New Member and New to CPAP...new issue with ASV trial

[JCFlorida]

Hi,

Great to find such a valuable resource. Just started CPAP therapy 8 days ago. In lab sleep study about a month ago. AHI of 43.3 with O2 dropping to 82%. Diagnosis: OSA-hypopnea syndrome. Airsense autoset 10. Use Airfit 30i mask one night, then switched to Airfit F20. First night AHI was 23. After changing mask when down to AHI of 15 and the last few nights averaging about 9-10. Averaging 7-8 hours with mask. Needless to say still feeling groggy. Last night I had 8+ hours on mask. Took it off then "slept" another 3 hours without it. Feel like my head is in a fog. I suspsect I am not getting enough REM sleep. Will see sleep APRN in another week to evaluate. She said if AHI is not down to 5 or less might do another sleep study.

I downloaded Oscar. Don't know exactly what I am looking at. But hopefully, I followed instructions for posting last night's activity graph and I can get some advice at on how to continue down this path to get that "sleep refresh" feeling. I know it will take some time. Attached is Oscar data rom last night and sleep study report (no personal data). Thank you for taking the time to review.

https://imgur.com/a/HruYiGF

[Pugsy]

Welcome to the forum.

A couple of questions?

What altitude are you at?
Do you take any medications of any kind?

Most important question...did you actually get much sleep last night or was it really fragmented?
I see a lot of breaks in therapy where the machine was turned off and you had to be awake to do that.
Any idea why you didn't sleep so great? Comfort or adjusting to all the stuff on your face????

The bulk of your AHI is the CA(clear airway)/central index.
I suspect they are related to the awakenings you had and not real asleep events.
If you aren't asleep they just don't count except to make us wonder why you aren't sleeping solidly.

[JCFlorida]

Thank you very much. I get up 2-3 times for bathroom. Take lipitor and a pepcid ac at night. Depends on water consumption. Trying to stop by 8pm. I live in Florida, so no altitude to speak of. First week so, not fidgeting with the mask as much as the first few days. Felt like I slept except for bathroom breaks. But still feel pretty groggy. But as I understand it your body is adjusting not to CPAP.

[zonker]

to emphasize what pugsy has said, many of us get central apneas when we first start. and that very much related to starting out and we're not used to the machine. so we end up being pretty restless and waking ourselves up throughout the night. even if we don't remember waking up, we do.

sometimes, this goes away as we adjust to the new way of sleeping.

good luck!

[JCFlorida]

Thank you. I am sure that applies to me, as well. Read alot of success stories here and want to get better educated.

[Pugsy]

How old are you?
I assume male??? Are you of an age where the old prostate causes a bit of a problem during the night?

Up for a little experiment?
How about turning EPR off or set it to ramp only and make use of the ramp which it looks like you are using ramp now.
It's about the only thing we can do to maybe help reduce the centrals...at least with this machine.
I don't know if it will do much or not but I think it is worth trying.

If you were a family member of mine that is what I would advise right now. Turn off EPR or if you need EPR for comfort set it to ramp only.

[JCFlorida]

Male. Just reached Medicare age. I see on my document that came with machine flex/epr is 2 and Ramp is 4. I looked under options on machine:
Ramp time set to auto, Pressure Relief set to On. Is EPR the same as Pressure Relief?

[Pugsy]

Yes, you need to look at the machine and go into the clinical menu setup area to turn EPR off and set it to ramp only.
That choice is only available in the clinical menu setup area. There is a secret handshake you need to do to get into that area.

You probably don't have this manual
https://www.respshop.com/manuals/ResMed ... %20her.pdf
but it explains how to get into that special area where you can make changes

[JCFlorida]

Thank you very much.

[zonker]

just a side note. that getting up to pee several times a night is likely to be cut down to maybe zero with proper sleep apnea treatment.

[Pugsy]

just a side note. that getting up to pee several times a night is likely to be cut down to maybe zero with proper sleep apnea treatment.

CPAP only helps nocturia if the nocturia is from the apnea events solely.
If someone has that old enlarged prostate causing the need to go pee...the best optimal cpap therapy in the world isn't going to help. Gotta maybe work on the prostate issues as a different problem needing separate attention.

BUT...what we can do is at least try to optimize the therapy (in this case reduce the number of centrals) and see if the nocturia gets reduced once the apnea events are under better control.
Won't hurt to at least try and the therapy needs work on improvement anyway so might as well see if we get lucky or not.

[zonker]

just a side note. that getting up to pee several times a night is likely to be cut down to maybe zero with proper sleep apnea treatment.

CPAP only helps nocturia if the nocturia is from the apnea events solely.

oh! of course. my post wasn't meant to contradict yours in any way. if you'll notice, my post was chock full of weasel words. well, on second glance, mebbe not. i DID type "likely".

<sigh> sometimes, what i'm composing in my mind doesn't make it down my arms and out my fingers. let's try that again.

i mean to say, i can only go by my own experience. i'm a 69 yr old male, so certainly "medicare age" as jcflorida states. yet when i started cpap, one of the first or second things that happened was my nocturia went away.

so i was just trying to hold out hope that this would be the newbies experience as well.

[Pugsy]

i'm a 69 yr old male, so certainly "medicare age" as jcflorida states. yet when i started cpap, one of the first or second things that happened was my nocturia went away.

As did my nocturia but then I was 14 years younger and female. Just the elimination of the nocturia made cpap so worth it for me. I was getting up to pee 4 or 5 times a night and that totally stopped.

And yes for some guys...even the older guys...the nocturia can totally go away as long as there isn't something else adding to the problem.

So for the OP here I just wanted to add in a little reality check and while there is a chance his nocturia will go away...there is also a chance it won't but that doesn't mean we won't try.

4 or 5 pee breaks during the night is going to totally trash a person's sleep architecture and it's no wonder the OP still feels like crap during the day. His sleep quality is in the toilet for sure. He's not getting a chance to go through all the needed sleep stages in the amount that the body needs for the restorative powers of sleep to work their magic. He would feel like crap even without OSA in the mix.

At this point we don't know for sure just how much of an impact those centrals are having on the body or heck we don't really know how many of them are real asleep centrals or arousal related.

Figured might as well try to reduce the centrals if possible and see what's left over that needs to be dealt with assuming we can reduce the centrals. Gotta start somewhere and at least try.

[ozij]

Welcome to the forum!
Three things caught my attention on the sleep study:

1) The recommendation to have a sleep study with CPAP titration
2) The present study reports 40 central apneas in total, in addition to the obstructive breathing evnets.
3) You've also got periodic limb movement, which apparently are not causing many arousals.

Unlike the central (i.e. clear airway) apneas we see on OSCAR, central apneas on a properly scored sleep study are only counted when your EEG indicates you're asleep. Our machines don't distinguish sleep breathing from wakeful breathing, and may - as Pugsy said - score central apneas when we're awake.

I assume you never had the titration study.
During a titration study, they try you on different modes of CPAP therapy, some that handle central aponeas better than what's available on an APAP. After that they can recommend a machine that can give you the therapy mode that gives you the best treatment / sleep. The machine you have now is not necessarily the one you need.

Your time of getting used to having a mask on your face and air blowing in will serve you well for the titration study.

[zonker]

His sleep quality is in the toilet for sure.