Need an opinion on my current charts please

[Lifeisabeach]

Howdy all. I need an opinion on some changes I made to my machine and the results before I continue on with them. Some quick background here first for perspective. My machine settings had been 16/8 for several years now and my case was considered well under control. I hadn't habitually checked my AHI myself, but my P.A. had been satisfied getting me down to an AHI of 3.0 when I first got started due to the severity of my case. I only have data going back a couple years, and while I've had some nights in the earlier part of that period with AHI under 1.0, those were fairly uncommon with the AHI being more around 3ish typically. That mysteriously changed middle of last year and my AHI shot up. I first found out at my followup visit in December, and that lit a fire under me to stay on top of this and get more involved.

I'll try to avoid rambling too much here, but the short answer was my P.A. wound up dropping my pressure from 16/8 to 15/7 in February. That helped for a short while, but my numbers wound up shooting up again and has been very erratic, ranging from 3.0 to the 40s, with 10-20 being more typical. This no doubt has been complicated by meds I was put on by an endocrinologist in January and significant weight loss as a consequence. My P.A. was supposed to re-check my numbers after a month or so, and we were expecting I'd get re-tested, but I never heard back, no doubt due to COVID. Meanwhile, I've been reading up on posts and tutorials, and last week I decided to try a couple changes because this has gone on too long and I was increasingly confident I was better off managing this myself, with a little help/advice as needed. Dropping my pressure to 14/7 got me around 3, but that was within range of my existing erratic numbers. Since it had been so erratic, I decided switch my machine to VAuto mode and left it at the defaults, planning to revisit it if anything seemed off. I've been reviewing my data every morning and as far as I can tell, this did the trick. But before I continue, I need a more qualified opinion to make sure I'm not overlooking anything. So here come the charts. First is an overview of the past couple months just to show what my trend had been.

Overview

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Here's a representative day from a couple weeks ago with an AHI of 17.07. Lots of large leaks and clear airway events are seen.

Old Daily

screenshot_22.png (561.49 KiB) Viewed 899 times

And here's last night's data. My AHI was 0.46 with a near complete elimination of the clear airway and large leak events that have been plaguing me. The previous few nights since switching to VAuto mode have all been comparable to last night.

Last night

screenshot_19.png (559.42 KiB) Viewed 899 times

I was very surprised to not only see my AHI so low, and consistently so (at least so far!), but how much my pressure needs plummeted. The average is roughly 9/5 now when a year and a half ago, it was 16/8 and my case controlled with that at the time. But anyway, I need to be sure I'm not misreading or overlooking anything here. I don't have any oximetry data, but is there any reason or need for me to get an oximeter to be sure my sats are normal when sleeping? Any adjustment to VAuto mode that I should be making, or should I switch back to S-Mode and use these new numbers that VAuto mode is giving me as my new, fixed settings? Thanks.

[Pugsy]

The high PS of 8 when using S mode probably caused all those centrals.
If you went back to S mode I wouldn't use more than 4 PS....but my personal opinion...if it ain't broke don't go trying to fix it.
I would continue with things just like you are using as long as you are sleeping well and feeling decent.

[khauser]

The high PS of 8 when using S mode probably caused all those centrals.
If you went back to S mode I wouldn't use more than 4 PS....but my personal opinion...if it ain't broke don't go trying to fix it.
I could continue with things just like you are using as long as you are sleeping well and feeling decent.

I'm pretty sure that last line should start with "I would"....

Also, while I know nothing about the more advanced machines and their protocols, there's not much denying how much better the report looks. If I were you I'd leave it along for at least several days to (a) see if its a fluke and (b) see if you start feeling better.

[Pugsy]

The high PS of 8 when using S mode probably caused all those centrals.
If you went back to S mode I wouldn't use more than 4 PS....but my personal opinion...if it ain't broke don't go trying to fix it.
I could continue with things just like you are using as long as you are sleeping well and feeling decent.

I'm pretty sure that last line should start with "I would"....

Also, while I know nothing about the more advanced machines and their protocols, there's not much denying how much better the report looks. If I were you I'd leave it along for at least several days to (a) see if its a fluke and (b) see if you start feeling better.

Fixed that little typo.

The one thing I didn't see above was comment as to sleep quality and overall daytime feelings.

Based on the auto mode data alone....I doubt it was a fluke. He was using a PS in fixed mode that was too high and causing centrals...probably didn't feel so great or sleep so great either after that ugly night. If he went back to 8 PS even in auto mode...the ugly would return.
It's not the mode he is using so much as the PS difference that was the critical change.

I see no need to add overnight pulse oximetry at this point UNLESS he's not feeling the good numbers. I just realized I didn't address this question.

[Lifeisabeach]

Thanks ya'll. Yeah, after trialing the reduced IPAP level to 14, I was about to drop the EPAP down next since I had recently read that tidbit about it being the likely culprit for centrals, then I decided it'd make more sense and be more expeditious to just take advantage of the VAuto feature, let it find what my IPAP level should be, then adjust the pressure relief to lower the EPAP if need be. I have this more advanced model, it seemed silly to not be taking advantage of it.

As for how I feel? Yeah, very different for at least the first couple days. Saturday and Sunday mornings I was awake unusually early (5ish) and couldn't go back to sleep, so I wound up getting up. Normally I'd eventually be dragging a bit when up that early, but nope. My lungs felt... a little strange after waking up. Like they were adjusting to the lowered pressure levels after waking up. It's hard to describe, but I felt like I was breathing easier during the day.

Yesterday I was dragging and took a short nap early afternoon, but I think the relatively short nights simply caught up to me. Not dragging today, feel about average (my old average) to be honest. But I had one too many drinks last night, soooooo.... Anyway, thanks for the insight. I'm still utterly gobsmacked over how much that pressure dropped. I'm highly confident this will continue to work and I agree... no sense in switching back to S-mode as long as this is working.

[Lifeisabeach]

Well I'm 4 weeks into this and my AHI has consistently been under 1.0, usually significantly under. I can confidently say my case has never been under control this well since I began over 10 years ago. My P.A. is going to lose her freaking mind when I have my next followup.

But that's not even the best news. I just had a followup with my endocrinologist. He wanted to start me on testosterone therapy with my last followup, but I was hesitant. I was hoping to lose a little more weight first, but I also wanted to make sure my sleep apnea was back under control due to how badly I reacted to taking testosterone injections before my sleep apnea was even being treated (the injections made it much, much worse). The short story on that is I have an acute case of low T, baseline of 102 ng/dl when I was 35 and stayed around that for a few years; it started to rise when my sleep apnea was first under control, going up to 240 after 3 years before my doctor stopped testing me; I requested to be re-tested last year, hoping I had normalized but instead it had crashed to under 100; came up a little after seeing an endocrinologist and meds got some weight off me. My followup today was to re-check the levels and plan on starting therapy. Those plans are now shelved because my levels shot up from 193 ng/dl taken 3 months ago to 308 ng/dl, putting me in the normal range for the first time, ever. He wasn't expecting that at all, and after I told him the history with my sleep apnea and the recent issues and changes, he believes that is what's making the difference. My next followup is in 6 months, and it will be very interesting to see where I am.