New APAP User--QUESTIONS

[Mondayz]

Hello all,

I have just received and have been using my first APAP machine, and I am newly diagnosed with mild sleep apnea (7 AHI). I have a few questions for some of you who have been living with this for a number of years and who have had some time to learn about how the machines function and the illness is best handled.

1) I have been using my APAP for 13 days now. On the first few nights, my AHIs were something like 0.3, 0.8, 0.7. and 1.1 for example. Then, randomly throughout the next few days, my AHIs were being reported as 2.3, 2.7, 2.5, etc. Now, I know that anything under 5 is deemed as good, but is this normal? Why were my first few nights so good and then this increase happened? On the nights that I feel I do not sleep as deeply, my AHI is lower than the ones where I wake up feeling like I had great rest. Does the deeper more restful sleep lead to higher AHI? If so, this may explain it, as perhaps the first few nights with the machine I was not sleeping well as I adjusted.

For reference, I am using the Autoset 10 by Resmed with a nasal pillow.
My pressure range is set at 6-10. I fought long and hard to get an APAP rather than a normal CPAP machine. This is important because of my second question.


2) Reviewing my data on OSCAR, I have noticed many nights where my pressure has gone all the way up to 10. The fact that the machine is automatically adjusting me all the way up to 10 seems to denote a need to go higher. I even set my pressure manually to 11 one night, and lo and behold, the machine maxed out at 11 again. Should I adjust it even higher? It doesn't seem like the times when the pressure went higher were during times of apnea or hypopnea, so perhaps the rising pressure prevented one? As I said, I am still very new to this. What are your thoughts? Is there any harm/benefit in increasing the max pressure to 15 or so?

Any advice or tips would be greatly appreciated!

[LSAT]

You can set the max pressure to 20...The machine will only increase the pressure high enough to stop apnea events....It may never go any higher than 12. The most important setting is the Min pressure. Some people can't get enough air if it bis set too low.

[Dog Slobber]

Post the graphs OSCAR produces, instead of telling us what OSCAR says.

Format the graphs as described in this topic.
viewtopic/t158560/How-to-post-images-for-review.html

[palerider]

2) Reviewing my data on OSCAR, I have noticed many nights where my pressure has gone all the way up to 10. The fact that the machine is automatically adjusting me all the way up to 10 seems to denote a need to go higher. I even set my pressure manually to 11 one night, and lo and behold, the machine maxed out at 11 again. Should I adjust it even higher? It doesn't seem like the times when the pressure went higher were during times of apnea or hypopnea, so perhaps the rising pressure prevented one? As I said, I am still very new to this. What are your thoughts? Is there any harm/benefit in increasing the max pressure to 15 or so?

Absent of a compelling need for a reduced max pressure setting, max pressure should be set to whatever the machine max is, (20, 25, 30cmh2o)

Any advice or tips would be greatly appreciated!

I'll tell you more when I see graphs.

[Miss Emerita]

I just wanted to say welcome and congratulations on starting your apnea treatment. You are off to a great start, with some restful nights, your use of Oscar, and the prospect of great advice from the experts here.

[Wulfman...]

Hello all,

I have just received and have been using my first APAP machine, and I am newly diagnosed with mild sleep apnea (7 AHI). I have a few questions for some of you who have been living with this for a number of years and who have had some time to learn about how the machines function and the illness is best handled.

1) I have been using my APAP for 13 days now. On the first few nights, my AHIs were something like 0.3, 0.8, 0.7. and 1.1 for example. Then, randomly throughout the next few days, my AHIs were being reported as 2.3, 2.7, 2.5, etc. Now, I know that anything under 5 is deemed as good, but is this normal? Why were my first few nights so good and then this increase happened? On the nights that I feel I do not sleep as deeply, my AHI is lower than the ones where I wake up feeling like I had great rest. Does the deeper more restful sleep lead to higher AHI? If so, this may explain it, as perhaps the first few nights with the machine I was not sleeping well as I adjusted.

For reference, I am using the Autoset 10 by Resmed with a nasal pillow.
My pressure range is set at 6-10. I fought long and hard to get an APAP rather than a normal CPAP machine. This is important because of my second question.


2) Reviewing my data on OSCAR, I have noticed many nights where my pressure has gone all the way up to 10. The fact that the machine is automatically adjusting me all the way up to 10 seems to denote a need to go higher. I even set my pressure manually to 11 one night, and lo and behold, the machine maxed out at 11 again. Should I adjust it even higher? It doesn't seem like the times when the pressure went higher were during times of apnea or hypopnea, so perhaps the rising pressure prevented one? As I said, I am still very new to this. What are your thoughts? Is there any harm/benefit in increasing the max pressure to 15 or so?

Any advice or tips would be greatly appreciated!

You probably (more like obviously) need to increase both your minimum and maximum pressures.
As long as you're using software to monitor your therapy, it will tell you how you're doing and what types of events are causing the increases in pressure......(primarily snores and flow limitations will do it).
If you're still having apneas and hypopneas, that generally tells you your minimum is probably too low.


