Newbie here looking for feedback and advice on hypertension

[kuk_sleeper]

Hi all,

I am 33 year old male diagnosed with mild OSA (AHI 10 event/hr). I have been using a Airsense Resmed 10 cpap for over 20 days now. I wanted to get some feedback on any improvements that I can make. I was suffering for high blood pressure. I was hoping cpap therapy would help reduce my BP but I checked it today and there is no change. I wanted to reach out to fellow cpap users on their experience with cpap therapy and blood pressure reduction.

Background
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I am 33 years old, BMI 27 which puts me in overweight but not obese category. I have been snoring and felt like I wasn't sleeping well for a long time. My blood pressure was on a upward climb and is now at 140/90.
My family used to complain that I sleep a lot. Most days I wanted to take a nap at noon. Some days I was tired and couldn't concentrate in the afternoon since I couldn't take a nap.

I went in for a sleep study (and a cpap titration study) ,got a result of 10 AHI and was recommended cpap with pressure 11.2 cm.

Sleep study result
------------------------------
AHI 10 events/hr
Arousal index 64.3 events/hr
Significant snoring
Oxygen desaturation noted, lowest being 90.0%
( No Central or Mixed Apnea seen)
OSA seen mostly in supine position
Recommend cpap with 11.2 cm pressure

ENT examined me and didn't see any issue that can be corrected with surgery. He mentioned that I have a small chin that might not hold my tongue during sleep.


Treatment
-------------
I rented a Resmed Airsense 10 system with a Bestfit full face mask (disposable) and I have been using it for past 10 days. I keep it on 4-20 pressure initially. Then I increased the minimum pressure to 5. I have average AHI of .74 (as seen in SleepyHead)

I do not see a sudden improvement . But I do notice that my need for a afternoon nap is (mostly) gone. One night I slept for only 4 hours with 0 AHI and felt great the next day. I know that cpap is helping me.

I was hoping that my blood pressure would come down. Today I took a measurement and it still at 140/100. I am currently between job and have no stress at all. I was bit disappointed that my BP didn't change all at. I still have to get my weight under control and start exercising (I haven't started medication for BP yet. I am trying to get it under control with lifestyle changes).

I wanted to reach out to the community to see if anyone (especially with mild OSA) had their BP reduced by cpap therapy?

Also I wanted to get some feedback on my Cpap usage. I will be posting some graphs from sleepyhead.

Edit
A few people asked about my BP and why i am not on meds. My BP has been climbing and now is at 140/90. I was put on a ambulatory machine (which measures BP over 24 hour period) and the doc who saw the result said it was ok. But the reading I have been taking at home and reading at doctor's office has been slowly approaching 140/90. The sleep study wasn't recommended by a doctor. I consulted a sleep specialist out of my own interest, due to my disturbed sleep and due to my hypertension.

[Julie]

Have you made an effort to not sleep on your back? It looks to me like you might not even need Cpap if you were able to do that for most of the night - there are ways to train yourself even when you're asleep. Snoring doesn't necessarily mean you have apnea and vice versa, and can often be addressed in other ways.

[kuk_sleeper]

https://imgur.com/a/0Rq4V

[kuk_sleeper]

Have you made an effort to not sleep on your back? It looks to me like you might not even need Cpap if you were able to do that for most of the night - there are ways to train yourself even when you're asleep. Snoring doesn't necessarily mean you have apnea and vice versa, and can often be addressed in other ways.

I haven't. I have heard of the "ball stitched to your shirt" technique etc but haven't tried it. Frankly I am ok with using CPAP even it helps me a little bit. Also I suspect my OSA is worse that what my sleep study suggests since I slept very well in my sleep study. It was a dreamless deep sleep from 10 to 3:30 am which I normally do not get unless I am very tired.

[Pugsy]

While using cpap effectively will sometimes reduce blood pressure readings that's really when the sleep apnea alone is the cause of the hypertension.
Unfortunately there are a lot of other causes for hypertension out there and the best cpap therapy in the world won't necessarily fix it.
I speak from experience..over 8 years on cpap and its very effective for the sleep apnea stuff but it hasn't done one thing for my blood pressure.
I still need blood pressure medication.

You probably should be talking with your doctor about your options and what he feels is necessary in your situation.
He might be good with giving cpap a little more time to see if that blood pressure comes down or not..
While some cpap related improvements are rather sudden and come about seemingly overnight...most don't for the bulk of us.
Those people who see immediate improvements in anything are actually in the minority.

So for some people cpap and treating their OSA have seen dramatic drops in blood pressures rather quickly....others it takes some time and for others like myself...no luck and I still have to take BP meds.

You need to be having a chat with your doctor about your options.

[kuk_sleeper]

Thank you for the reply Pugsy. I have posted the sleepyhead graphs. Can you take a quick look to see if anything stands out?

