Newbie: Newly Diagnosed Sleep Apnea

[bjhughes]

My doctor got back to me and after analyzing the APAP results he thinks the pressure range is too high. He wants it at 5-10. This is based on the data download, he doesn't have access to the oximetry data since I could only send him images like I posted here.

[palerider]

My doctor got back to me and after analyzing the APAP results he thinks the pressure range is too high. He wants it at 5-10. This is based on the data download, he doesn't have access to the oximetry data since I could only send him images like I posted here.

Unless you're suffering from painful stomach from swallowed air, or (possibly) having centrals showing up, there's ZERO legitimate reason to lower the max pressure on a machine.

Anybody who says you need to lower the max setting is just ignorant of how the machines work.

[bjhughes]

My doctor got back to me and after analyzing the APAP results he thinks the pressure range is too high. He wants it at 5-10. This is based on the data download, he doesn't have access to the oximetry data since I could only send him images like I posted here.

Unless you're suffering from painful stomach from swallowed air, or (possibly) having centrals showing up, there's ZERO legitimate reason to lower the max pressure on a machine.

Anybody who says you need to lower the max setting is just ignorant of how the machines work.

I doubt the doctor is ignorant on how the machines work, he's a sleep specialist and pulmonologist. There are centrals (clear airway, right?) showing up, as well as a large number of hypopnea events. The most severe show up from bedtime (21:00-21:30) to near midnight (22:30 - 00:00), then most of the events are mild. I had a bad night last night and took a short nap from 10:30 to 12:00 and had quite few central, or hypopnea but few obstructive. In all cases my oximeter always shows lower SpO2 early in my sleep period than later on. One night I had a large cluster of all kinds events until 22:30, the pressure climbed to 18.5, I shut the machine off, started it up again and was fine the rest of the night with few events, the pressure never climbed past 11.5

[palerider]

My doctor got back to me and after analyzing the APAP results he thinks the pressure range is too high. He wants it at 5-10. This is based on the data download, he doesn't have access to the oximetry data since I could only send him images like I posted here.

Unless you're suffering from painful stomach from swallowed air, or (possibly) having centrals showing up, there's ZERO legitimate reason to lower the max pressure on a machine.

Anybody who says you need to lower the max setting is just ignorant of how the machines work.

I doubt the doctor is ignorant on how the machines work, he's a sleep specialist and pulmonologist.

You'd be surprised at how much ignorance there is out there in the medical community.

There are centrals (clear airway, right?) showing up, as well as a large number of hypopnea events. The most severe show up from bedtime (21:00-21:30) to near midnight (22:30 - 00:00), then most of the events are mild. I had a bad night last night and took a short nap from 10:30 to 12:00 and had quite few central, or hypopnea but few obstructive. In all cases my oximeter always shows lower SpO2 early in my sleep period than later on. One night I had a large cluster of all kinds events until 22:30, the pressure climbed to 18.5, I shut the machine off, started it up again and was fine the rest of the night with few events, the pressure never climbed past 11.5

What's your CAI OAI and HI? a few centrals here and there are insignificant.

[bjhughes]

My doctor got back to me and after analyzing the APAP results he thinks the pressure range is too high. He wants it at 5-10. This is based on the data download, he doesn't have access to the oximetry data since I could only send him images like I posted here.

Unless you're suffering from painful stomach from swallowed air, or (possibly) having centrals showing up, there's ZERO legitimate reason to lower the max pressure on a machine.

Anybody who says you need to lower the max setting is just ignorant of how the machines work.

I doubt the doctor is ignorant on how the machines work, he's a sleep specialist and pulmonologist.

You'd be surprised at how much ignorance there is out there in the medical community.

There are centrals (clear airway, right?) showing up, as well as a large number of hypopnea events. The most severe show up from bedtime (21:00-21:30) to near midnight (22:30 - 00:00), then most of the events are mild. I had a bad night last night and took a short nap from 10:30 to 12:00 and had quite few central, or hypopnea but few obstructive. In all cases my oximeter always shows lower SpO2 early in my sleep period than later on. One night I had a large cluster of all kinds events until 22:30, the pressure climbed to 18.5, I shut the machine off, started it up again and was fine the rest of the night with few events, the pressure never climbed past 11.5

What's your CAI OAI and HI? a few centrals here and there are insignificant.

I changed the setting myself last night as it was too late for the DME supplier to go in and change them. I had what felt like a pretty good night.

