New CPAP user looking for guidance

[jasonkelly214]

Hello! I was diagnosed with sleep apnea about a month ago and just received my machine this week. I've had a chance to use it twice now and loaded my info into OSCAR. I wanted to get some thoughts from you guys on my results because although I know it's only been two days with the machine, my results do still have a higher AHI than I expected. It's around 22 for each night with 100+ clear airway apneas. I have a followup for the doctor to review the data but not for another 4 weeks. I'm wondering if my results warrant checking in with them before then. At the time of my diagnosis I had asked about a bi-level machine because my sleep study results did show a lot of central apneas, but they basically just told me they start everyone on a cpap but would review it later. From what I've been able to read and scratch the surface on (there's a lot to this sleep apnea thing!) I may require a bi-level machine with a backup rate.

I normally wake with a strong headache in the front of my skull but I did not have that the past two nights, though normally I grind my teeth and I don't think I did the past two nights so I'm not sure on this one yet. I'm not sure if I can say yet if I felt more rested and alert during the day but I definitely woke up easier than I used to.

Here are my first two nights with the machine:





Let me know if I missed anything or did anything wrong, I did read the wiki and the how-to on posting data.

[zonker]

Hello! I was diagnosed with sleep apnea about a month ago and just received my machine this week. I've had a chance to use it twice now and loaded my info into OSCAR.

<snip>

Let me know if I missed anything or did anything wrong, I did read the wiki and the how-to on posting data.

welcome to the zoo! many smarter people than i will come in soon to comment. i'm here to give you a wee bit of guidance. this will help the experts get more info from you.

your first attempt at posting graphs went fairly well. but you've put in too much info. yes the wiki says after leak rate, you put whatever you want in there. however, if you do that then post the charts, it shrinks things up and makes it harder to read. what you have is okay for now; i'm just suggesting changes for the next time you post.

the majority of forum members make their own changes. we don't wait for the doctor or dme or whoever to do it. so if you are comfortable with that, it's pretty much going to be the type of advice you receive.

i see that you are at a starting pressure of five. most doctors prescribe low minimum pressure. most of us aren't getting good therapy in that range.

i DO want to say a big thank you for going through and reading the available material here. shows initiative, which many people don't have.

good luck and godspeed!

[Pugsy]

Here's how I happen to like to see the graphs organized.
viewtopic/t158560/How-to-post-images-for-review.html

When too many graphs are included they end up being tiny and really can't be seen well enough to evaluate.
I mention this for future posting or sharing of reports. No real urgent need to redo these as we can see well enough things aren't going so great.

Three questions for you..
The sleep study where it was mentioned you had some central apneas.....was it a home study or an in lab sleep study? How many did it mention?
Did you have an in lab sleep study with a cpap machine to come up with the pressure settings you are currently using?
Were you actually asleep when you see the clustering of events shown?

For now...the only thing I would recommend changing is turning the Flex exhale relief OFF and see what happens.

[jasonkelly214]

thanks for the replies. I can do better graphs next time.

I did an in lab study.

They did not use a cpap on me to determine pressure.

If I’m reading my results correctly from my sleep study I had 9 obstructive, 2 mixed and 12 central, 141 hypopneas, and 22 RERAs.

I believe I was asleep during those events but I’m not sure. I have still been waking up to roll over a few times but maybe only 3 times all night.

What does that setting do? I’m not sure I saw the ability to turn that off but I can check.

[Pugsy]

Flex is the exhale relief that Respironics machines use. Sometimes with some people how Flex creates a bilevel situation can actually cause central apneas to happen and that's why the first thing we suggest when Flex is being used and we are seeing more centrals than we would like to see is just turn it off and see what happens to the number of centrals.
Your starting pressure is so low you shouldn't even need it anyway.

If you don't know how to turn it off...you can go here and request the clinical manual and it will explain how to get into the setup menu area to turn Flex off. You can request it via email.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

12 centrals all night during an in lab sleep study.....not an alarmingly high number at all. We can all have a few centrals here and there anyway. You earned the OSA diagnosis because of the hyponeas mainly and unless those were central in nature (and in a lab they should have been able to tell the difference) I don't see the centrals themselves being a problem during the initial study.
Now they might be now but they might also be just because your pressure settings aren't quite optimal but I don't like to make too many changes at once unless there is no choice. Turning FLex off will also effectively increase your pressure overall a bit...and might reduce the centrals...so that is why I only advise one change at this time.

[jasonkelly214]

I found the flex setting though it only had the option of setting it between 1 and 3, short of using the clinical manual. It did help however, I didn't feel like I was fighting the machine to breath as much. Here are my results from last night, I made two changes, I turned off the setting for which mask it's supposed to have since I'm using a philips machine with a resmed mask; and I turned flex down from 3 to 1.

[Pugsy]

How did you sleep last night? Wake often or sleep soundly for the most part?

