Optimizing my CPAP Therapy

Hello! I'm looking for some help really dialing-in my CPAP therapy so I can be sure I'm getting the most benefit.

I started CPAP therapy in late November. I feel like I've always been tired at some level for as long as I can remember, but I always just figured I didn't get enough sleep. My wife helped me finally decide that falling asleep all the time and always being tired was not normal. (She has also complained that I snore for as long as we have been married.)

I did an at-home sleep study, and I think my AHI was ~26 or 27. My PCP prescribed my CPAP. It was initially set the wide open 4-20mmH20. That seemed to help, but my AHI numbers were still around 5-6. I read here that 4-20 isn't really an optimal setting. My PCP had it set 7-20, and using OSCAR, I have ended up adjusting it to 11-20mmH20. After settling out at the new pressure, and switching from the Amara View to the AirFit F20, my AHI is down around 3. But I feel like this can still be better; I still find myself tired during the day even after a good night's sleep. It does help sitting up a bit, and that is how I get these best AHIs of around 3. Sleeping on my side might help too (I used to snore less that way), but I get significant aerophagia when I do, so I stay on my back.

I'll attach my OSCAR screen captures below from the last two nights. Let me know if any other information would be useful.

Thank you all in advance for your advice!

You're on the right track, go to a minimum of 12.

palerider wrote: ↑

Fri Mar 06, 2020 11:27 pm

You're on the right track, go to a minimum of 12.

excuse me, alphoptimal, while i confer with palerider.

can we talk about the vibratory snores? it seems to me that when i was on phillips, i saw more evidence of snoring than i do with resmed.

does this indicate in any way that the VS isn't real?

sorry, alphaoptimal. please carry on!

zonker wrote: ↑

Sat Mar 07, 2020 6:12 pm

palerider wrote: ↑

Fri Mar 06, 2020 11:27 pm

You're on the right track, go to a minimum of 12.

excuse me, alphoptimal, while i confer with palerider.

can we talk about the vibratory snores? it seems to me that when i was on phillips, i saw more evidence of snoring than i do with resmed.

does this indicate in any way that the VS isn't real?

sorry, alphaoptimal. please carry on!

Those are "VS2" which ... nobody has ever really figured out exactly what are... I've heard a lot of theories, something to do with some count within 2 minutes, or ...

The thing I like about Resmeds is that they show a 'how bad does the machine think the snores are', vs 'something happened', there's a difference between little small snores and huge ones.

Also, Resmeds, being much more responsive, tend to squash the snores more (if they're allowed to... ) than Respironics do.

Does that answer the question?

Alphaoptimal, does your wife report continued snoring? Also, is the aerophagia painful, or does it wake you up? If yes to either, that is certainly a problem. If no to both, you might try side-sleeping and putting up with the bother for a while. The body sometimes adapts on its own. The other thing you can try is positioning your tongue so it helps you route the air where it is supposed to go. Put the tip of your tongue behind your front teeth, let it spread out from side to side, press the middle and back of it up against your palate, then do a little swallow or suck to suction it into place. With time and practice, this is pretty effective for a fair number of people.

palerider wrote: ↑

Sat Mar 07, 2020 11:42 pm

zonker wrote: ↑

Sat Mar 07, 2020 6:12 pm

palerider wrote: ↑

Fri Mar 06, 2020 11:27 pm

You're on the right track, go to a minimum of 12.

excuse me, alphoptimal, while i confer with palerider.

can we talk about the vibratory snores? it seems to me that when i was on phillips, i saw more evidence of snoring than i do with resmed.

does this indicate in any way that the VS isn't real?

sorry, alphaoptimal. please carry on!

Those are "VS2" which ... nobody has ever really figured out exactly what are... I've heard a lot of theories, something to do with some count within 2 minutes, or ...

The thing I like about Resmeds is that they show a 'how bad does the machine think the snores are', vs 'something happened', there's a difference between little small snores and huge ones.

Also, Resmeds, being much more responsive, tend to squash the snores more (if they're allowed to... ) than Respironics do.

Does that answer the question?

yes, it does.

thanks!

My wife says she still hears the occasional snore, but it's much better than before. And on the odd time when I'll get up and forget to turn the machine back on, or a couple times when I have removed it overnight, she definitely notices the snoring much worse then.

I haven't had the aerophagia as much lately (probably because I stopped sleeping on my side), but early on, it has woken me up a couple of times overnight needing to burp and walk around a bit. More recently when I have it, I feel like it's not uncomfortable at first, but after being awake for a while in the morning, my gut is pretty uncomfortable for several hours into the morning. But maybe it's something that I have been getting a bit used to, because more recently it hasn't been as bad. I'll try the tongue trick tonight.

Last night I raised the lower pressure to 12 mmH20. My AHI was 3.2, so about the same as other recent days. I didn't pull up the data on OSCAR yet. I'll give it a couple of days and see how it goes and try and download the data.

Thanks for any other advice anyone has.