Three days in and some questions

[Asld]

Hi Everyone,

I am three days into using my CPAP machine and have some questions.

Background:
I did a sleep study and was called back for an urgent next day appointment by the doctor two weeks after my results were reviewed.
Some key numbers and information which may be helpful but there may be some other ones that are relevant:
- Age - 36
- BMI - 27
Sleep study results:
- AHI = 65
- Oxygen levels = 80%
- Mean AHI event = 21 seconds
- Longest AHI event = 85 seconds

After speaking with the doctor, a few things:
- Weight isn't an issue
- Surgery isn't an option and would be pretty unpleasant nonetheless
- CPAP machine is the best option
- I got a feeling that he was considering revoking my driver's license. Doctor was crystal clear that if I didn't use a CPAP machine, my driver's license would be revoked.

Doctor's prescription was for a CPAP machine with a setting of 7 cmH20

I am three days into using the CPAP machine and am getting more and more comfortable with it.

Some details on the settings currently:
Range is 4 to 10 cmH20
Ramp start pressure is 4cmH20
Ramp time is 30 minutes with Ramp on
Device mode is AutoCPAP with AFlex
Heated tubing is turned off
Humidifer setting is set to 3


First night: --- Second Night --- Third night (I turned off Ramp as I got comfortable)
AHI = 20.3 --- 16.4 --- 12.3
Usage 7:14 hrs --- 7:18 --- 7:30
Mask fit: 100% for all three nights
90% pressure = 8.2cmH20 --- 8.7 cmH20 --- 9.9 cmH20


While I am seeing that the number of AHI is decreasing, my three night sample is making me question if the max pressure is set too low.

Some questions:
- I am thinking that the pressure is too low, however I'm thinking that maybe it's actually that the max range is set too low. I was thinking of setting the range to the full 4 - 20 instead of the current 4-10. Is this a bad idea? Should I be changing the range to something else?
- Are there any other settings that I should consider changing?

[Pugsy]

Welcome to the forum.

First of all let's figure out what that AHI is composed of. Use available software to see the detailed data.
https://sleep.tnet.com/equipment
SleepyHead will work fine with your machine.
Examples of what you can see can be found here along with how to post images if you want member input.
viewtopic/t158560/How-to-post-images-for-review.html

Assuming that the bulk of the AHI is either OA or hyponea it's not the maximum that is the most critical setting...it's the minimum.
Would need to see the detailed report to see where the pressure wants to go but for sure more minimum...probably around that 7 cm instead of the 4 cm and depending on if the maximum of 10 gets maxed out very much with the minimum pressure of 7...more maximum or just open the max up if you wish.

But it's the minimum that does the bulk of the work holding the airway open and preventing the apnea events.

Now if the bulk of your AHI is CA/Centrals....then we have another discussion and more pressure won't fix it.

[Asld]

Here's a capture of the Sleepyhead software (this may or may not be the screen capture that is what you are looking for).

Sadly, I have no idea what any of what you referenced above means (still figuring it all out; mostly just processing that this is happening).

[palerider]

- I am thinking that the pressure is too low, however I'm thinking that maybe it's actually that the max range is set too low. I was thinking of setting the range to the full 4 - 20 instead of the current 4-10. Is this a bad idea? Should I be changing the range to something else?
- Are there any other settings that I should consider changing?

More like 7-20, the min pressure is whats important, the max is usually irrelevant. But min needs to be high enough to prevent most events from happening in the first place.

[Pugsy]

Well crap..over half your AHI is Clear Airway/Central apneas.

I need to see a detailed graph...the one that looks like I showed in the thread with examples and format for the graphs.
viewtopic/t158560/How-to-post-images-for-review.html
Don't need all those graphs...just the basics on the right side (Events, Flow rate, Pressure, leak) and on the left side the AHI bar graphs and the statistics.

Also...tell me how your sleep quality is...are you waking up a lot during the night for any reason?

Do you have a copy of your sleep study? If not, get it.

[Pugsy]

I would still stand by suggestion of increasing the minimum to 7. Leave the max alone for the time being.
Let's fix what can be fixed with more pressure on your machine (the OAs and hyponeas) and cross our fingers that those CAs are post arousal related. Meaning the OAs maybe wake you up a bit and then we get a CA related to being awake (you may or may not remember it) and post arousals CAs should go away if we reduce the arousals.

