Newbie Data and Questions

[tbirdwilson]

I'm three weeks into CPAP, and I'm far less than pleased with my results. I really don't mind the mask(s), and I have averaged about 7 hours a night.

I tried Dreamware mask, but allergies and mouth breathing were giving me terrible results. Like, AHI between 10-20+. So I switched to Amara View, and things improved a bit. A few low numbers, but mostly between AHI 5-10. It seems obvious that I need a pressure adjustment. I was prescribed 7cm. What I have noticed is a lot of hypopneas in particular, with both masks. I know how to adjust the pressure (though I'm still in my "trial" period and technically am not supposed to?) and tried APAP (7cm-11cm) last night but AHI was 15 with a TON of centrals.

I have to wait until June 3rd (4 weeks from now) to meet with a sleep doc to review my results. I think that's just ridiculous, considering how high my AHI continues to be. I would be curious to get some experienced eyes on my last 3 weeks of results for advice on making adjustments. I imagine keeping CPAP (not APAP, since it raised centrals) and starting to raise my pressure a half step and re-evaluate. I'll post a screenshot of my Sleepyhead data when I can, but in the meantime, would bumping up my pressure in 1/2 cm intervals and watch be a sensible course of action?

[Pugsy]

I'll post a screenshot of my Sleepyhead data when I can, but in the meantime, would bumping up my pressure in 1/2 cm intervals and watch be a sensible course of action?

Please post a screen shot of your SleepyHead daily detailed report from last night at your first opportunity.
If your centrals are actually caused by the cpap/apap pressure itself then increasing the pressure ranges could potentially make the centrals worse. Now on the other hand if the centrals were more along the lines of post arousal centrals because of sub optimal pressures then increasing the pressure to better hold the airway open and prevent the airway collapses that might be causing the arousals then more pressure might indeed help.

For anyone to really do more than make a WAG (wild ass guess) at what you might could do to help your results we really need to see what you are seeing on those reports.

We really need to see that report first before suggesting pressure changes that could potentially make the centrals worse.

One question though....are you sleeping soundly or having a lot of fragmented sleep during your hours on the machine? If a lot of fragmented sleep the centrals could maybe be awake/semi awake centrals.

[tbirdwilson]

Thanks for your response. I don't see the paperclip attachment icon in my post window. Otherwise, I'd post that Sleepyhead data. What am I missing here?

[dhoppe]

See if this helps:

https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/resources/sleepy ... screenshot
https://sleep.tnet.com/reference/tips/imgur

These are the directions I used to post my screenshots.

[Pugsy]

Unfortunately this forum format doesn't let us do attachments. Instead we usually just use screen shots of the reports.

Thread with some examples of what we like to see along with some hints on how to manage the images.
viewtopic/t103468/Need-help-with-screen-shots.html

How to use imgur to post screen shots
https://sleep.tnet.com/reference/tips/imgur

You don't have to use imgur as any photo hosting site will do.

The reason I am concerned is that if your AHI is primarily central in nature (clear airway events) we don't treat centrals with more pressure with your type of machine even if the pressure isn't the cause and/or making them worse.

[tbirdwilson]

[tbirdwilson]

Thanks for the patience with my neophyte questions and such.

My perception is that I'm sleeping mostly through the night. I would say I consciously wake 2-3 times over the course of an average night.

Btw, the centrals have mostly been low on a fixed pressure of 7. It's definitely been more obstructive and hypopneas, overall, since I started CPAP. But this screen capture is from the only night I tried apap.

I should add that before CPAP I was experiencing heart palpitations during the day, and an occasional racing, irregular heartbeat upon waking in the middle of the night. And nocturia, too. All of those symptoms have essentially stopped. So there has been some benefit, despite the high-ish AHI.

Let me know if there's any important data I left out of the screen capture.Thanks again.

[Pugsy]

Auto adjusting pressure mode (apap) clearly shows that it wanted to try to fight something related to obstructions.....they respond to snores, flow limitations and OAs and hyponeas that meet algorithm criteria.
They do not respond to clear airway events on purpose.
So an increase in pressure we won't expect to have any effect on the centrals unless the centrals are a byproduct of the OAs, hyponeas, etc that could potentially be causing arousals (that you may or may not remember). During arousals it is common for clear airway events to be flagged simply due to normal pauses in breathing. Hold your breath for 10 seconds...that qualifies as a clear airway event...no air movement for 10 seconds...we do that all the time and don't realize it. The machine doesn't know if you are awake or semi awake or asleep...so it just calls it as it senses it. They are "real" to the machine but not necessarily "real" to us in terms of them being related to sleep apnea and warranting concern or treatment.

I think it is something worthwhile to try if you are comfortable doing so. If it were me I would try 1 cm more on the minimum and also up the maximum 1 cm. If the centrals weren't so numerous I might be more aggressive with the pressures but until I had a better feel on what is causing them and if they are a real problem I would tend to be more conservative with pressure increases but that's just me and how I look at things.
If the centrals don't worsen and the obstructive stuff decreases somewhat but maybe not quite enough then maybe another small increase is worth trying.

The pattern shown with the centrals doesn't stand out at obviously related to pressure itself. Usually when that happens we see centrals all night long at any and all pressures. I would still keep one eye on them though and if you see a dramatic change/increase/frequency increase in those centrals with a pressure increase I would back off and wait till I could talk to the doctor about them. You don't have an alarming number of centrals (we've seen much worse) but they are numerous enough that we want to keep a watchful eye on them.

Hope I haven't confused you with the explanations. I prefer that people understand what they are doing and why and possible issues instead of just saying "yeah, increase the pressure".
If something needs further clarification just ask...I will try to clarify my thoughts better.

[tbirdwilson]

1/2cm increase to 7.5cm last night resulted in a sub 5 AHI. 4.7 to be exact. Fixed pressure, 7 hours of sleep. Definitely the right trend. I hope my "team" sees is that way (the un-sanctioned tampering). But screw 'em. It's my health at risk, not theirs.

I teach science, and it's actually kind of interesting to be generating hypotheses, experimenting with this machine, pressures, variables, etc. and observing the results.