[Dog Slobber]

I found the flex setting though it only had the option of setting it between 1 and 3, short of using the clinical manual. It did help however, I didn't feel like I was fighting the machine to breath as much. Here are my results from last night, I made two changes, I turned off the setting for which mask it's supposed to have since I'm using a philips machine with a resmed mask; and I turned flex down from 3 to 1.

You can disable Flex completely by going into clinical mode and turning it off. When you reduced Flex from 3 to 1 your Centrals dropped from 12+ to ~6. Turning it off could virtually eliminate/reduce them.

Here is a link to the Provider Guide that decribes how to get into Clinical mode.

https://www.mediquip.co.il/wp-content/u ... ovider.pdf

[jasonkelly214]

How did you sleep last night? Wake often or sleep soundly for the most part?

I think about the same. Still woke up about 4 times to turn over and switch sides. Definitely less than usual in a night that’s for sure.

Before the cpap I would wake all night and drink water constantly because I was so warm and dry. I haven’t been waking to drink water but I’m still waking with fairly dry eyes and a bit of dry mouth and a bit thirsty, not sure if that’s expected to go away or if that’s just me.

Turning it off could virtually eliminate/reduce them.

Here is a link to the Provider Guide that decribes how to get into Clinical mode.

Ok thanks I’ll do that.

[jasonkelly214]

Hi everyone. It's been a month with the cpap and I had a followup with the sleep clinic so I wanted to get some more feedback from you all. My AHI was hovering around 15 with my CPAP set at the auto setting so the lab decided to set my pressure at a constant value. They chose 8 cmH2O which seemed too low to me. Well three nights in and numbers were 21-24. I adjusted my settings to 9 cmH2O and now my numbers are around 8-9 AHI.

Here is my score with the pressure at 8:


Pressure at 9:


Pressure at 9:


Do I need to increase my pressure further? I turned off the flex exhale relief.

Another question, does anyone feel like the forced air is getting into their stomach? Maybe it's my imagination but I was belching a lot as I fell asleep last night and this morning I had a lot of abdominal pressure and had to relieve a lot of gas when I woke up. tmi?

Lastly I need help with my mask. I have the resmed airfit f30 full face. It works ok, but I have to have the straps really tight to prevent it from leaking that it hurts my head and the straps rub on my ears. I also have a beard.

So the sleep lab sent me a philips nasal pillow to try but I couldn't stand it. the noise piece fit ok and it was comfy but it was so insanely loud! It pisses air out of the front and then it has that valve at the top and it pisses air out of that too, it was making crazy noises as the air hole on top of the mask was getting blocked by my pillow or my hair, is it supposed to do that? Are there better nasal pillows I can try?

[Julie]

Hi - couple of things... have you made a real effort to not sleep on your back (whether with stuff in behind you or some other way)? It would bring all those hypopneas way down.

The aerophagia (tummy problem) is probably a result of your raising the min. pressure - try lowering it by 1-2 cms as it should help.

Give those 1-2 nights and see how things go - but if you are backsleeping I think it could make a large diff. if you can manage to change it, though probably won't happen overnight.

[Miss Emerita]

"So the sleep lab sent me a philips nasal pillow to try but I couldn't stand it. the noise piece fit ok and it was comfy but it was so insanely loud! It pisses air out of the front and then it has that valve at the top and it pisses air out of that too, it was making crazy noises as the air hole on top of the mask was getting blocked by my pillow or my hair, is it supposed to do that? Are there better nasal pillows I can try?"

The air is going out the vents, which it needs to do to keep CO2 from building up too high. But the noise can be a real problem, that's for sure.

The quietest, best diffused vent on a nasal pillow mask has got to be the ResMed P10. The headgear is very minimalist too. If you give it a try, get a fit pack, meaning a set of Small, Medium, and Large pillows. You'll want to try them all. People can be surprised by what turns out to work best.

[Pugsy]

Sounds like they sent you the DreamWear nasal pillow mask. It can be quite noisy for some people. The ResMed brand has a similar model that I found horribly noisy and annoying.

I second Miss Emerita's vote for the ResMed AirFit P10 nasal pillow mask.
The venting...you can barely feel it with your hand an inch from the vent holes and it is totally silent in terms of vent noise.

Now if you are hearing a lot of Darth Vadar breathing noise...that's more of a conductive noise and there are ways to reduce that annoyance.

[zonker]

Another question, does anyone feel like the forced air is getting into their stomach? Maybe it's my imagination but I was belching a lot as I fell asleep last night and this morning I had a lot of abdominal pressure and had to relieve a lot of gas when I woke up. tmi?

no, it's quite common. i'm very susceptible to it myself. as julie mentions, one way to eliminate it is to reduce pressure. but you don't want to do that because it'll screw with your good numbers.

for the majority of folks, this goes away after you acclimate. so hang in there and we'll hope it gets better.

good luck!

[Pugsy]

Add in a bit of exhale relief if you can.

wiki/index.php/Aerophagia