Advice needed for CSA sufferer. Thanks

38 year old male
165lbs
5ft9
32in waist
Suffered with fatigue, anhedonia, irritibility, brain fog, and nocturia for many years. More recently photophobia and constant bloodshot eyes have been added to the list. I have ruled out and/or are being treated for other possible etiologies by my PCP, endocrinologist, neurologist, retina specialist, and psychologist. I was diagnosed with mild mixed sleep apnea in March of 2022 with an in clinic sleep study. AHI of 12.6 with large majority being central apneas. This was during the cpap recall so rather than wait a significant period of time for a Resmed, i settled for a Resvent iBreeze 20a.

link to sleep study info:
https://imgur.com/a/3Zsa0wH
I no longer suffer from RLS and I have learned to sleep on my side.

I have experimented with many settings on my device. From the beginning of therapy my AHI was always <5 but no symptom resolution. I have to use a chin strap and mouth tape or i blowfish and get massive leaks,drooling, etc with any pressure. Above 12 i have to utilize polident and it isnt always successful. Currently i am running in APAP mode with minimum of 9cmH20 and maximum of 13cmH20 with EPR set at 3. Ive attached my 2 most recent sleeps from Oscar. Flow limitation appears to be all over the place regardless of sleep habits.

Any advice would be greatly appreciated as i am tired of being tired. My Pulmonologist states that since my AHI is less than 5 i should be feeling better and my issues do not stem from sleep apnea . I have another follow up in December.

Welcome! I'm uncertain about what your machine can do and what data it can generate for display in Oscar, so I have a couple of questions.

From doing the math on the left panel, I'm inferring you don't have any CAs. Is that right? And can you turn on CA flags in Oscar?

Does your machine allow you to use more pressure relief (or pressure support)? In other words, can you change your settings to achieve a greater delta between your pressures for inhalation and exhalation? That might help with flow limitations and hypopneas.

How was your minimum pressure determined? Would you be willing to experiment with a higher minimum? That might head off some obstructive apneas.

Finally, "photophobia" caught my eye. Have you been tested for autoimmune diseases?

Appreciate the timely response.

My machine does flag central apneas. How well it does this, I am not sure. According to my 1 year review on the machine, it has never flagged a single one therefore it hasn't reported any to Oscar. Which means there is no CA flags to turn on in Oscar as the only event types available are PB, OA, H, FL, and RE.

My machine has a IPR setting(Intelligence Pressure Release) to lower pressure at exhale. Which has been set at the maximum of 3 for a couple weeks now. I had previously not used IPR. It doesnt seem to improve the flow limitations at present.

My minimum setting is purely experimentation. For the majority of my cpap usage, I used a continuous pressure of 12 with similar results. I have been unable to run a higher minimum pressure as I have struggled to keep my mouth shut. Tape and chin strap work well enough with lower pressures. I struggle above 12, even with a layer of polident holding my lips shut. I am willing to experiment again.

Thyroid antibodies are low/negative. CRP was very low and ANA was negative. Typically bloodwork is unremarkable. I will add that the light sensitivity, while never ceasing, is significantly worse on the rare occasion i do not use my cpap the whole night or if my total sleep length is shortened. This makes me believe that my sleep is the cause or atleast having a strong influence.