New user intro, looking for Sleepyhead feedback + Progress!

[kasmca]

EDIT: I will be using this thread to document my progress as I work to optimize my settings as a new user based on assistance from this forum.

Hi there,

This is my intro post. I am a 44 year old male who's been snoring and gasping for air in my sleep for years, but never looked after it. I finally did a sleep study at the hospital last Nov 2016 and got my follow up appointment with a Respirologist in early Jan 2016. My AHI was 49.1. I slept 50% on my back and 50% on my side. On my back my AHI was 74.5 and on my side was 23.5. SaO2 is above 90%, 91.8% of the time. The remaining 8.2% was between 80-89%. As a result I was prescribed an APAP machine.

I acquire my machine last Thursday. I decided to go for the Resmed Airsense 10 Autosense for Her. Same as the regular one but with an extra "for her" setting. I figure I can try that mode in the future to see if it works better for me. I also got a Climateline Air heated tube. For the mask I was looking at the P10, DreamWear, N20, ESON, Swift FX and Wisp. Also after much research on this board and trying them some out, I decided on a Dreamwear mask. I don't breath through my mouth and I wanted to minimize the footprint (faceprint?).

I have been using the machine for 4 days. My numbers were surprisingly excellent with high My Air Scores (only lost points due to taking off the mask), low AHI and minimal leaks. See below:
- Jan 19 - AHI: 1.45, MyAir: 95 (sleepyhead screenshot)
- Jan 20 - AHI: 1.67, MyAir: 98 (sleephead screenshot)
- Jan 21 - AHI: 0.95, MyAir: 100 (sleephead screenshot)
- Jan 22 - AHI: 3.53, MyAir: 100 (sleephead screenshot)

The problem I am having with the Dreamwear mask is that I wake up much more tired that before using APAP therapy. I believe this is primarily because I am waking up constantly throughout the night. I have always started off sleep on my back. Everytime I shift to my side, I think the Dreamwear mask moves and causes a small leak, waking me, and I readjust and then sleep on my back again.

I have a fitness tracker that also tracks my sleep. Prior to therapy, I would usually get more than 50% restful sleep and a bit less than 50% light sleep. Since therapy, I am only getting about 25% restful sleep.

If you look at my sleephead stats (links above), you would say that APAP therapy is a great success for me, but in reality, I'm not getting as restful a sleep and I feel tired and more irritable during the day.

I am looking for suggestions for the experienced members of the forum. I am considering switching to the P10 mask to give that a shot. I have a 14 day exchange policy on the mask. I know that most likely I will just need patience to get used to therapy, but any helpful tips are greatly appreciated.

Also, I have noticed that I am sitting near the top of my 5-10 cmH2O prescription for much of the night. Does this suggest that I would benefit from increasing my dosage?

Thank you so much, if you have made it all the way to the end of this post. This looks like a great community and I look forward to participating going forwards! Thank you all for your support.

[LSAT]

I think I would increase your pressures to 7/15....It may not reduce your AHI much, but it may stop the wake ups from the pressure variations.

[Pugsy]

Fragmented sleep for any reason is going to trash sleep quality and thus we feel like crap during the day no matter how good the AHI might be.
Do you take any medications of any kind? If so what? Make sure that medication side effects aren't potentially making the situation worse.

You do hit the max of 10 but don't really spend a large amount of time there.
There does appear to be a lot of pressure variations going on and for some people pressures changing like that can impact sleep quality. Not everyone is bothered but it's not all that uncommon either.

Seems like once you get to sleep and the pressure increases you spend a good bit of time at 8 cm or above.
If it were me I would increase the minimum to 8 or 9 cm and maybe raise the max to 11.
See if limiting the pressure changes seems to help with the wake ups or not.
If you can't comfortably make the jump from starting out at 8 or 9 from the 5 immediately then try going up in smaller increments or make use of the ramp for a short period of time.

This is all that I see...the pressure changes as maybe being a factor in causing the wake ups.
Of course other things can cause wake ups too and if you know for sure the cause then of course do what you can to address the cause.
I don't know if a different mask will help or not. If you are waking often fiddling with the mask for some reason the obviously it is worth considering.

Did you wake often prior to cpap therapy or is it worse now that you are on cpap?

[OkyDoky]

I remember when I first started, I had frequent semiconscious mask adjustments because of leaks or just because it was different. You have leaks very well controlled. Many would envy your leak graph.

I also think the 8 min and 11 max without ramp would be good to try. Since your events are low, if you have difficulty breathing out you could increase your EPR to 3cm. At 8cm that would lower your expiration pressure to 5cm.

Nothing wrong with using ramp for a short time if needed but many have found it is not needed or are more comfortable at a 6-8 starting pressure than 4cm.

