My First 12 Days of APAP: Settings Advice?

Hi everyone,

I have just completed my first 12 nights of using my S9 Autoset device and would appreciate some feedback. Here is the link to my SleepyHead Charts:
http://imgur.com/a/pLzuW

and my original sleep test:
https://www.dropbox.com/sh/mdcubyrmb50l ... KfFBa?dl=0

Here are some notes:
-There is one day missing (forgot to install the SD card), but I was compliant
-Original pressure settings were 6-16cm, but I changed them to 8-15cm based on my charts. I've now read the "dial a winging" is a foolish practice, so I've come to the forum for better advice.
-The machine originally was set up for a 10 minute ramp and EPR (2cm), but I've disabled both functions as I am comfortable without them
-The climate control is set for automatic, and the temperature is now at 80 degrees Fahrenheit

The Good News:
-My AHI numbers are normally <2.0
-I have been 100% compliant. I tolerate the mask and the pressure well and using the machine has not been a hassle.
-My partner can now sleep without earplugs
-My leak rates seem to be low

No So Good News:
-I sometimes exhale through my mouth. My partner confirmed this and I sometimes notice this when I wake up during sleep. My lips were also chapped this morning. I will look into purchasing a chin strap or try the tape method to see if that helps. Can anyone confirm potential mouth breathing from my SleepyHead charts?
-I am more aware of waking up during the night as I change sleep positions, whereas before APAP I would feel as if I slept all through the night. I normally cycle between left side, back, right side, back, left side, etc.
-I feel tired. Although my AHI scores are low, I don't really notice any difference between my energy levels before and after therapy. If anything, I feel slightly more lethargic since using APAP. I realise that only 11 days of use is still way too early in the game before I may begin noticing improvements in my energy levels.

I have undergone a sleep test (AHI 96 supine, AHI 40 on side) and plan on going in for an overnight titration test in a couple of weeks/months once my budget allows (I live in South Korea, where sleep apnea is not covered under insurance). The sleep test was the absolute worst night of sleep I've had in my life because I couldn't really sleep on my sides due to all of the wires and monitoring sensors, and the technician kept waking me up multiple times during the night to reattach wires to my face. I therefore think that my sleep test was not indicative of a typical night of sleep that I would experience in my own bed. That's also why I am a little leery of going in for a titration test ($600 out of pocket) where the prescribed CPAP pressure may not be best reflect my real-life sleeping habits.

Based on my data, should I make any changes to the pressure settings on my device? Any other advice or feedback is certainly appreciated as well.

Thanks!

Ansan,

It's past my bedtime, but I didn't want to leave your message completely unanswered. However, I am going to have to leave a detailed explanation of your data for later.

However, there are some things that I do want to address now:

Ansan wrote: -I am more aware of waking up during the night as I change sleep positions, whereas before APAP I would feel as if I slept all through the night. I normally cycle between left side, back, right side, back, left side, etc.

You are still learning how to sleep with the CPAP. In time you will learn how to turn over in bed without waking all he way up. Right now you're still learning how to turn without getting tangled in the hose and without moving in such a way as to cause the mask to shift. It takes time to learn how to do this without thinking about it, but most of us learn to do this within the first several weeks or couple of months of therapy.

-I feel tired. Although my AHI scores are low, I don't really notice any difference between my energy levels before and after therapy. If anything, I feel slightly more lethargic since using APAP. I realise that only 11 days of use is still way too early in the game before I may begin noticing improvements in my energy levels.

Again, it's a process. Some people around here also believe that there's such a thing as a "sleep deficit" and that when you first start sleeping well with therapy, you can wind up feeling like you need even more sleep. Or not. And then there are a few folks (like me) who wind up having a whole lot of problems learning how to sleep well with the equipment, and some of us feel much worse for a while before we start to feel better.

It's also worth knowing that sometimes the first signs of improvement are pretty subtle. Keeping a journal of how you feel sometimes helps you pick up those subtle signs that things are beginning to turn around.

I have undergone a sleep test (AHI 96 supine, AHI 40 on side) and plan on going in for an overnight titration test in a couple of weeks/months once my budget allows (I live in South Korea, where sleep apnea is not covered under insurance). The sleep test was the absolute worst night of sleep I've had in my life because I couldn't really sleep on my sides due to all of the wires and monitoring sensors, and the technician kept waking me up multiple times during the night to reattach wires to my face. I therefore think that my sleep test was not indicative of a typical night of sleep that I would experience in my own bed. That's also why I am a little leery of going in for a titration test ($600 out of pocket) where the prescribed CPAP pressure may not be best reflect my real-life sleeping habits.

Two notes:

1) Even though you don't think the night in the sleep lab is very typical, you need to understand that an AHI = 40 on your sides indicates that even on a good night in your own bed you've got OSA and that it's likely severe OSA (as in a untreated AHI > 30).

2) The fact that you're leary of spending $$$ on the titration test is understandable. The fact that you've got an APAP means that you probably can afford to NOT get the titration study done: In the US a number of the biggest HMOs are now routinely doing the titration for newly diagnosed OSA patients by giving them APAPs set wide open at 4-20cm for one to two weeks and checking the data recorded at the end of the titration period. The final pressure recommendation is usually based on the machine's 90% or 95% pressure setting. If the patient is to keep the APAP, then usually the pressure range is tightened up so that the min and max pressure settings are within 2-3 cm of the 90%/95% pressure level. If the patient is to be switched to a straight CPAP, usually the pressure is set to the 90%/95% pressure setting. Since the titration study would also be out of pocket for you, I'd strongly suggest that you just keep delaying getting it and see if you can convince the doc to just use the APAP data to tweak the pressure settings after another week or so.

Based on my data, should I make any changes to the pressure settings on my device?

Once you have 14 days of data, it makes some sense to look at the 95% pressure range and then tighten the APAP range appropriately.

Robysue, thanks for the great info. I am almost at the 14 day point, so that might be a good time to evaluate things and tweak my settings. I have gone ahead and ordered the Respironics Premium chinstrap off of Ebay and it should be arriving in Korea sometime late next week. My most recent SleepyHead results from last night showed some major leaks and I am wondering if that was coming from the nasal mask or from excess mouth breathing. I still inhale through my nose, but sometimes exhale through my mouth or make a fluttering sound with my lips.

I would like to try the chinstrap and perhaps tape solution before switching over to a full-face mask. In the meantime, I will keep updating the LMGUR photo albums with my SleepyHead charts. Thanks again for helping me out.