Newbie looking for help

[Jcoyne97222]

First of all, I want to thank all of you for this site!

I am new to APAP but years ago failed getting used to CPAP because I was left on my own to try and figure things out. (This time around my sleep help hasn't been much better.) I have talked with my sleep Dr about my previous failure and haven't been overjoyed with their help. I won't go into that but if I hadn't found this forum I for sure would have failed again.

I will try not to go put too much info into this post because I have tried quite a bit on my own before actually posting for the 1st time. I want to try and get enough info to give everybody an idea of what my issues are and what I have tried.

I started with a Airfit F20 full face mask which leaked horribly. I would be up for hours trying to adjust the mask only for it to start farting every time I got into a good sleep. After some reading on here and some other sites I found the Airtouch F20 which has the memory foam. It has made a big difference in being able to actually sleep with the mask on through the night.

Some nights I have woken up with a bad dry mouth so I have switched to using mouth tape which has helped. I began using 3M blue tape until I got some of the "X" CPAP tape. My mouth dryness with the X tape is greater than when I was fulling taping my mouth with the blue tape. The mouth dryness is tolerable and have been playing with my humidity setting.

I haven't been able to get my AHI down any lower than the 9 range. Last night was 16.85 which surprised me when I read the stats. I had raised my low pressure and starting pressure to 7 (from 5) because when I go to sleep the initial 5 seemed kind of low. Last time I talked to my sleep technician she wanted to raise my max up to 20 to bring down my AHI. I told her my mask won't hold that level! Her response was well, lets try it. 20 minutes into sleep I woke up from face farts. I turned it down to the 18 and was able to sleep. I ended up the following night dropping the max level to 17 because I woke up with farts and found the machine running at 18.

We went with the full face mask because I have been told I am a mouth breather. After switching to using the mouth tape I have to question if I need a full face mask? Can I get a better seal with a nose mask?

I picked up an SD card and started recording my data last night. I have installed OSCAR. It took me some time to get the hang of OSCAR and get the view to show the charts you guys seem to like to see.

I am wondering what direction I should go?



Thanks again!

John

[Julie]

Hi, you'll get lots more from others here, but one thing is that 20 is the usual max setting for Apap... 4 is the machine's default low and difficult for most to breathe at, so 6 or 7 is a more likely minimum setting, but that being said, you have lots of clear airway (central) events and Apap is not the preferred machine type to use... and changing settings on an Apap won't really help, so another type of machine should be prescribed (wondering who did prescribe the Apap, but then GPs are not known (to say the least) to be even a bit knowledgable re OSA/Cpap, etc., and referral to a sleep specialist would be a much better idea.

Even if you were on Apap for mostly obstructive events, the setting responsible for most of the 'help' is the min... the max so often being left at 20 or only a bit lower depending on circumstances... the min. goes up and down as you breathe and it's the one that you would be concerned about - again, with a reg. Apap for obstructive events, which you have some of, but in your case because of the clear airway ones, a whole other kind of machine should be prescribed. And BTW lowering the max from 20 to a much lower # (e.g. 10 or so) could keep the min. pressure from rising when needed to, to deal with events.

[Pugsy]

How much of the night are you perhaps on your back???
Did you wake often during the night above?

[Jcoyne97222]

I am not really sure about how much time on my back. I know from my home sleep study that was done, they state in the results that I was Supine for 4 hrs 13 min out of a total of 6.5 hours of the test. Kind of weird because I thought I slept mostly on my side but I guess I don't really know how I sleep?

I know I got up once to go to the bathroom I think around 3pm. I believe I woke up another time for dry mouth but don't think I got out of bed.

[Jcoyne97222]

Hi, you'll get lots more from others here, but one thing is that 20 is the usual max setting for Apap... 4 is the machine's default low and difficult for most to breathe at, so 6 or 7 is a more likely minimum setting, but that being said, you have lots of clear airway (central) events and Apap is not the preferred machine type to use... and changing settings on an Apap won't really help, so another type of machine should be prescribed (wondering who did prescribe the Apap, but then GPs are not known (to say the least) to be even a bit knowledgable re OSA/Cpap, etc., and referral to a sleep specialist would be a much better idea.

Even if you were on Apap for mostly obstructive events, the setting responsible for most of the 'help' is the min... the max so often being left at 20 or only a bit lower depending on circumstances... the min. goes up and down as you breathe and it's the one that you would be concerned about - again, with a reg. Apap for obstructive events, which you have some of, but in your case because of the clear airway ones, a whole other kind of machine should be prescribed. And BTW lowering the max from 20 to a much lower # (e.g. 10 or so) could keep the min. pressure from rising when needed to, to deal with events.

Julie,

Thanks for your quick response.

The office I am going to is a Sleep clinic that my GP referred me to. Naturally the GP group owns the Sleep clinic... I find them more of sales people though. I don't find them knowledgeable or available to discuss my results or how it's going. That's what has brought me here. My sleep study was an at home study at my request because my sleep study years ago was done in a hospital setting and I really struggled to sleep at all.

