Tweaked everything I could, any help appreciated

[Weef23]

Hi All,

I've done my best to use the knowledge of past posts to tweak my settings through data gleaned with Sleepyhead. I'm at a loss has to get any better.

Initial at home sleep study was REI 22.7, OAI 4.2 CAI 0 Lowest Desat=81%. Mostly hypopneas (18.5 per hour), less OAs (4.2 per hour)

I'm a fairly new user of A/CPAP, and just received a machine about 2 weeks ago, a Phillips Dreamstation APAP with humidifier. They originally set it for 4->20cmH2O, but my AHI was ~10. I increased the pressure to a minimum of 9.5, the pressure was a bit too much, so I added the AFlex mode set to level 1 to make it more comfortable. Doing these changes, I got my AHI down to 3->4.5 over the last 2 days. I think I've tweaked as much as I can, since I'm seeing a few centrals which I can't "fix". Here's my data for the last 2 nights. The first night was pressure 9.0 and AFlex 1, the second night was 9.5 and Aflex 1. Can anyone see anything that could help? I think I feel better than pre-treatment, but I wouldn't say its night and day.

Please let me know if you'd like me to zoom in on anything. I believe I am being woken up by the family around 7 and toss and turn a bit and fall back asleep maybe on my side from supine. I go to bed around 1 or 1:30am and fall asleep fairly close after that. Maybe tossing and turning until 2ish. Last night (sunday) maybe tossed until 2:30am?

Thanks so much for any help you can offer!

[Pugsy]

How is your overall sleep quality? Sleeping soundly for the more part or waking often?
How are you feeling in general?
Take any medications of any kind, if so, what?

Have you taken the crash course in distinguishing awake vs asleep events? If not, take it.
http://freecpapadvice.com/sleepyhead-free-software

Some of your clustering of events is happening at known awake times where you know you were tossing and turning. These events aren't real sleep apnea events if they are just the machine flagging irregular breathing by mistake.
Remember the machine doesn't have a clue if you are asleep or not. All it measures is air flow or your breathing. It can and will be fooled by awake/semi awake irregular breathing. Those events (which we call SWJ or sleep/wake/junk) aren't real and they have to be removed from the evaluation process. You can't fix them with pressure settings per se. Instead you have to try to fix the cause of the poor sleep quality and the delayed sleep onset and the tossing and turning. Easier said than done I know.

[Weef23]

Thank you Pugsy for your quick reply.

How is your overall sleep quality? Sleeping soundly for the more part or waking often?
- I believe I have always slept soundly. Even untreated I slept through the night, just snored like a freight train according to the wife. And need a pot of coffee to wake up in the morning.

How are you feeling in general?
- I've felt off for probably ~15 years. Memory is so bad, thought I had early onset alzheimers since 30 years old! (now 40). Most likely have been untreated for apnea for that long. I'm skinny so the doctor never brought it up. Instead went down many other roads beforehand (lyme disease, low hormone levels, slowly creeping up blood sugar levels, etc)

Take any medications of any kind, if so, what?
- No medications at this time. I've kept myself fairly healthy tryign to do the basics of exercise and eat right. Never struggled with my weight.

I naturally fall into a 1am->9am sleep cycle. Even avoiding all bright/blue light at night, this is just what my body has always preferred.

I will take the crash course right now, appreciate the link!

[Pugsy]

Do the crash course for figuring out awake vs asleep events first.
We can't fix anything until we know exactly what we are trying to fix.

If indeed those CAs are probably SWJ then we have to ignore them and work on why not going to sleep more than pressure settings.
If it weren't for the CAs on Sunday night your report would have been right respectable.

[Weef23]

Thank you again. I will read it tonight when not working.

That actually gives me some optimism that you think it's not looking awful on Sunday! Maybe it'll just require a period of "getting used to it" and stop messing with settings for a few days and see what happens.

I'll get back to you later in the week if anything has changed. Really appreciate the help and another set of eyes (especailly from an expert!).