New user trying to understand why apnea events are not <5

[Gagne]

Looking for some guidance. During my sleep study I was having an average of 41 events per hour (320 events in 7 hours and 39 minutes with over 20 awakenings). I was sent a Resmed Airsense 10 AutoStat. I started therapy on June 27th. When I turn on the machine the pressure setting image says 8.0-16.0. I am a both nose and mouth breather so the first few weeks I tried two different nasal masks with both chin strap and tape and I had a very difficult time. I felt I could not breathe. My husband has had a Cpap for 18 years so he said I was mouth breathing and that I needed to try a full face mask. I am using the Resmed F40. I am able to tolerate this one and it doesn’t appear to be leaking but my apnea scores are ranging between 5-8 per hour. Central Apnea seems to be .8 every night. I am trying to sleep on my side (area episodes were highest on my back in the sleep study). I have the ramp turned off (it felt much harder to breathe and pressure relief turned on).

Why am I not getting lower apnea scores? I downloaded the SD card data into SleepHQ. I will link below.

https://sleephq.com/public/da5953ae-ca6 ... 7f3c3bff5c

Thank you in advance for your help.

[Pugsy]

You need to share one of the nightly detailed reports and not so much the weekly trend data.

Most likely you need to be using more minimum pressure to start with but without seeing the detailed information we can't say for sure.

[Gagne]

Thank you for the quick reply. I figured out there it is night by night. Here is 8/1/24 and 7/31/24

https://sleephq.com/public/14a2f1ce-308 ... 6eb937a382

https://sleephq.com/public/72e00ecd-d53 ... 9490673e9b

[Pugsy]

Primary sleep position????

Do you know if your OSA is worse when you are on your back or REM stage sleep?

You need more minimum at times during the night and most likely more maximum. How much more we don't know yet because it may depend on if the pressure needs are related to supine sleeping or REM.

[Gagne]

I think I am sleeping about half the time on my back and half the time on my side. On my sleep study night the data showed the following number of ahi:
Supine : 55.9
Prone: 23.8
Right: 40.8
Left: 19.4
Non supine: 33.2

The sleep study showed I was in REM sleep 21% of 7 hours and 39 minutes. There is a chart that shows the events buyt it is a bit confusing. Am I allowed to upload a screen shot?

Thank you so much for your help.

[Gagne]

I am normally an active sleeper going from left to right side when I awake but according to the sleep study I end up on my back too.
I really appreciate the help. I am not able to see the actual sleep medicine neurologist until late January 2025. There are no appointments at any location. My primary care ordered the sleep study and the local Johns Hopkins pharmaequip has helped me on the phone to get started. It is all a bit stressful and overwhelming.

This is the one night I had a low event score:

https://sleephq.com/public/1d09adcf-261 ... bcaf244db9

This is my highest night of events:

https://sleephq.com/public/a88a13da-45c ... f00fe2d86c

[Pugsy]

Some of the OAs on the "worse" night were arousal/awake related flagging. You weren't sound asleep. If you aren't asleep they really don't count for much except point to not sleeping so great from some reason on other.

How are you sleeping and feeling?
Please always report this (how you slept and how you feel) when asking for advice because numbers don't tell the whole story.

Your home sleep study that you had done made an educated guess as to sleep stages. I say "educated" because it didn't really have anything like EEG leads to measure sleep status/stages. Probably gets close though.
Looks like your worse O2 desats also happen during what the home study wants to call REM stage sleep.
Doesn't surprise me because REM can worsen OSA and can cause higher pressure needs. I have this myself. My OSA is 5 times worse in REM than in non REM.

I am thinking something around 10 cm minimum (up from the 8 cm minimum) or maybe a little more.
The machine needs to be able to get to where it needs to better prevent the airway from collapsing and as it is right now it takes a little bit too long. Either REM or supine related.
You can sometimes control sleeping position but you can't control REM so I don't know how hard I would try to stay off my back given your REM OSA AHI is fairly significant.

[Gagne]

Thank you so much for your knowledge able insight. I certainly feel better (less daytime fatigue and less headaches) than before I started using the machine but I still feel tired upon waking. I was having frequent night time urination (2-4 times a night) and that has improved greatly. I am waking up once or twice in the night and I think I am falling back asleep quickly. The bigger issue is that I am waking at 5-6am which is much earlier than usual. I will use the bathroom and try to go back to sleep again but I usually can’t fall back asleep.

Do you think that the high end pressure is ok or do you think that needs to be adjusted up as well?

[Julie]

I think you want to be sure (with your MD) that nothing else is going on either (not suggesting that anything is).

[Pugsy]

Do you think that the high end pressure is ok or do you think that needs to be adjusted up as well?

It depends on what happens once your minimum pressure is increased and the apnea events are better prevented.
It depends on if you still hit the max very often or not.
Hopefully with a more optimal minimum pressure the machine won't go to that max line again so the max setting becomes a moot point.

[Pugsy]

I am reminded of what happened to a woman a while back who was in a similar situation as you are where the minimum wasn't quite doing a good enough job. I forget all the particulars except she was routinely seeing pressures of around 18 cm.
She also needed more minimum and once she upped her minimum to a more optimal level her max pressure never went above 13 cm after that correction. So sometimes more minimum actually means that the maximum the machine wants to go to is considerably less. No guarantees but it is very possible and certainly worth trying.

[Gagne]

Thanks again for all the help. It makes a lot of sense. Fingers crossed it works for me too.

[Gagne]

Update: I changed the lower pressure to 10 instead of 8. I left the high pressure at 16. I used this new setting for two nights and both were almost identical. Apnea events lowered to 6. Still hoping to get below 5 events per hour and ultimate closer to zero. I tried to make an effort to sleep on my side both nights. I noticed that the central apnea events went higher.

Here is the report:

https://sleephq.com/public/653bf8b1-a31 ... 59a2c4c447

https://sleephq.com/public/f57f2778-9bf ... e68bd05a50

Any further thoughts? Thank you in advance for the help.

[Gagne]

I seem to have posted twice when I tried to edit. Sorry! I am not sure how to delete.‍♀️

[Pugsy]

I removed the first duplicate post and left the second one because you had 2 links in it and only 1 in the first.

You likely need a little more minimum and for sure you need to increase that 16 max setting. See that clustering of OA flagged events when you maxed the pressure at 16 for a period of time...?? The machine wanted and needed to go higher than 16 and couldn't.