[Woodup]

I used the Dreamwear for about the first 15 months of therapy, and I found the tube frame stretched over time. Fortunately I had purchased the variety size pack, and was able to experiment with different frame and pillow sizes. I ended up a frame size lower than initially (from large to med.) in order to limit the leaks over time. It was a bit tight in the beginning, so I just loosened the headgear straps. As the frame loosened over time, I just tightened the straps.

A note regarding increasing your max. pressure above 14 cm should you decide to do so. Be sure to monitor the number of CA's (Clear Airway or Central Apneas) that occur afterward. A CA count 50% or greater of the total AHI, or greater than 5 CA's per hour indicates treatment-emergent complex (central) apnea. A very small percentage of CPAP users develop this while on therapy, typically at max. pressures 14 cm or greater, so it's nothing to be concerned about at this point - just something to be aware of. I have treatment-emergent complex apnea, and have become familiar with the issue and studies related to its onset.

Importantly, keep your sleep doctor in the loop and post data from the new settings for others' feedback - you won't regret it. The people here are awesome!

[Pugsy]

Central apneas caused by cpap pressure isn't limited to higher pressures. It can happen at 6 cm just as easily as at over 10 cm or over 14 or whatever.
While sometimes people do have centrals caused by cpap pressure that can be reduce simply by lowering the pressure a bit...it doesn't always work out that way. I have seen people get cpap induced centrals at 5 or 6 cm too.

If someone is maybe wanting to test the theory that the pressure changes themselves I don't think opening up the potential range is necessarily the way to go...hence the idea to maybe limit the max to 11 or so.

[LSAT]

A note regarding increasing your max. pressure above 14 cm should you decide to do so. Be sure to monitor the number of CA's (Clear Airway or Central Apneas) that occur afterward. A CA count 50% or greater of the total AHI, or greater than 5 CA's per hour indicates

• treatment-emergent complex (central) apnea

. A very small percentage of CPAP users develop this while on therapy, typically at max. pressures 14 cm or greater, so it's nothing to be concerned about at this point - just something to be aware of. I have treatment-emergent complex apnea, and have become familiar with the issue and studies related to its onset.

SO, You are saying...If a person has nights with AHI of 2.0-3,0 and 50% of the events are CAs, they have Central Apnea? That's BS.

[kasmca]

Thanks for all the replies.

I am not on any medication.

I just exchanged my DreamWear for an Airfit P10 this morning. I've tested it out a bit and I think it will work better for me. I'll let you know in a few days if it works out. I want to limit any changes to one at a time, perhaps one every 4-5 days, especially since I have been getting great AHI's and low leaks.

Based on your feedback, here are some things I will be trying out to see if it will reduce my night wakings. Of course the first change is switching to the P10. I needed to do this first as there is a time limit due to the exchange policy from my supplier.:
- Bumping up my cm H20 up to 7-11
- Disabling the ramp up time
- Bumping up the EPR from 2 to 3
- Trying the 'for her' algorithm to see if it is indeed gentler.

Thanks again, I will keep you updated.

[Pugsy]

Good plan. Keep your variables to a minimum so you can better evaluate any changes you experience.
There's no rush to go changing everything right this minute.
Good luck with the P10. Sometimes better sleep quality is just a matter of a different mask. I know there were some masks out there that I tried that got trashed real because I just couldn't get where I could sleep well with them for any number of reasons.
One only lasted 90 minutes.
That said...I am trying a new mask tonight. Not because I am particularly unhappy with the P10 but because it's brand newly released and you never know it might work out even better and I don't get to experiment very often. For me it's kinda fun to experiment just because I am bored.

[Woodup]

A note regarding increasing your max. pressure above 14 cm should you decide to do so. Be sure to monitor the number of CA's (Clear Airway or Central Apneas) that occur afterward. A CA count 50% or greater of the total AHI, or greater than 5 CA's per hour indicates

• treatment-emergent complex (central) apnea

. A very small percentage of CPAP users develop this while on therapy, typically at max. pressures 14 cm or greater, so it's nothing to be concerned about at this point - just something to be aware of. I have treatment-emergent complex apnea, and have become familiar with the issue and studies related to its onset.

SO, You are saying...If a person has nights with AHI of 2.0-3,0 and 50% of the events are CAs, they have Central Apnea? That's BS.

Thanks for pointing out my bs.

My insurer's definition (if it isn't recognized, it's statistically insignificant): http://www.carecentrix.com/ProviderReso ... Policy.pdf

In the future I'll avoid posting or just link to medical source docs, studies, etc. and avoid any potential non-medical degreed interpretation. Are you a sleep doctor, perhaps? I'm looking for a good one and you don't seem to be too far away. If not, could you refer me to a good one who might post here frequently?