During my sleep study my average AHI was 58 so my events are much reduced but not down to the goal. The sleep study doesn't show OA vs CA's.

Can't wait to hear other feedback.

John

[Julie]

Why do you say the study doesn't show OAs or CAs (or are you ref'g another study)? Look on the left hand panel for both of those - they're def. there.

[Jcoyne97222]

The results I got from the sleep clinic doesn't break out CA and OA. It just gives me an average AHI and then breaks out the AHI for supine an non-supine.

My point is I don't know how many CA's I had during my "sleep study"

[Julie]

A lot - too often people worry about 'centrals' when there are only a relative few when going to sleep or awakening, but we call those sleep-wake junk and they don't matter to anything much. In yours, however, there are a lot all the way through the report - see the purples, etc... so they are something that needs fixing, tho' again, Apaps are not good at it... and here's where I hope Pugsy or Roby Sue etc. returns to tell you which machine type would be needed to deal with them.

[Pugsy]

Since the original diagnostic sleep study didn't separate centrals/clear airway apneas from obstructive apneas we don't know if the centrals seen now are something that has been there all along or something that popped up with the addition of the cpap machine.

It's a bit premature to go talking about needing a different machine at least right now.
It clearly obvious that the obstructive stuff (OAs and hyponeas) aren't being adequately prevented.
It wouldn't be impossible for that much obstructive stuff to be causing wake ups or arousals (may or may not remember) and the centrals flagged could be simply related to arousals and if we can reduce the obstructive stuff the arousals might get reduced and then with less arousal then we have less centrals.....if those centrals are arousal/awake related.

My thoughts are to treat what we can see clearly needs better prevention and see what happens with the centrals once the OAs get reduced.

First thing I would do is try to figure out if I was on my back very much and if I was on my back a lot I would try staying on my side more and see what happens.

It does appear that the obstructive stuff is needing much higher pressures and much higher pressures does come with the baggage of making the job of keeping the mask sealed much more difficult.

[Jcoyne97222]

I will ask the wife about what position she sees me in. She won't have much info because she mostly sleeps like a rock and never moves. Another thought is I can use my security camera next weekend when at our 2nd residence.

Regarding mask seal.... Is a nose mask a better option to get a better seal? With the full face mask the pressure literally just pushes it off my face until the air leaks between my face and the mask. No matter how tight I make it.

I was reading that the EPR setting can cause CA's. This setting was turned on and set to 3 (high) last week remotely by my sleep technician. Any thoughts on EPR?

[Pugsy]

Some people (actually a very small minority of EPR users) will have EPR itself triggering centrals but it really isn't all that common.
I use a machine that gives me essentially EPR of 4 (but it's called Pressure Support) so I use 4 cm difference between inhale and exhale and I don't have centrals pop up in numbers that might be concerning.

So it isn't something that is a given foregone conclusion that EPR is a problem for everyone....it's only a problem for a very small minority of cpap users.

If you didn't see a huge drop in the number of centrals when you turned EPR off then it is unlikely that EPR is the cause of your centrals.

[Jcoyne97222]

I have just started to capture data last night so I don't have any idea how many Centrals I had with it off. I will watch a few more days with it on and then try turning it off.

[ozij]

According to the image you posted - and granted, it's a single night - you spent half the night at a pressure of 11.28 or more.
To me, that indicates that your minimum pressure of 7 too low - it's letting too many obstructive events occur.
The first thing I'd do is a gradual raise of the minimum pressure, aiming to be at about 11 or so. This could prevent some of the obstrutive events that are driving your pressure up.
By gradual I mean at a rate you can tolerate. I'd start with a raise of 1, but if that feels too dramatic, try less.

I agree with Pugsy that it could be back sleeping - but for some people the struggle to keep of their back may be more detrimental the quality of their sleep than sleeping at higher minimal pressure.

[lazarus]

In support of Pusy's and Ozij's comments:

I had many central apneas documented during my diagnostic sleep study, a full-night lab NPSG. I also had a fair amount of central apneas show up during my full-night lab PAP titration.

In my case, though, it was the obstructive apneas that were triggering the centrals. After a few weeks of eliminating my obstructive apneas with optimized PAP, the centrals disappeared completely too, so far never to return. That was 15 years ago. That was with bilevel with 4cm difference earlier in my treatment, and in more recent years with an APAP with EPR set at 3.

Simply stabilizing the airway over time all night every night with optimized PAP can sometimes be enough to eliminate central apneas--even true, real, lab-scored and verified central apneas, in my case--without specialized PAP approaches.

[Jcoyne97222]

Thanks everybody.

Last night I had one of my best nights with an AHI of 7.39 with my CA events at 1.5.

I feel like I am really getting used to sleeping with the mask so I think I am going to let it go for a few days and watch the data.

ozij,
I see the logic you are talking about with the minimum pressure but when I raised it from 5 to 7 the next day my AHI spiked up to 16. So I think I should watch the data for a bit. I think I was changing too many settings. When you make multiple changes or changes too often its hard to tell what caused what.