Am I Doing This Right? CPAP Settings

Hi, firstly thanks to all on CPAPTalk forum as I found this to be a really helpful resource in coming to terms with apnea.

Subsequent to a home sleep study (and being diagnosed with moderate apnea AHI 16.4), I was given a loaner machine (DeVilbiss Intellipap 2) with a nasal pillow mask (Aloha, I think) for just 3 days. While the Intellipap reports a much reduced AHI (5.5, CA = 1.5), I didn't feel any marked increase in sleep quality and in fact was slightly more tired than usual (except on Night #3). Pressure setting was set at 4.0-12.0, with me waking up at least once each night due to suffocation paranoia.

I eventually reached out to a ResMed distributor and arranged for a 10-day trial, and would like to hear from you guys if there are any significant issues or concerns looking at my SleepyHead report from my first night (yesterday/this morning). I've set the pressure at 7.0-16.0. Felt more refreshed in the morning, but woke up once in the night taking about an hour to get back to bed. Am on the AirSense S10 Autoset for Her with a Swift FX mask for context.



Let me know if there are additional information that may be useful!

Regards.

Hi

newguyla wrote:.... Pressure setting was set at 4.0-12.0, with me waking up at least once each night due to suffocation paranoia.

Hi newguyla, Welcome... And yes, it is a fun place here.

I am no guru here and mostly like reading to learn things. Any beginning is tough, real tough for most. The changes are overwhelming and often the negative secondary effects are noticed before the positive ones.

Regarding the settings, AHI went from 16 without CPAP to below 6 with, which is already pretty good.

Improvement will come as others here will jump in and give you the right advices.

The trick is to set the Min pressure just a little below of what you need. What you need is a pressure at which obstructive apnea no longer appear. For some people when OA are taken care of, they change into CA's. The CA may improve with time as you need to get used to your machine. Some people would say you need to put your heart in it. Well I havent managed this yet. I only got as fare as to get my nose and mouth stuck to it.

There is one more thing to be aware off, in very rare cases the CPAP positive air pressure can push the epiglottis backward and create a complete seal that cannot be relieved by higher pressure and make you choke. If this is the case CPAP will not work.

Do you have your 'Results' from your study? You seem to have mostly central events vs obstructives and all the pressure settings on that machine won't help as a different type of machine is needed to address the centrals... your machine won't do that. Other more knowledgable people will get into more detail with you here, but as it stands now, you need to get your full report from your MD and let us know about it - you're not getting any useful therapy as things are now.

Julie wrote:Do you have your 'Results' from your study? You seem to have mostly central events vs obstructives and all the pressure settings on that machine won't help as a different type of machine is needed to address the centrals... your machine won't do that. Other more knowledgable people will get into more detail with you here, but as it stands now, you need to get your full report from your MD and let us know about it - you're not getting any useful therapy as things are now.

I don't agree that a different machine is needed. The total AHI is very low...the CAs are scattered and are...as Pugsy would say..."Sleep/awake junk."

LSAT wrote:

Julie wrote:Do you have your 'Results' from your study? You seem to have mostly central events vs obstructives and all the pressure settings on that machine won't help as a different type of machine is needed to address the centrals... your machine won't do that. Other more knowledgable people will get into more detail with you here, but as it stands now, you need to get your full report from your MD and let us know about it - you're not getting any useful therapy as things are now.

I don't agree that a different machine is needed. The total AHI is very low...the CAs are scattered and are...as Pugsy would say..."Sleep/awake junk."

I agree with LSAT, no need for a different machine based on this data.

newguyla,

The one night of data that you posted is pretty good: Usage is over 7 hours. AHI is very low. (And those few CAs are nothing to worry about.)

The leak line is a bit ragged, but stays below the Resmed definition of Large Leak (24 L/min). You might be doing a bit of minor mouth breathing, particularly late in the night where the leaks are more ragged and a bit higher. Not enough to worry about, but enough to keep an eye on.

The biggest thing I'd tell you is to be patient: You may not notice much improvement in how you feel during the daytime for a few weeks or a month or two. So it's important to not get discouraged if you have some days where you are still tired or sleepy.

Here's the deal about the Pie Chart showing almost all centrals...it's a whole pie but your AHI was only 1.93.
It's not like you had a gazillion centrals...if you only had one event the entire night and that one event was a central the entire PieChart would show central. So while it may initially look a bit scary seeing the pie chart almost totally central...it doesn't mean that your problem is all central and you need a different machine.

I suspect some of those centrals are probably Sleep/Wake/Junk (SWJ) centrals flagged when the machine mistakes awake breathing irregularities as some sort of apnea event. Especially those seen flagged near known awake times like the break in therapy time. At any rate even if all those centrals flagged were real there's not enough of them to warrant a different machine at this time nor enough to do much worrying about.

I agree with RobySue...give it a bit of time. I know we all would like to see the immediate "miracle" where we wake up and feel like superman or superwoman but most people don't get that miracle...I didn't. I just knew I would but I didn't.

If you are waking often during the night...that will mess with our daytime energy levels because the awakenings mess with sleep cycle architecture. Work on trying to figure out what might be causing the awakenings (if you are having very many).
The pressure settings appear to be working well for you....I don't see any need to change the pressures at this time.

I'm just trying to get my AHI down to something reasonable, like 7. Now doesn't that put things more in perspective?

Wow, thanks for the awesome advice and encouragement guys! It's almost bedtime here (SE Asia), will stick to the same settings and see how the night goes!