New to CPAP – Requesting Some Guidance

Hi all! I'm hoping to get some guidance from you to improve my treatment with CPAP.

I am a 30 year old male with a normal BMI that has been extremely tired for over a decade. I had a sleep study back in 2016, and though the doctor didn’t mention it, the report shows a potential UARS diagnosis (RDI > 5).

As I kept getting more tired with each passing year, I decided to try another sleep study using a WatchPAT ONE in 2023. My diagnosis came back as mild OSA based on a pRDI of 9.4 and O2 nadir of 91%. My overall AHI was 3.4. Both of these are a little bit higher than my sleep study in 2016.

I was prescribed CPAP therapy and received a ResMed AirSense 11 Autoset a little while back. It arrived with a minimum pressure of 4 cmH20, maximum of 20 cmH20, and EPR of 1. It is hard for me to see much of a difference yet, though I see some encouraging signs starting to emerge (like not feeling terrible following a nap after work).

I recently put an SD card in my CPAP machine and was hoping to get some recommendations based on my OSCAR data. I’ve been reading a lot of threads on this forum, and am not really sure which category I fall into (mild OSA, UARS, something else) and what adjustments I should make to improve my fatigue.

I uploaded a recent nightly overview from OSCAR below (I also uploaded them here). I also attached a zoomed in view that seemed to be from a calmer time and one where a clear airway was detected. This seems to be one of the “smoother” looking nights with the best metrics. It has been normal over the past year for me to get up a couple of times per night (and it started prior to CPAP therapy), though I didn’t always wake up quite as much during the night.

Are there any setting adjustments you might recommend going forward? The only adjustment I have made thus far is adjusting the EPR to 3 a couple of nights ago. I can’t tell whether that made much of a difference yet.

Thank you!

I have to say off the top that I am not really sure you need or will benefit from an APAP. But, since you have one, you could try these settings to see if it can be made more comfortable and possibly helpful.

Minimum Pressure at 6 cm Maximum Pressure at 7 cm Ramp Start pressure at 6 cm

I would leave the rest of the settings the same including EPR at 3 cm. These settings will reduce the pressure you are getting, and more does not appear to be needed as your main component are CA or central events where pressure is of no benefit in preventing. In fact higher pressure can cause CA events. CA events can also be restless sleep.

This is quite a low maximum pressure, but unless you start to see obstructive events showing up, there is no need for a higher pressure. Are there nights when pressure goes higher than the 8.6 cm for this night? Since it is an AirSense 11 it should have the option of the "For Her" mode. You may want to try that mode to see if makes any difference. But, don't change it at the same time as the pressure settings suggested above. You need a few nights with those settings first to get a baseline.

Thank you very much for your reply! I will try the new settings that you recommended.

Regarding the maximum pressure, I did see that on some nights the pressure has hit as high as 10, but it seems to be for a very short duration.