Hi everyone, 8 days into therapy

[AllieKat]

Hi cpap land! I am newly diagnosed with OSA, and apparently I have a "mild" case and the events apparently occur only during my REM sleep. Anyway, I went through all the stages of loss before I would even succumb to buying the machine, I just couldn't believe it was true, as I don't snore! I witnessed my dad suffer for years with OSA, so I knew all the symptoms, and the only one I had was Daytime Sleepiness- excessive to the point of falling asleep while driving more than once. It began to effect my relationship with my partner, so I had to do something. So after 7 days, I MIGHT be noticing a difference, I wouldn't say it's like HALLELUJAH!! I'm all better, but I might be seeing small improvements. So far my AHI ranges from .3-.8 and my mask fitting percentage is 100%, so I think I am doing good. I really hope I see some major improvement in my daytime energy. I need to begin an exercise program, and up till now, I do one good workout, and I am dead. The rest of the week there is ZERO energy to do anything, and that is not me, it is no way to live. Even as a morbidly obese person I had more energy than I do now. I had lapband surgery and lost 125 pounds, and BOOM! Started developing OSA symptoms. Kinda the opposite right? I thought losing weight makes you healthier, but it sure don't always feel that way. Anyway, I took the plunge and just need some support on this journey, as I kinda feel like I'm a little alone in this thing. My partner is trying, bless her heart, but I need people that know what the heck this is all about. So, thanks for being here

[kaiasgram]

Welcome Allie,

You're doing amazing for one week in -- Congrats. Let us know what specific problems/adjustment issues you're having along the way and we'll do our best to help. It's not at all unusual that improvements do not kick in immediately. Give this some time.

As you hang out here you'll see that there are some folks who lose weight only to find that they need a higher cpap pressure rather than less. And others who hoped desperately to be liberated from their cpap machine and were dismayed to discover that they still had apnea when they reached their goal weight. So the idea that you'd start having symptoms after weight loss doesn't seem too far fetched to me. Could also just be a coincidence that the onset of symptoms corresponded with your weight loss.

Glad you found us here. We encourage people to list their equipment like most of us have in our signature boxes.

[tedburnsIII]

What was your optimal sleep study recommended fixed pressure?

Despite your low AHI, you may default (APAP) to a very low pressure and still have low AHI, and that low pressure may not provide adequate oxygen saturation. There could
also be other issues.

Your recital of empirical experience lacks the really important details about your sleep study and sleep titration, if applicable.

Additionally, not everyone has overnight dramatic improvement.

[Pugsy]

I know everyone wants the overnight miracle that they read about but the cold hard facts of life are that those people are a lucky minority. Most people will find it takes some time before they start feeling the good numbers.
So while you are giving it time...like you have much choice
it doesn't hurt to evaluate some other stuff just in case other stuff is also a factor in not feeling so great.

So how about we start with the usual stuff first.
How many hours of sleep are you getting...not in bed time but sleep time?
Are those hours of sleep fragmented by wake ups or arousals and if so any idea why?
Do you have trouble going to sleep or staying asleep?
Do you take any meds?

[bwexler]

Welcome to the forum. I think there are more than 12,000 of us alone here. Join the crowd.

I have my own private theories about lap bands and other weight loss surgery. I believe they all restrict nutrient absorbsion. The result may be declining health in which ever area of your body you are most vulnerable. Your body happened to choose apnea. Now with the help of your xPAP you will overcome it, but the symptoms will not disappear overnight.
I think you should be vigilant in monitoring your general health so you can nip any new problems in the bud.

[Noctuary]

I know everyone wants the overnight miracle that they read about but the cold hard facts of life are that those people are a lucky minority. Most people will find it takes some time before they start feeling the good numbers.

I know, 18 months and I'm still waiting.

[AllieKat]

Ok, Just getting back to respond...thanks for all the info everyone.
I'm only getting about 5-6 hours of sleep per night, I do arouse occasionally, when my mouth falls open-I am still learning to not be a mouth breather. That happens about 2-3 times a night, that I remember. No trouble falling asleep or staying asleep- now that I am more used to this gear on my face. I don't expect an overnight miracle, just hopeful, and tired of being tired. I am being compliant at wearing it every night. I have seen others talk about another data monitoring program on this site, but don't know how to download it.

What was your optimal sleep study recommended fixed pressure?

Despite your low AHI, you may default (APAP) to a very low pressure and still have low AHI, and that low pressure may not provide adequate oxygen saturation. There could
also be other issues.

Your recital of empirical experience lacks the really important details about your sleep study and sleep titration, if applicable.