For the time being we aren't ignoring the CAs/Centrals but we are putting them on the back burner for right now.

[palerider]

Here's a capture of the Sleepyhead software (this may or may not be the screen capture that is what you are looking for).

It's not, read the first post up there on the forum... where it says "READ THIS BEFORE POSTING". There's instructions in there about what we need to see to help you.

[Asld]

Sorry, I did skim over the newbie thread; was in the process of installing sleepyhead.

The 4AM to 4:30AM would definitely be when I wake up to go to the washroom

My sleep quality is decent / okay. I am definitely noticing improvement in my overall health. Previously, I could barely walk when I got up in the morning; over the last two days I don't have any aches or pains in my legs/ankles first thing in the morning. I have gone from having to take one stair at a time to go downstairs in the morning, to being able to walk downstairs normally

I wake up four hours in to go to the washoom and then maybe 2-3 hours after that (washroom and also it's time to get up). I have two young kids who wake up; I don't get out of bed but my wife does; I may or may not wake up but usually that four hour into sleep is when they wake up for milk or something.

I don't have a copy of my sleep study but will get it from the doctor.

[Pugsy]

Okay, the central clustering is mainly close to known awake times so there's a good chance that they are SWJ events getting flagged by mistake. Sleep/wake/junk is when the machine mistakes awake breathing irregularities for some sort of apnea event.
These machines have no way to know if we are asleep or not...they only measure air flow and our awake breathing is more irregular than our asleep breathing so sometimes it flags awake breathing. We have to be asleep for the events to matter. Awake events don't count.

Go ahead and increase that minimum to 7...don't change the max at this time. Let's wait and see where it wants to go with a more optimal minimum.

[Julie]

I certainly agree with raising the min. pressure... and also wonder how you sleep - on your back, your front, sides, etc. as they can make a difference, as can e.g. tending to sleep with your head down to your chest (more or less), which can explain at least some of the flow rate problems, often improved a lot by wearing a soft (small) cervical collar - it keeps your head up more, airway more open and if your jaw tends to fall open at all, will help it stay closed and not lose Cpap air that way. Many people find them helpful. On your back provokes more events than side sleeping.

[Asld]

Okay, the central clustering is mainly close to known awake times so there's a good chance that they are SWJ events getting flagged by mistake. Sleep/wake/junk is when the machine mistakes awake breathing irregularities for some sort of apnea event.
These machines have no way to know if we are asleep or not...they only measure air flow and our awake breathing is more irregular than our asleep breathing so sometimes it flags awake breathing. We have to be asleep for the events to matter. Awake events don't count.

Go ahead and increase that minimum to 7...don't change the max at this time. Let's wait and see where it wants to go with a more optimal minimum.

Thank you for taking the time to explain. I will adjust the minimum and leave the maximum and report back.

I certainly agree with raising the min. pressure... and also wonder how you sleep - on your back, your front, sides, etc. as they can make a difference, as can e.g. tending to sleep with your head down to your chest (more or less), which can explain at least some of the flow rate problems, often improved a lot by wearing a soft (small) cervical collar - it keeps your head up more, airway more open and if your jaw tends to fall open at all, will help it stay closed and not lose Cpap air that way. Many people find them helpful. On your back provokes more events than side sleeping.

I prefer to sleep on my sides, but have been sleeping more on my back with the machine (over the last three nights). I'm getting used to sleeping on my side with the mask on.

[Asld]

So this is from last night.

My sleep was decent; I actually had a dream which is not always the case. I did wake up with a sore throat; didn't like the immediate 7 cmH20 so will probably turn the ramp back on for tonight.

You can see that I woke up around ~3:10am to go to the washroom, but didn't wake up other than that time. I did have some trouble falling asleep. I am finding that I may be falling asleep but then wake up needing to take a deep breath and then quickly falling back asleep; particularly at the beginning of going to bed.

Question: Does taking a deep breath cause a CA event?

I adjusted the minimum settings to 7 with a max of 10 with no ramp up.

[palerider]

So this is from last night.

Please review how to organize your sleepyhead page for effective screenshots, instructions below