New user - any advice appreciated

[flcpap17]

Male/26/6’2/197lbs

Was diagnosed last week with mild sleep apnea in a home test (AHI of 6, RDI of 9). I can’t seem to get below an AHI of 3. I believe my current settings have me between a pressure of 4-11. I downloaded OSCAR but do not know what any of this means.

Thank you ahead of time for the help.

[Julie]

Hi, pretty good for a newbie, but I wonder why your max pressure setting's only at 11 vs the more usual 20... or wasn't anything explained to you? Plus 4 for the min. setting is the default low and most cannot inhale decently at that. I'd raise the max to 20 for now, and the min. to 6, as it's the 'one' that does the real work... then see how things look in a couple of days. Do you feel any better yet (not necessarily expected so soon, but we ask). Are you on any meds?

[flcpap17]

Hi thank you so much for the response, this community has been so helpful. I still feel pretty tired throughout the day, but cognitively I see a huge impact. I am much quicker at processing things which is helpful as I am in the financial services industry.

I am on the lowest dose for a blood pressure medication. I am a 6’2 and under 200 lbs and run an average of 4-6 miles a day. Yet I have high systolic blood pressure. Doctor did a sleep test (at home) and it was concluded I had sleep apnea. It runs in my family so it was not a huge surprise. Hoping this brings my bp down.

[Pugsy]

Raising your maximum is unlikely to make any difference at all. It won't change the machine's response and if you aren't hitting your max of 11 now...it won't go higher if you raise the maximum.

Now the minimum pressure setting....that one is the most critical setting and increase it a bit might clean up what I call "clutter" on the report....the CAs/centrals we ignore because more pressure won't fix those but everything else you see on that report is related to airway obstructions and they might be reduced with a small increase in the minimum pressure.

Your OSA is mild but that is based on the sleep study AHI numbers which don't always reflect the impact or symptoms of that AHI.
Snores and Flow Limitations aren't part of the AHI but they can sure disrupt sleep quality and anything that messes with our sleep quality will mess with how we feel.

Don't fixate so much on the numbers alone...always take into account how you are sleeping and feeling as a measure of how successful cpap therapy is going.

I hope this helps your BP issues but bear in mind it might not. While it does help reduce BP in some people it doesn't always. I am a prime example of that. If sleep apnea is the cause of your BP issues then it might help but there are other reasons for BP issues unrelated to sleep apnea and cpap can't fix any issue that is unrelated to sleep apnea no matter how much we want to put all our problems in the sleep apnea basket and have cpap fix it. My sleep apnea has been well controlled for 11 years now and I still get to take a BP pill each morning.

Also...bear in mind that some BP meds can cause fatigue. I drew the short straw on that one as well

And your sleep quality will greatly affect your energy levels. If you wake often you can expect to not feel as well as you want even if the AHI is super low and there's no clutter on your reports.

[chunkyfrog]

I suggest you raise your low setting from 4 upward, a little at a time, until your graph smooths out.
That should reduce your untreated events, hopefully.

[flcpap17]

So maybe set it to 6? Around the average pressure

[Pugsy]

The whole idea with the minimum pressure is to prevent the airway collapse issues in the first place. Stop them from happening and then allow the machine to increase the pressure when special circumstances point to a need for more pressure like maybe sleeping on one's back or even REM stage sleep which often cause OSA to worsen and a need for more pressure.

If you use 6 minimum...should do a good job but given it looks like you don't need a lot of pressure for special circumstances your machine probably won't vary much except for those spiky looking things (test pressure probes which look like saw teeth and it's just normal testing and not a direct response to something) but that's okay.
If 6 isn't a comfortable starting point...try 5 and see what happens and maybe try 6 once you are more used to 5 starting point.
Some people really notice a small increase in a negative manner and others can handle big changes without issue. I have no idea which way you are.

[Miss Emerita]

I just wanted to say welcome. You're off to a great start: using the machine all night, using Oscar, joining this forum, experiencing cognitive improvement (yay!). With increases in your minimum pressure, you will probably see your index of potentially disruptive events dropping way off. Even so, it can take a while for you to experience the full benefits of apnea treatment, so be patient. Meanwhile, google all your meds and talk to your doctor about any with side effects having to do with sleep or daytime fatigue.

Keep us posted, would you?

[flcpap17]

Here are the results last night after setting the minimum at 6. Did not seem to help all that much. Should I continue to move it up?

[Pugsy]

How did you sleep last night? Have very many wake ups?
We usually advise sticking with a new setting for a few nights and let the body adjust a bit before changing things unless the results are horrible for some reason. The body/brain does take a bit of time adjusting to any new setting.

If you remember a few wake ups then we always have to consider the possibility that some of the flagged events are false positive events and those don't count except for us to wonder why the wake ups.

You can go here and watch the videos to learn about arousal related flagging. While it talks mainly about central/CA apneas...we can have false positives in any event category.
http://freecpapadvice.com/sleepyhead-free-software

[flcpap17]

@Pugsy I feel like I slept great. Around 5am I was a little restless, but I feel awake right now and am mentally/emotionally doing better. I also feel my bp may have went down. I used to be able to feel my heart beat all of the time, but now I can’t for the most part.

[Pugsy]

There is some truth to the "give it time" adage. Some years back I did an experiment where I chose a setting that worked "okay" and kept with it for 6 weeks without changing anything. It was giving me an AHI around what you are seeing and I was sleeping okay with it.
After 6 weeks my AHI was reduced 50% and that was with my doing doing in terms of changing anything. All I did was give it time.

You are lucky in that you don't need a lot of pressure to hold your airway open.

Remember we don't sleep the same each night and it is normal to have some variations in what we see on paper. So it's possible to have a "bad" night on occasion and it just might mean we slept poorly or maybe were on our backs more or whatever. If we continually change the settings every night based on one night ....just chasing our tails.

I usually suggest people give a new setting at least a week before deciding if another change is needed unless the results are just horrible.
Especially when new to cpap therapy because there's always the "new to cpap" variable in the mix.

How you sleep and feel is even more important than the overall AHI because without sleep the numbers don't mean much.
Always factor in how you feel in general. I know that we tend to be a numbers are needed for validation society and we want a quick fix but with this cpap stuff we have to be more patient than usual. Numbers are a part of it but not the whole picture.

If that were my report and I was sleeping good and I was new to cpap therapy, I would give myself a week at the new settings and see where they seemed to trend. I know that I might have an AHI of 3 one night and 0.5 the next night and not change a thing. It just happens. Heck last summer I had a night when the AHI went to 9.4...that got my attention but it was a fluke and more related to poor sleep because of some extra back pain than my apnea.