Confused Newbie

[sleepygrl]

Hi Everyone,

I've been looking around the site and would like to thank you for all of the information you have made available. I have learned many things, but I still have some questions I'm hoping you can help me with. I'm not sure how much detail you want to wade through, so I'll try to keep it short and fill in the gaps if you wish.

I was recently prescribed a CPAP machine. I now realize it is a brick, so I understand that I'm flying blind. I was told that it was set to a low setting and to take it home and use it to get used to it prior to my titration study. It's a Resmed Airsense 10 CPAP and my average events are 0.3/hr. On a pressure of 5. Is this normal? This seems odd to me, unless some people have their OSA controlled at such low pressure. I've used it for 6 days.

Thank you!

[sleepylynn]

Hi, fellow sleepy.

I'm a newbie, too, but one of the first things I've learned since joining the forums is that your apnea's severity level doesn't necessarily translate to how much pressure is required to treat it. The pressure required is based on the anatomy of your airway, not on how "bad" your apnea is.

I'm sure a more experienced member will be along shortly to give you a better explanation.

[LSAT]

Hi Everyone,

I've been looking around the site and would like to thank you for all of the information you have made available. I have learned many things, but I still have some questions I'm hoping you can help me with. I'm not sure how much detail you want to wade through, so I'll try to keep it short and fill in the gaps if you wish.

I was recently prescribed a CPAP machine. I now realize it is a brick, so I understand that I'm flying blind. I was told that it was set to a low setting and to take it home and use it to get used to it prior to my titration study. It's a Resmed Airsense 10 CPAP and my average events are 0.3/hr. On a pressure of 5. Is this normal? This seems odd to me, unless some people have their OSA controlled at such low pressure. I've used it for 6 days.

Thank you!

It is unusual, but not impossible. If the titration shows that you need a cpap, try to exchange the unit for one with data...The Elite or Autoset

[sleepygrl]

I will see what I can do about the machine.

Can you tell me about titrations? I'm assuming they start at the "getting used to it pressure" and up it if needed? Would I be correct in assuming that they can't start with an airflow of 0 as the patient would be rebreathing exhaled air?

Would the only way to investigate the need for CPAP then be sleep study without CPAP?
(I know you'll roll your eyes at my denial : ) But I had CSA events on the sleep study as well, so I'm just wondering if were addressing the whole problem)

I feel better about things when I understand them, so thank you for your patience.

[Pugsy]

Usually the titration sleep study will start out with a pressure of 4 or 5 cm...Mine was 5 cm.
As someone already mentioned...severity of apnea doesn't have any bearing on the pressure needed to hold open the airway. I know people with 80 plus AHI and they do quite nicely with 5 or 6 cm and I know people with very mild OSA of 12 needing 20 cm. There doesn't seem to be any rhyme or reason to it..it's just one of those things. The fact that your AHI is nice and low now with a relatively low pressure just means you got lucky as lower pressures are a bit easier to adjust to as long as they aren't so low that you feel suffocated.

Centrals on the diagnostic sleep study...some centrals are normal so it doesn't necessarily mean something bad is going on. There's a central called a "sleep onset central" which is considered normal. They happen during sleep stage transition from awake to sleep. They aren't a problem unless present in really large numbers. Everyone can have a few centrals and it's not a big deal...it's only when there is a truckload of them that they cause a problem.

I don't think your machine does a breakdown into event categories but I haven't seen a report from your model machine but if it does you would be able to see if you have any centrals now.
If it doesn't show a breakdown of that AHI into each category...another reason to push for the Elite or AutoSet because those models show the event category breakdown.

[n2it]

Usually the titration sleep study will start out with a pressure of 4 or 5 cm...Mine was 5 cm.
As someone already mentioned...severity of apnea doesn't have any bearing on the pressure needed to hold open the airway. I know people with 80 plus AHI and they do quite nicely with 5 or 6 cm and I know people with very mild OSA of 12 needing 20 cm. There doesn't seem to be any rhyme or reason to it..it's just one of those things. The fact that your AHI is nice and low now with a relatively low pressure just means you got lucky as lower pressures are a bit easier to adjust to as long as they aren't so low that you feel suffocated.