Den

.

[Mondayz]

Attached are some of my OSCAR files. One from the first night that I owned an SD card for it, and the rest are from the past few nights. Any input or advice is greatly appreciated. Sorry for not posting these earlier.

[Mondayz]

Here are two more; the one was the worst night I've had AHI wise.

[Janknitz]

Also pay attention to leaks. With a nasal mask, if you are mouth breathing, that could cause pressure increases.

As for deeper sleep causing a higher AHI, yes, if you are more deeply asleep, that's usually when apnea is more likely to occur.

Remember the machine does not respond immediately to apneas and hypopneas, so if your pressure increases don't seem to be correlated, that's why.

It may be that you need a higher minimum pressure so as not to have the "chase" the apneas when they occur in deep sleep. Chasing apneas causes higher pressures. Ideally the machine should prevent the apneas in the first place with adequate pressure. Your charts will help us see what might be going on.

Good for you for trying this and sticking with it. Most people with low AHI's don't perceive the benefit as well as those of us who have severe apnea. By tackling this now you may never have to deal with severe apnea.

[Pugsy]

Do you end up on your back a lot later on in the night? Seems like a pattern of increased activity everywhere starting about midway through the night.
My first guess would be maybe you were on your back.
REM stage sleep would also do it but REM cycles and yours seems more constant.

If it was me the only thing I would change is open up the maximum and let the machine at least try to sort things out.
It isn't horrible results though and your "worst" night wasn't really all that bad and it doesn't seem to be consistent anyway.
I never do much about random off nights anyway for any reason. We can all have fluke nights here and there and if we go trying to change things based off fluke nights we would be driving ourselves crazy.

Overall though...actually very decent reports. If sleeping good and feeling good there is no urgent reason to change anything at this point.

Did I miss any mention of how you were sleeping and feeling in general? That is every bit as important as any numbers or graph details.

[Mondayz]

Do you end up on your back a lot later on in the night? Seems like a pattern of increased activity everywhere starting about midway through the night.
My first guess would be maybe you were on your back.
REM stage sleep would also do it but REM cycles and yours seems more constant.

If it was me the only thing I would change is open up the maximum and let the machine at least try to sort things out.
It isn't horrible results though and your "worst" night wasn't really all that bad and it doesn't seem to be consistent anyway.
I never do much about random off nights anyway for any reason. We can all have fluke nights here and there and if we go trying to change things based off fluke nights we would be driving ourselves crazy.

Overall though...actually very decent reports. If sleeping good and feeling good there is no urgent reason to change anything at this point.

Did I miss any mention of how you were sleeping and feeling in general? That is every bit as important as any numbers or graph details.

I sleep on my back mostly since I can’t keep the nasal pillow on correctly when on my side . I always wake up with leaks .

The entire reason I ended up looking into my sleep was because out of nowhere I developed severe anxiety for no apparent reason. My symptoms have somewhat subsided since I am now sleeping better , but I am still having some issues with it, and I still never have any dreams I can remember. Everyone I spoke to said that once they had their CPAP they had these vivid dreams etc but I can’t recall a single one yet. Perhaps
I am just not waking during REM.

One question I have is: can my insurance stop paying for the CPAP or take it back if I mess with the changes ? The changes I made to the pressure are appearing as red on the summary report, so I’m assuming they can see that. The 6-10 pressure originally set is green in color .

[Pugsy]

Your insurance doesn't care anything about changes.....all they care about is that you use the machine the required number of hours so they don't waste their money paying for something you don't use.
All insurance companies will ever see is the hours of use...they never see any results or settings...and they don't really care.

Now the DME (whomever supplied you the machine) might care but there is no law that says you can't change stuff on your machine if you want to.
Sometimes DMEs will tell people it is against the law but if you ask them to prove it they can't because there is no such law.
Now the DMEs aren't supposed to change anything without the doctor's okay....but you can do whatever you want and they can't do a darn thing about it except slap your hands.

And sometimes they won't even notice small changes anyway unless you tell them. If you change that maximum they might not even notice. ...and if they do ...who cares.

Actually not remembering dreams is a good thing compared to remembering a lot of dreams.
We won't remember a dream unless we wake up during or right after one and are awake long enough to formulate a memory...so you might be waking after REM (which is normal to do anyway) and simply not be awake long enough to remember it.
When people remember a lot of dreams that means they are waking often during the night and staying awake long enough to remember it and that's not a good thing.

Also...people assume we dream only in REM and that's not the case. We can actually dream in any sleep stage...not just REM.
So remembering a dream because of the wake up doesn't guarantee we made it to REM.

[palerider]

I'd raise the min pressure to 8, and max 20.

[Mondayz]

Thank you for the replies, gentlemen. I’m new to all this so I really appreciate the guidance . I’ll try to mess with some of the settings a bit now that I know the insurance won’t ditch me.

[Dog Slobber]

Thank you for the replies, gentlemen.

Pugsy is not a man, and palerider is not gentle.