New to CPAP- need help figuring out settings

[htalt]

Hello,

I have only been using my CPAP for about 3 weeks now, and I have only recently finally been able to sleep most of the night with it on. My problem that I am trying to get figured out is my flow limits, and trying to smooth out my breathing chart. I am not sure how I would go about this, and I was wondering if anyone would be willing to look at my SleepHQ data to help me understand what is going on with my breathing. My sleep study report showed a lot of hypopneas.

I have tried using EPR of 2 but that seemed to cause a lot of centrals, so I brought it down to 1 but that doesn't seem to be good enough. My pressure was originally prescribed as 6-12, but I have been messing with the pressure settings to find something comfortable. 6 felt too low so I have it around 7.8, 12 felt a little high so I brought it down to 11. I have been using APAP mode for the last few weeks, and just last night decided to try straight CPAP mode and see how it went. I'm not sure if it was better or not. I am sharing last night and the day before. I appreciate any insight and information anyone is able to give me, thank you for your help!

https://sleephq.com/public/3b284b3d-d15 ... 0db4d025a8
https://sleephq.com/public/bc633763-e07 ... 2dc485cde2

[Pugsy]

How are you sleeping and feeling?
Are you experiencing any nasal congestion?
Do you remember very many awakenings during the night?
Have you ever actually hit the max of 12 setting?

Can you upload a night with EPR set to 2 where you felt you had more centrals than you wanted to SleepHQ?

[Pugsy]

Another question..

Do you take any medications of any kind? If so, what?

I did a quick evaluation of the flow rate (breathing) zoomed in on both of the reports you shared.
The bulk of the flagged events are arousal or post arousal related. You weren't sound asleep...and if not asleep they don't mean much except you weren't asleep.

Plus you had a LOT of other arousals that didn't have events flagged so it looks like crappy sleep quality from something other than airway issues. No amount of tweaking of the pressures is going to fix sleep quality issues when the issues aren't related to airway issues.

Got anything else going on that could cause arousals or awakenings? Pain, mask issues, leak issues....anything?

[htalt]

I haven’t been sleeping very well the past few weeks while I have been getting used to using the CPAP, it’s only in the last few days that I feel like I’ve actually been able to sleep a good chunk of time so I have been feeling actually a bit worse since starting honestly. I do have nasal congestion but I’ve been working with an ENT to get that under control, it’s only been about a month though working on that.

I do feel like I wake up a lot at night, the past couple nights I feel like have actually been my best with not waking up that many times that I can remember. I have hit 12 before I’ve seen it on my sleep report the next day, but I’m wondering if it’s getting that high due to mask leaks. I believe I have the wrong size for my mask and I’m waiting for the replacement size to get here in the mail, so I’m just trying to make do with what I have in the meantime. I can upload a night where I noticed the most centrals, I will have to do that later today when I am home from work though.

Yes I take one medication it is pantoprazole for heart burn, taken during the morning. How can you tell if a breathing event is an arousal or post arousal? I’m still having trouble understanding the charts. All I had heard was the breathing should be very round and smooth top to bottom, and seeing mine looking very jagged all over the place is what has me worried about it. The only other thing I can think of going on is just anxiety about sleeping with the mask on. I’m still getting used to it, and I’m feeling anxious about being asleep with it so I feel like I’m not able to fully relax and just let go so it can take over.

Thank you for your responding!

[Pugsy]

How can you tell if a breathing event is an arousal or post arousal?

You learn how to evaluate the flow rate. I am really short on time right now but later this evening I will explain in more detail but here below is one example that I like to use because the difference is so blatant.

I circled the asleep breathing in red and both images are of the same time frame. One is just zoomed in on closer.
The awake/arousal breathing including the flagged events is so obviously different from the asleep breathing that I think you can get a general idea. I don't know what woke me up but it wasn't related to airway issues. Probably pain/discomfort since that is my usual culprit. I am old and have some bad arthritis issues.






Here's one of yours below...see those big gulps of air right before the flagged events??? We don't take big gulps of air like that when we are asleep. Asleep breathing is nice and regular and boring.



See the lack of big spikes in breathing on this image below? I was asleep when these 2 OAs got flagged. I slept right through them. BTW it was all that I had for the entire night...no big deal. They really didn't even cause an arousal.
These are real asleep flagged OAs.


Don't feel bad about having trouble figuring this out. Took me almost 2 years to grasp and even now sometimes I have trouble figuring the iffier ones out with any certainty. It's an ongoing learning process.

Here's another example. I think you can spot the awake breathing fairly easily. It's not mine (forget whose) but it's fairly obvious.



Gotta run. More tonight when I have more time.

[htalt]

https://sleephq.com/public/c44c4d12-80b ... e313aba83c

Here is a night that I had EPR on 2 and felt like I had a lot of CA.

Thank you for your explanation of the difference between breathing on the charts. That does make a lot more sense, I was pretty worried looking at my chart at some of the breaths thinking omg I must be fighting for my life at night with the way the lines are all over the place. I haven't had a follow up appointment with my doctor to go over my charts since I started on CPAP, that's coming up in a few weeks but I just thought I would see what anyone had to say about my charts, and if there is anything you can spot that I should tweak to make it go better.

Thank you for your insight, and for any other information you can share!

[Pugsy]

Here is a night that I had EPR on 2 and felt like I had a lot of CA.

You had a grand total of 5 centrals over a little more than 6 hours of use.
4 of those were obvious arousal related and you weren't asleep.
1 was sort of iffy but even if it was the real deal and you were asleep it's normal to see an occasional real central.

EPR didn't cause the centrals. When EPR causes centrals people get 5 or 10 or 15 or more PER HOUR and they aren't arousal related at all.
You don't have a problem like that with using EPR.