Centrals on the diagnostic sleep study...some centrals are normal so it doesn't necessarily mean something bad is going on. There's a central called a "sleep onset central" which is considered normal. They happen during sleep stage transition from awake to sleep. They aren't a problem unless present in really large numbers. Everyone can have a few centrals and it's not a big deal...it's only when there is a truckload of them that they cause a problem.

I don't think your machine does a breakdown into event categories but I haven't seen a report from your model machine but if it does you would be able to see if you have any centrals now.
If it doesn't show a breakdown of that AHI into each category...another reason to push for the Elite or AutoSet because those models show the event category breakdown.

lol, You're unreal Pugsy. What a great resource we all have...

[sleepygrl]

Here are the sleep study results.
Sleep Study #1
BMI 32.5, neck 37.0 cm
Decreased sleep efficiency, normal REM latency, increased stage 1, decreased stage 2 & 3, increased stage 4 and decreased rem.
24.2 % wakefulness, 0 terminal wakefulness
Central apnea: 12 Hypoapnea 34 AHI 8.0/hr (mild) RDI 8.0/hr (mild) but 29/hr in REM, 0.5/hr NREM
Respiratory arousals 9, Spontaneous 71
AI 13.8/hr, 92 stage shifts.
Sleep latency the following day (minutes) 13.3/4.0/2.5/3.4 No REM

Sleep Study #2 - 9 months later on Modafinil (Provigil)
BMI 33.5 (had been higher, was on it's way down after starting Modafinil 6 weeks prior
neck 40.5 cm
Normal sleep efficiency, normal REM latency, increased stage 1, decreased stage 2 & 3, markedly increased stage 4 and decreased REM
9.5 % wakefulness, 13.3 min terminal wakefulness
Central apnea: 9 OSA: 9 Hypoapnea 173 AHI 32.1/hr (severe) RDI 32.1/hr (severe) 52.6/hr in REM, 25.6/hr in NREM
Respiratory arousals 47, Spontaneous 65
AI 18.8/hr, 106 stage shifts
Sleep latency the following day (minutes) 7.3/5.7/3.5/10.1/4.8 No REM

So I understand that the results changed and the OSA became apparent. I was told it was due to the fact that a snapshot of one night is not always representative of what happens. I understand but I also wonder about the BMI change. I'm currently at 31.5 not quite 2 months later and on a flow of 5 have 0.3 events/hour at home. I understand that pressure doesn't always correlate to the severity of the disease but was surprised that they cleared up so well. Is that normal?

My family has only reported snoring in the past year, and I've been falling asleep on the couch for decades. I understand that OSA can present without snoring, can it present in a teenager?

My REM sleep seems to be taking a beating. Is that normal?

I was surprised at the results of the second day test - I felt so much better. But given the chance I still fell asleep during the day.

All the spontaneous awakenings and stage shifts - are they normal?

So many questions, sorry. I was told that the CPAP would be my new best friend but last night I hated it - woke me up with a leak that I half heartedly tried to fix and gave up. I'll keep on trying, but I guess I'm stuck in the denial stage.

Thanks

[highstick]

I will see what I can do about the machine.

Can you tell me about titrations? I'm assuming they start at the "getting used to it pressure" and up it if needed? Would I be correct in assuming that they can't start with an airflow of 0 as the patient would be rebreathing exhaled air?

Would the only way to investigate the need for CPAP then be sleep study without CPAP?
(I know you'll roll your eyes at my denial : ) But I had CSA events on the sleep study as well, so I'm just wondering if were addressing the whole problem)

I feel better about things when I understand them, so thank you for your patience.

I've got the same machine and it's set to ramp from 4-10. I've fought claustrophobia and this machine is finally the solution...Starts at 4 and ramps up over time and "need". I didn't understand that until about a week ago and figured out how to turn the dial and see that it had ramped up...If you take off the hose, hit the switch to check "hour usage", it resets to 4 again.

I understand the frustration you have with "understanding"...just be patient and read as much as you can...Are you using the MyAir app? That has really been a motivator for me to see progress. I'm due for my first followup with my ENT in a little over a week, but the Airsense 10 has been my savior!