[kasmca]

Hi there,

I wanted to provide an update. I have been using the Airfit P10 nasal pillow mask for the last 4 nights. Here are my Sleepyhead screen shots:
- P10 Jan 24 AHI:2.01 (sleepyhead screenshot)
- P10 Jan 25 AHI:3.76 (sleepyhead screenshot)
- P10 Jan 26 AHI:3.35 (sleepyhead screenshot)
- P10 Jan 27 AHI:3.53 (sleepyhead screenshot)

The AHI scores are consistently higher than from when I was using the Dreamwear mask (see first post) averaging 3.16 compared to 1.90, but I am feeling like I am sleeping better as the mask isn't waking me as much when I shift from sleeping on my back to side. My AHI numbers may be lower with the Dreamwear simply because I wasn't getting a restful sleep by waking up so much causing me to have less events. Can't have an Obstructive Apnea if you are semi-awake.

I think I may try to work with the P10 and try to get the AHI numbers down by some of the suggestions above.

[Jay Aitchsee]

Your charts aren't looking too bad. I see you've got that P10 leak pretty much under control, judging by your last chart.

Most of your events are OA and should respond to a little increase in pressure. It appears (without studying in great detail), many of your events occur after the pressure has returned toward the minimum. You mentioned in a post above raising the pressures to 5 and 11. I think you should continue with that, giving some consideration to raising the minimum even further, say to around 6 or 7. You are hitting your max of 10 now so increasing the max a little could help too.

The disadvantage to raising the pressure, in my opinion, is largely one of comfort and disturbance. If you raise the pressure and feel that you aren't sleeping as well, or CA's increase, then a smaller increase might be warranted.

Edit: In rereading your posts, I see you said you were going to raise the pressure to 7 and 11, not 5 and 11. I'm not sure where I read the 5. In any event, I think you should proceed with that as many of the replies above have also suggested.

[palerider]

A note regarding increasing your max. pressure above 14 cm should you decide to do so. Be sure to monitor the number of CA's (Clear Airway or Central Apneas) that occur afterward. A CA count 50% or greater of the total AHI, or greater than 5 CA's per hour indicates

• treatment-emergent complex (central) apnea

. A very small percentage of CPAP users develop this while on therapy, typically at max. pressures 14 cm or greater, so it's nothing to be concerned about at this point - just something to be aware of. I have treatment-emergent complex apnea, and have become familiar with the issue and studies related to its onset.

SO, You are saying...If a person has nights with AHI of 2.0-3,0 and 50% of the events are CAs, they have Central Apnea? That's BS.

Thanks for pointing out my bs.

My insurer's definition (if it isn't recognized, it's statistically insignificant): http://www.carecentrix.com/ProviderReso ... Policy.pdf

In the future I'll avoid posting or just link to medical source docs, studies, etc. and avoid any potential non-medical degreed interpretation. Are you a sleep doctor, perhaps? I'm looking for a good one and you don't seem to be too far away. If not, could you refer me to a good one who might post here frequently?

you quoted a broad statement, and lsat pointed out the flaws in it.

as he said, if your ahi is 2, and 50% of that is CAs, then the CAI is 1, and ... well... no rational person would say that someone with a CAI of 1 suffers from central apena problems. just because some insurance company draws a line in the sand and makes a statement doesn't make it legit, or rational, or useful. just like the "AHI5 or less is good enough" is crap. AHI5 means a disturbance every 12 minutes, all night long, no way to get rested with that shit.

but that's what you get quoting insurance guidelines.

[kasmca]

Thanks Jay

I will be increasing my pressure to 7-11 tonight and will post back after a few days of data.

[kasmca]

I just wanted post an update and get some feedback on how I can lower my AHI's. I have turned off the ramp since my last update. I have also been using the Airfit P10 since Feb 2. I have changed my pressure from 5-10 to 6-11 cm H2O for 19 days now. I think it is better as my 95% sits near the top. I may need to bump up to 7-12. My AHI's are unfortunately trending worse. Last night was 5.96, last week avg 4.04 and last 30 days was 3.23. Leak rates are also averaging worse. Here are some Sleepyhead screenshots:

- overview and trending
- Feb 15, 2017 - AHI:5.96
- Feb 14, 2017 - AHI:3.92
- Feb 13, 2017 - AHI:4.90
- Feb 12, 2017 - AHI:3.65
- Feb 11, 2017 - AHI:3.44
- Feb 10, 2017 - AHI:3.26
- Feb 9, 2017 - AHI:3.01
- Feb 8, 2017 - AHI:4.31
- Feb 7, 2017 - AHI:3.33
- Feb 6, 2017 - AHI:5.58

Things I have yet to try out:
- Changing EPR settings - currently set to 2
- Try the Autoset for Her algorythm

Any feedback is appreciated. Thanks!