holden4th

If your OSA is truly moderate then a CPAP setting of 18 does not make sense an. My diagnosis was severe (AHI of 60 untreated) and was recommended a setting of 13.

Some questions:

What machine do you have? Is it an Auto or a set pressure? What mask are you using? Are you a mouth breather? Do you use a chin strap or a soft cervical collar?

As you said you fall asleep quickly then ramp should be off.

Your AHI is great but your SPO2 levels are not good! The one thing I can't understand is the 75% average saturation - it has to be a typo as this figure is approaching hypoxemia and it doesn't agree with the rest of the figures. I would get this looked at right away as it might be an initial indicator of something going wrong. Your wide HR range is also not normal. Logic suggests that if your SPO2 dropped significantly then your HR might increase to try and cope.

Let's put your results into perspective.

An AHI of less than 5 is considered as normal (though it really isn't) but it's the magic number that sleep specialists quote when considering whether or not OSA is being successfully treated. However, I know that I can feel the difference between a <1.0 night and a 5.0 when I get up in the morning. Between 5 and 15 is considered 'mild' sleep apnea but it's still apnea and will have an affect. from 15 to 30 is 'moderate' and would definitely require some form of intervention, the best of which is PAP. Moderate sleep apnea will definitely affect your daytime fatigue levels and will also impact on your health in the long run. Anything above 30 is severe and is quite debilitating. The only problem is you don't realise how bad it has been affecting you until you treat it and I'm talking from personal experience here

SPO2 levels should also be looked at seriously as they are the immediate 'effect' of OSA. Lowered oxygen levels in your blood directly impact your major organs, especially the brain and nervous system. Levels of between 96 - 98 are considered to be optimal. Anything below 94 is impacting on your bodily systems. Below 90 and it's serious and is usually seen in people with respiratory disorders (emphysema, COPD) and OSA sufferers.

Finally, your libido, and I'll go out on a limb here but I am fairly sure I'd be correct. One of the biggest issues for many with OSA is their mental state. This includes depression, poor decision making, adverse reactions to minor incidents etc. I know because this is what I was like before treatment but didn't realise it. There is a lot of research into the physiological and psychological factors that affect libido and poor sleep is well up there as a negative factor. It is pertinent that you, yourself have included it in this discussion and you are correct in doing so. If you treat your OSA your libido might get back to its normal levels.

So to sum up your situation: You have been diagnosed with moderate sleep apnea and this should be treated. As a result of your poor sleep your SPO2 levels drop at times to 90 which is below what is required for your body to effectively rejuvenate itself overnight. This leaves you with two options:

Denial (which is the state you seem to be in at the moment) or

Proactivity - accept that there is a problem and work to solve it.

Taking the latter approach has revolutionised my life.

Best wishes.

The advantage of BiPAP/BiLevel is a lower exhalation pressure and for people with COPD or similar this makes therapy much more comfortable. I use a BiLevel machine for my therapy even though I don't have any respiratory issues. What it does for me is make xPAP therapy a better experience. Yes, I happily worked with APAP but BiLevel feels better and it has also lowered my AHI numbers.