What should I change first?

[Sleepingbaby]

I have been on CPAP since last July. I have used the F30 since October and have achieved 0 leaks and low AHI. The cushion I am using now is about a month old. This is the first time I am trying to post an Oscar report. Not my worst night but the leakage is constant the last couple of weeks. I restart every time I wake up hearing the leaking at the higher pressure. I need more hours of solid sleep.Ramp is off What can I change?

screenshot-20210314-093828.png (66.8 KiB) Viewed 1056 times

[Pugsy]

Actually turn off EPR as your first change. If you have never tried it with EPR off.
If you can't fall asleep with EPR off....change EPR to ramp only and make use of the ramp feature for approx however long it takes you to fall asleep.

[Sleepingbaby]

Thank you.
My EPR is on, full time and 1. Never liked the ramp at the start so that is why it is off but the EPR was 2 then. One step at a time. The EPR is now off for tonight.
Thanks to this board I know HOW to make the adjustment.

[Pugsy]

I doubt that eliminating EPR is going to help much but there is a slim chance it might so might as well give it a try.

Next thing to try is go to regular auto mode and not the for Her auto mode at same settings.

I don't know if the OAs seen are causing arousals or not...but arousals could be contributing to the CA/central flagging...so we need to try to deal with the OAs first because they are something that we can try to kill with pressure tweaking.
Turning EPR off effectively increases the overall pressure slightly...and to kill the OAs we need more pressure but I want to go slow because more pressure can also trigger centrals.

[Miss Emerita]

Sleepingbaby, when you were diagnosed with apnea, did they tell you the breakdown of events (obstructive apnea, central apnea, hypopnea)? If they didn't, could you get that information?

[Sleepingbaby]

I was only told my AHI was 48 and I needed CPAP. I have had a 2nd sleep study with my equipment on but have to wait until April to speak with the Doctor. Will note to ask then. How will knowing those numbers help?

[zonker]

I was only told my AHI was 48 and I needed CPAP. I have had a 2nd sleep study with my equipment on but have to wait until April to speak with the Doctor. Will note to ask then. How will knowing those numbers help?

everyone's ahi is composed of the events that miss e is asking about. however, not everyone has the same events in the same quantity.

it's important that we know these so that we know where to start in helping you improve your cpap journey.

good luck!

[Pugsy]

I was only told my AHI was 48 and I needed CPAP. I have had a 2nd sleep study with my equipment on but have to wait until April to speak with the Doctor. Will note to ask then. How will knowing those numbers help?

Your initial diagnostic AHI wsas composed of central apneas (those Clear Airway apnea on the OSCAR software) and obstructive apneas and hyponeas.
Obviously you have a high number of central apneas right now. We don't have any way to know for sure right now if you had those prior to starting cpap therapy or if they have just popped up with the start of cpap therapy. It's kinda important to figure out if at all possible.
Obviously if you had a large number without using cpap then cpap use hasn't caused these and it's unlikely that anything we do here with little tweaks here and there is going to help reduce them.

With your sleep quality to obviously poor we also don't know if those centrals are causing the poor sleep or just a symptom of poor sleep and are maybe false positives getting flagged while awake or semi awake.

We really can't do anything to treat real asleep central apneas with your machine but we can try to reduce the number with a few little tricks.....worth trying. Might get lucky.

[Miss Emerita]

If you live in the US, you have a legal right to a copy of your sleep study. The office people should be able to send it to you.

[Sleepingbaby]

What a change turning the EPR off! Still waking at the higher pressure but I am working on trying not to reset the machine.
Repost of yesterdays chart and then last night chart to compare Thank you.

screenshot-20210314-093828.png (66.8 KiB) Viewed 955 times

screenshot-no-EPR-20210315-092935.png (64.01 KiB) Viewed 955 times

[Pugsy]

Big change indeed. Not great but a much improved from previous report.

Here's the deal with centrals that are showing up AFTER starting cpap meaning they are what we call treatment emergent centrals (assuming that is what we are dealing with at this point) they can be caused by too much pressure (or any pressure sometimes) and using bilevel pressures which is what using any form of exhale relief creates.

It is normal to have a handful of centrals here and there and those we don't worry about. Obviously prior to last night you were experiencing a lot more than just a handful. Looks like removing the bilevel situation helped reduce the centrals significantly. We can live with this for now. It's acceptable.

But still too many OAs and hyponeas which are obstructive in nature most of the time and we normally deal with those with more pressure and your machine is trying more pressure but it just can't get to where it needs to go fast enough to prevent the airway from collapsing.
So lets give it some help with more minimum. For tonight try 8 cm minimum and lets see what happens.
Again is you aren't comfortable with no EPR at 8 cm...you can go in and set it for EPR in ramp only and make use of the ramp feature.

I want to go up in small steps with the minimum because of that other reason that centrals pop up...higher pressures. I am not sure how much of an impact those higher pressures might be having on the clusters of centrals just yet.

[Pugsy]

Oh, at some point I want you to change to regular auto mode but we don't have to do that right now.

And see if you can resize your graphs a bit to include the flow limitation graph. No need to redo this one from last night....I can tell by the statistics enough to know it looks a bit ugly and isn't unexpected what with the for Her mode being used and the way the pressures are going from the statistics numbers themselves. I already know what it will show. Flow limitations are a major driving force for pressure increases because FLs are early warning signs of the airway trying to collapse. Normally we would just let the machine sort it out but when centrals are popping up sometimes we have to make compromises.

[Sleepingbaby]

thank you. Love learning something new every day!
I have written to the clinic to ask for my sleep test results. Will update if I get numbers.
I also have AFIB and high blood pressure being handled by drugs and trying to lose some weight which will help with all these issues.

[Sleepingbaby]

Got my study reports and no breakdown of numbers. This is a quote from my first study (no machine):
"There were a total of 145 apneas and hypopneas recorded. for an overall AHI of 33 per hour".."in REM sleep AHI of 75 per hour"
there is no such breakdown in the study done with the machine to compare.
So last night is EPR off and minimum up from 6 to 8. I also wear earplugs. I am female. I think I handled the higher pressure better but would wake to "feel" leaking so that is the resests. thank you for your help. P.S. Where do I find central numbers in Oscar?

[Pugsy]

CA on the events graph are clear airway apnea events.....those are centrals.

About half your AHI is central apneas.....were you awake at around 05:30 when the cluster of CAs and CSR green flagged time showed up?

Some of your events are likely false positives since they are near known awake time.
We throw those awake false positives out the window in terms of apnea therapy but they do of course mean being awake which is unwanted.

Go here and watch the videos and learn how to zoom in on the flow rate so you can identify asleep flagged events and rule out awake/arousal flagged events.
http://freecpapadvice.com/sleepyhead-free-software