The CAI, OAI and HI, I assume, are the numbers in the left bar of OSCAR, last night CAI was 0.00, OAI was 0.26, and HI was 2.06, my AHI was 2.32. I've had AHI from 1.99 to 7.27 with the 7 - 20 range, so last night might have just been one of the "good" ones. I'll need to see confirming results before I accept that the lower pressures work.

Here's an image from OSCAR of last night's session with the pressure set from 5 to 10 and flex was turn off too, it would be good to get the AHI down lower from what I've read here:

[palerider]

The machine wanted to go higher than 10, .... and most of the night it was above five.

I'd go for 7-20 if it were me, and see what that looks like... but that's up to you.

[bjhughes]

The machine wanted to go higher than 10, .... and most of the night it was above five.

I'd go for 7-20 if it were me, and see what that looks like... but that's up to you.

7-20 was where I started and had erratic readings on my oximeter from bedtime to about midnight. In most cases my AHI was worse, usually due to those first 3 hours.

I’m not saying that 5-10 is where I should be but the 7-20 was not working. It’s more likely I need to push the min and max up slowly to find a sweet spot. Or even tighten the range. I also think I could benefit from a neck collar or pillow.

[palerider]

The machine wanted to go higher than 10, .... and most of the night it was above five.

I'd go for 7-20 if it were me, and see what that looks like... but that's up to you.

7-20 was where I started and had erratic readings on my oximeter from bedtime to about midnight. In most cases my AHI was worse, usually due to those first 3 hours.

I’m not saying that 5-10 is where I should be but the 7-20 was not working. It’s more likely I need to push the min and max up slowly to find a sweet spot. Or even tighten the range. I also think I could benefit from a neck collar or pillow.

"tighten the range" is a misnomer, what is *important* is "raise the minimum". (which, effectively tightens the range, but it's rarely the max setting that has an effect), all "tightening the range" does is prevent the machine from responding to your needs.

If your oxygen is too low, raise the minimum, it's the exhale pressure that provides oxygenation.

[bjhughes]

The machine wanted to go higher than 10, .... and most of the night it was above five.

I'd go for 7-20 if it were me, and see what that looks like... but that's up to you.

7-20 was where I started and had erratic readings on my oximeter from bedtime to about midnight. In most cases my AHI was worse, usually due to those first 3 hours.

I’m not saying that 5-10 is where I should be but the 7-20 was not working. It’s more likely I need to push the min and max up slowly to find a sweet spot. Or even tighten the range. I also think I could benefit from a neck collar or pillow.

"tighten the range" is a misnomer, what is *important* is "raise the minimum". (which, effectively tightens the range, but it's rarely the max setting that has an effect), all "tightening the range" does is prevent the machine from responding to your needs.

If your oxygen is too low, raise the minimum, it's the exhale pressure that provides oxygenation.

So far my nights have been better with the 5-10 instead of 7-20 but I can see where the machine was trying to push to the maximum almost always during the first few hours of sleep and that's where I was experiencing those erratic SpO2 readings, drops sometimes as much as 95% down to 80% in minutes. Now, I did shut off the flex at the same time as the 5-10 pressure change so maybe that helped. Since changing to 5-10 my 90% pressure was at the max of 10 on the first night and at 8 last night I would assume that if I raise the minimum I should also raise the maximum by the same, at least for testing.

So, I would go to 6-11 up from 5-10 and see if that helps get my AHI lower. My cardiologist just put me on a beta blocker today so I'm thinking I should start that drug at night, not change the pressure settings until I've seen if the drug impacts my data. Just trying to stick with that 1 change at a time idea.

[zoocrewphoto]

The first two graphs that you posted with the 7-20 setting showed that most of your events were obstructive. The only way to fix obstructive events is to raise the minimum. By lowering the minimum, you leave yourself open to have more obstructive events.

I can see that you have some clear airway events, but they don't look that bad, and often they will improve once you get used to the machine and sleeping better. You will probably do better if you work on eliminating the obstructive events first.

As far as the doctor, they know about diagnosis, but they often don't understand the machines and their settings. They tend to look at hours of use and total ahi. I can see a doctor experimenting with the maximum pressure, but cutting the minimum when you already have obstructive events getting through? That seems like a poor decision.

[centrum]

the only time it can be helpful to lower the maximum pressure is to get used to cpap therapy or a new mask. the process can be long, but the long-term goal is to have a great night's sleep, get up to rest and let the machine do the work without limiting the maximum pressure. for the minimum pressure, it must be mounted to avoid a maximum of events even before the device has to increase the pressure. otherwise, with a minimum pressure too low, a bunch of events will disturb sleep to the point of waking up even before the pressure has reached its level of effectiveness.