Looking for input on CPAP setup / new forum member

[Flor]

Hello everyone,

First time poster here - grateful for the opportunity to share with fellow CPAP users and get tips and input. I read the stickies and hope I'm sticking to what information you need and am not adding too much - but in case it helps, a little bit of a background on my journey so far: I'm 37, male, 6'1, ~175 pounds and was diagnosed about this time last year with sleep apnea. It took about 5 months to feel really comfortable with the CPAP. I now really enjoy it and wouldn't want to sleep without it. I started with the N30i mask and didn't like it nearly as much as the mask I have now which I am quite happy with - the P30i. My nostrils are on the smaller side so it works a lot better and I feel much more... oxygenated? For lack of a better term. I also wear a chin strap and use tape to keep my mouth closed - which, in combination, work well. I also sleep slightly elevated (10 - 15 degrees or so).

My symptoms prior to diagnosis were waking up and gasping for air. I rarely would tire throughout the day, but the gasping for air was miserable and painful. So, as far as the therapy goes, most nights are good. Now that I'm using the CPAP, I feel groggy again at night or when I wake up, which in my case I think is a good thing. Untreated, I rarely if ever felt groggy or struggled to get up after sleeping (like I had a good, deep sleep) - so I'm actually quite happy with that and it's confirming to me that the treatment is largely successful. That said, if it's possible, I'd like to be around .5 AHI a night, but at least with my current setup, that has seemed elusive. I had EPR off until about 3 - 4 weeks ago, but would wake up winded due to the pressure being around 8 - 10. Setting EPR on has helped with that and is much more comfortable. However, either because of it or just my overall pressure setting perhaps being too low, it seems that my AHI is higher than it was at that time.

Last night was a good example of what I'm trying to figure out and avoid - my AHI was 3.2 and I woke up a few times. It wasn't painful, but I could tell I wasn't breathing quite right. Here are my graphs: https://imgur.com/a/w6nQFzq

It seems that around 4:40 to 5:20 in the morning the AHIs were around 11, but the pressure only hovered around 7.8'ish... And I'm curious as to why the pressure didn't increase or didn't show an increase during that time? Perhaps I should just elevate my base pressure to around 8 or 8.5? I'm careful to only adjust one thing at a time and test to see whether the results are better or worse.

Also, I'm curious as to why my apneas show up largely as "central" instead of "obstructive"? My provider mentioned that is common being on CPAP therapy and could just be a "side-effect" that occurs from time to time. Just looking to check that and maybe with my graphs something else can be seen or explained.

Overall, I'm just always aiming to improve and like to try to achieve that goal I have in mind of .5 AHIs / night. However, if that is an unreasonable expectation, let me know. Thanks in advance for any input or guidance!

[ChicagoGranny]

I feel groggy again at night or when I wake up, which in my case I think is a good thing.

You think feeling "groggy" is a good thing??? Define "groggy".

I'd like to be around .5 AHI a night

I hate to see goals like this. More on that as the discussion continues.

I'm curious as to why my apneas show up largely as "central" instead of "obstructive"?

We can't tell much about that from an OSCAR screenshot. I'm skeptical about the central apneas. If you use a free account at SleepHQ, we can tell much more.

Welcome!

[Flor]

I feel groggy again at night or when I wake up, which in my case I think is a good thing.

You think feeling "groggy" is a good thing??? Define "groggy".

I'd like to be around .5 AHI a night

I hate to see goals like this. More on that as the discussion continues.

I'm curious as to why my apneas show up largely as "central" instead of "obstructive"?

We can't tell much about that from an OSCAR screenshot. I'm skeptical about the central apneas. If you use a free account at SleepHQ, we can tell much more.

Welcome!

As far as feeling groggy goes - in my earlier years I was a heavier sleeper. I think that never changed, it's just that sleep apnea hit. Prior to CPAP treatment, I always felt very awake right away in the morning, like I hadn't been deeply asleep. Now when I wake up I feel more as though I've been deeply asleep, which I think is good... But, perhaps I'm wrong and it's not normal?

Good to know if having a certain AHI goal isn't a good thing - would like to learn more there.

I think I have everything setup at SleepHQ - let me know how this looks or if I need anything different:

https://sleephq.com/public/teams/share_ ... /dashboard

[ChicagoGranny]

I zoomed in on half a dozen of your CAs. Immediately preceding them, you take a deeper breath. This indicates arousals, and the CAs are called post-arousal CAs. They are not a problem. The arousals are the problem. You have a few too many arousals. Review your sleep hygiene and the side effects of any drugs you take.

How do you feel during the day? Energetic? Any excess sleepiness? At bedtime, do you feel fatigued, but not stressed?

[Flor]

I zoomed in on half a dozen of your CAs. Immediately preceding them, you take a deeper breath. This indicates arousals, and the CAs are called post-arousal CAs. They are not a problem. The arousals are the problem. You have a few too many arousals. Review your sleep hygiene and the side effects of any drugs you take.

How do you feel during the day? Energetic? Any excess sleepiness? At bedtime, do you feel fatigued, but not stressed?

Oh interesting, good to know. I'm not taking any medications. I believe I have pretty good sleep hygiene overall - in bed about the same time each evening. I fall asleep within 5 minutes usually of when I want to.

I feel pretty good overall throughout the day. Not high energy, but not low either. I can't say I'm ever sleepy.

I have higher than normal anxiety in general (but as noted, no medications), so some stress I suppose, but not excessive.

Are the arousals something that CPAP therapy can resolve or is that something different entirely?

[ChicagoGranny]

Are the arousals something that CPAP therapy can resolve or is that something different entirely?

CPAP therapy is about breathing. It can prevent arousals caused by breathing events. But there are many reasons for arousals that are NOT related to breathing events.

My symptoms prior to diagnosis were waking up and gasping for air. I rarely would tire throughout the day, but the gasping for air was miserable and painful.

So, CPAP is successfully treating your biggest problem. All I can suggest is to work on diet, moderate exercise, sleep hygiene and the ability to handle stress. Shouldn't everyone do that?

[spitintheocean]

I went through something similar when I changed my mask and turned EPR on. My AHI also went up a bit during the first month until my body adjusted. What you describe with the pressure staying around 7.8 is exactly what I saw. Raising the minimum to around 8.5 helped a lot, not by much, but enough to stop those clusters from happening. Might be worth trying it for a night or two.

[ChicagoGranny]

enough to stop those clusters from happening

At which times on his chart do you see clusters?