks happen,  and the machine struggles to keep me out of apneas. This also causes Large Leaks.  I am not saying this is your situation, just giving an example of how a piece of my OSCAR can look similar to yours.

If I remain on my side and have no large leaks, my AHI is below 1.00.  On my back, it is 10.00 for that period.

7. Your total time in apnea was 7 minutes.  I would work on Min/Max pressure settings to reduce time in apnea and lower AHI.  Check your prescribed pressure settings.  Consider raising the Min and Max. I like to raise Min a bit at a time (.2 or .4 cm).  Max can be set as high as 20 to fully allow the APAP machine to adjust, then brought back down to the 95% pressure found under Statistics.