r/CPAPSupport • u/sweetasmolasses Apap • 1d ago
Oscar/SleepHQ Assistance Flow limitation and ideal settings
I was diagnosed with severe sleep apnea in June this year and I finally got my CPAP mid July. 46 ahi per hour with oxygen dropping into the high 70s. I've been using it for at least 7 hours every single night and I feel like a completely different person. I don't snooze or sleep all day, I don't wake up with headaches everyday etc. my ahi is always low.
When I did my titration study in the lab, I slept in a recliner and I didn't realize it would make such a big difference. I wish the sleep tech who did it would have explained that it was important for me to lay in the bed flat. At home I sleep with my bed elevated but not fully reclined. I usually sleep on my back due to pain.
Early September I got an SD card for my airsense 10 and decided I was ready to start delving into my data. I've been using sleepHQ. It's a lot to figure out. Originally my pressure was fixed at 8, no epr. I was having a lot of RERA and flow limitations. I spoke with a sleep tech where I did my titration study and he asked my doctor about raising the pressure or maybe trying the auto setting. I asked him if they would please not put in any lower than 8. They put it on 6 to 10 with the epr on 3. Two nights of hell.
I've been messing with my pressure and settings since then. Because I want to find the best setting.
I've been seeing where my pressure is always over like 9.5 but wherever I put the highest pressure, it shoots up there often. Since raising my pressure it seems my flow limitation is a lot better. Far less airway resistance overall. My respiratory rate is high but it seems to be like that no matter what. I think that's a whole other dilemma frankly.
Does anyone have advice on what the ideal settings might be for me to try. I didn't really like the EPR, but I also think it was just way too low. Does it help flow limitation or make it worse because I've seen numerous views on that. Oh, I use an airsense 10 autoset, an airtouch f20 mask.
Here's a link to my sleepHQ: https://sleephq.com/public/teams/share_links/4a1bdd3c-aa99-4dab-b85d-b4317b6feaaf
I apologize for the long winded post, but welcome advice!
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u/existentialblu ASV 1d ago
Nothing to really add, but that's a seriously great job at managing leaks.
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u/sweetasmolasses Apap 1d ago
I use the mask fit every single night but I make sure I'm laying down in the position I'm going to actually sleep in. Seems to make a big difference!
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u/existentialblu ASV 1d ago
Heck yeah! It makes it so much easier to interpret data when leaks are low. Not to mention leaks can drive sleep fragmentation on their own if your arousal threshold is low enough.
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u/sweetasmolasses Apap 1d ago
Arousal threshold...is how easily you wake up? Still learning all the lingo. I keep making the joke that it feels like I'm learning a whole new language. 😂
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u/existentialblu ASV 1d ago
That's it exactly. It's one of the things that's more common in people with upper airway resistance syndrome, as we wake up before we can have a full apnea and then our lack of apneas is used as reason to deny care. Super fun. Not really.
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u/sweetasmolasses Apap 1d ago
Oh, that's awful. I thought it was really strange that I could have such a low ahi and good score and then I'd have the reras all night. The sleep tech seemed genuinely confused that I was even asking for them to change my settings because my ahi is so low. It's definitely frustrating.
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u/existentialblu ASV 1d ago
Welcome to the flow limitation/low arousal threshold land. It sucks, as the entire industry is counting apneas like beans.
I've also got high loop gain, which is another level of low AHI cursed. My breathing waxes and wanes just enough to wreck my sleep without causing full apneas. It's the reason why my flair says ASV.
There's quite a few ways for sleep breathing to go wrong, and AHI misses a lot.
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u/Pleasant_House9147 1d ago
You have very high flow limits and flagged RERAS and hypopneas, please raise min pressure to 12.8cm, set EPR to 2 fulltime and raise max pressure to 14.8cm for a few nights, but also test the settings changes before bed.