[chunkyfrog]

It appears that your Autoset is not set.
The default range of 5-20 is less than therapeutic, to say the very least.
Is this your own machine or a loaner?

[kuk_sleeper]

W.r.t my BP I guess I was hoping to get it reduced without putting in the hard work (Diet changes, exercise) I guess I have to do the hard way.


One thing I am noticing with Cpap is that I am waking up around 3-4 times during the night. Sometimes I feel like taking off the mask, but I do put it back on quickly.

[kuk_sleeper]

It appears that your Autoset is not set.
The default range of 5-20 is less than therapeutic, to say the very least.
Is this your own machine or a loaner?

The machine is a rental. I just checked the clinical menu and it say mode is "Autoset" with minimum pressure 5 and max pressure 20 under the heading "Therapy". That is how you set Autoset , isn't it?

[Pugsy]

The only thing that really stands out to me on the SleepyHead reports is maybe the Flow Limitation graph. It's a bit "busy" for lack of a better word.
Most likely it is the flow limitations that is driving the pressures all over the place since FLs are part of what the auto adjusting algorithm is designed to fight.
While there is no urgent need to increase that minimum pressure I would do it if it were me just to stabilize the pressure somewhat.
Those big of changes could be impacting sleep quality and might be responsible for some of the wake ups. It's a maybe and worth doing IMHO.
The machine wants to go higher and seems to want to average around 9ish. I would try a minimum of 8 if it is comfortable for you and not change anything else and see if the FL graph calms down a bit and the pressure changes/range calms down a bit.
It isn't an urgent thing based on AHI but it's just a bit of tweaking that I would do if this were my report.

I don't think that the FLs are the culprit for the hypertension....but hey, maybe I am wrong and I would be most happy if I were.
I think that you are most likely going to have to do the hard work you want to avoid to get that BP down. Trust me...been there and done that and I so wished that cpap would do the work for me but it didn't.

To give you an idea what I am talking about with the FL graph...here's mine...now look at yours.
Unless we can blame your FLs on nasal congestion issues...if it were me I would increase that minimum and try to clean up the FL graph a bit.
Will it help the wake ups and reduce the pressure variations or impact BP...don't know but worth trying.

[Pugsy]

I think ChunkyFrog meant that the AutoSet wasn't really "set" to a specific range because it is 5 min with max of 20 and that's pretty much wide open factory defaults. They actually did raise the minimum from 4 (factory default) to 5 but that's still pretty much wide open.

Once you go up to around 9 ish the machine doesn't ever really want to come down to 5 again for very long.
Might as well just start at where it wants to be anyway...and sometimes when the machine doesn't need to move around so much that maximum will reduce. Worth trying.

[kuk_sleeper]

The only thing that really stands out to me on the SleepyHead reports is maybe the Flow Limitation graph. It's a bit "busy" for lack of a better word.
Most likely it is the flow limitations that is driving the pressures all over the place since FLs are part of what the auto adjusting algorithm is designed to fight.
While there is no urgent need to increase that minimum pressure I would do it if it were me just to stabilize the pressure somewhat.
Those big of changes could be impacting sleep quality and might be responsible for some of the wake ups. It's a maybe and worth doing IMHO.
The machine wants to go higher and seems to want to average around 9ish. I would try a minimum of 8 if it is comfortable for you and not change anything else and see if the FL graph calms down a bit and the pressure changes/range calms down a bit.
It isn't an urgent thing based on AHI but it's just a bit of tweaking that I would do if this were my report.

I don't think that the FLs are the culprit for the hypertension....but hey, maybe I am wrong and I would be most happy if I were.
I think that you are most likely going to have to do the hard work you want to avoid to get that BP down. Trust me...been there and done that and I so wished that cpap would do the work for me but it didn't.

To give you an idea what I am talking about with the FL graph...here's mine...now look at yours.
Unless we can blame your FLs on nasal congestion issues...if it were me I would increase that minimum and try to clean up the FL graph a bit.
Will it help the wake ups and reduce the pressure variations or impact BP...don't know but worth trying.

I increased my minimum to 5 since I felt like I wasn't getting enough air to breath while the pressure was 4. I will increase the pressure to 8 and try. I haven't had nasal congestion for past few days so I dont think that is the reason for FL fluctuation.

I will report back tomorrow with the results.

[Julie]

I'd increase to at least 6 or 7 for a few nights and then see how things look... 5 is still so low.

[kuk_sleeper]

Hi Julie, Pugsy,

I set the minimum pressure to 8 yesterday. The FL graph is still "busy". I had a sore throat yesterday and I woke up a few times during the night. I will experiment with minimum pressure for a few nights and report back.

Yesterdays FL graph can be seen at https://imgur.com/a/sDIf6

[Jas_williams]

Don’t change anything leave settings as they are you had no OA events and no H events only a couple of CA’s which we can ignore. Those are great numbers.



Jason