Ted, I admit your are speaking above my knowledge. On my RX the pressure is listed as 5-15cm. What other details may I provide that folks would need to know? The only things they told me was that I had enough "events" during my study to qualify me as a mild case of OSA, that only occurs during my REM stages. I don't even know what titration means. Please enlighten me. How long should I wait before I go back to my doc and say "hey, I don't think I am getting a benefit, or some other level needs to be looked at"?



Additionally, not everyone has overnight dramatic improvement.

[kaiasgram]

AllieKat, you're doing just fine with the info you're giving us. And I don't think there's any basis for suggesting that you could have inadequate oxygen when using relatively low pressures, so please don't worry about that. CPAP machines only deliver enough air pressure to hold your airway open so you can breathe, but you are always the one doing the breathing. CPAP machines do not "provide oxygen saturation."

If you don't like the sensation of breathing with the minimum pressure of 5, then that's a comfort issue -- a lot of people don't like pressures below 6 or so, and many choose to bump up from 4 or 5 pretty soon after they start therapy.

Titration is simply the process of determining the pressure someone needs to hold their airway open during sleep so that they can continue to breathe. Sometimes titration is performed in the lab, but increasingly -- like in your case -- patients are given auto-adjusting CPAP machines with the min and max pressures set wide open, and the machine is allowed to adjust pressures as needed throughout the night.

You will want to keep an eye on where the machine actually wants to go, and start narrowing down the range so that you're not dealing with big pressure swings throughout the night. Some people are really sensitive to the pressure changes. You can use the link in my signature box to download SleepyHead, and then learn more about SleepyHead here: https://sleep.tnet.com/resources/sleepyhead

[tedburnsIII]

So, why did they titrate me up to 12cm as optimal pressure when 9.0 would've been just fine?

Clinical guidelines:

[kaiasgram]

So, why did they titrate me up to 12cm as optimal pressure when 9.0 would've been just fine?

This is not about your sleep study. Your sleep study data is your sleep study data. Alliecat is one week into her therapy and at this point we don't have anywhere near enough information to start speculating that she may not be getting enough oxygen while using her machine. And, for someone who has not had a chance to learn all the ins and outs of how this therapy works, she needs to know -- if this hasn't already been clarified for her -- that the CPAP machine does not deliver oxygen.

We should give her a little time to get SleepyHead up and running and show us some screenshots of what's going on at night. And to post her sleep study report if she's willing to do that. We don't know -- she may not have had any significant O2 desats during her sleep study.

It is very, very normal to not feel peppy only one week into therapy. We can serve her best at this stage by reassuring /reminding her of this and helping her learn how to monitor her therapy and get it optimized. First things first.

[tedburnsIII]

Perhaps your CPAP machine does not oxygenate but raising pressure, at least in my case, did indeed raise minimum Sa02 in the lab titration. I would think the same might be true for those who may have sat issues and therefore, without splitting hairs, more pressure results in more oxygenation for some people.

The point that I was trying to make is that relying on Sleepyhead, unless an oximeter is used, may not tell the whole story. That is why they monitor sats in the lab and for all titrations, apparently, they seek a minimum Sp02 of 90% whether the recommended pressure is 'optimal', 'good', or 'adequate'. At least that is how I understand the Guidelines.

[BlackSpinner]

Perhaps your CPAP machine does not oxygenate but raising pressure,.

Cpap will never "oxygenate" It keeps your breathing passages open so you don't DE-oxygenate due to not breathing.

[BlackSpinner]

Ok, Just getting back to respond...thanks for all the info everyone.
I'm only getting about 5-6 hours of sleep per night, I do arouse occasionally, when my mouth falls open-I am still learning to not be a mouth breather. That happens about 2-3 times a night, that I remember.

That is too much. You need a full face mask. You are losing therapy every time your mouth opens because the pressure drops below required pressure. This allows events to happen. You may only remember 2 or 3 times a night but there are the times when you don't wake up enough to remember it.

[tedburnsIII]

Perhaps your CPAP machine does not oxygenate but raising pressure,.

Cpap will never "oxygenate" It keeps your breathing passages open so you don't DE-oxygenate due to not breathing.

I get the distinction. Thank you.

But, upon second thought, at lower pressure of 9cm I had no events yet inadequate Sa02/Sp02.

[tedburnsIII]

I know everyone wants the overnight miracle that they read about but the cold hard facts of life are that those people are a lucky minority. Most people will find it takes some time before they start feeling the good numbers.

I know, 18 months and I'm still waiting.

Something is wrong. You should not have to wait that long. Do something about it.