New here!

[SnoreBill]

Hello all. Been reading here since just before my first sleep study about a month ago. Thanks to all for the informative posts AND questions.

I had the study done because I was continually tired and my wife has long complained of my snoring. My untreated AHI from the study is a very mild 7. I can't imagine what some of you must have gone through before being treated. Anyway I've been on a CPAP for 12 days now and adapted OK. Started on a small nasal cushion and went up to medium when the bridge of my nose was irritated badly. I left the machine on CPAP to start with at the prescribed pressure of 7cm H2O. I've been through a few head pillows now, I used to use two to control the snoring. My neck feels much better now. The CPAP seems to have stopped my snoring as far as my wife is concerned. So all in all pretty good if kind of different, expensive, and awkward.

My concern (you knew there had to be a question or concern, didn't you) is that the AHI reported by sleepyhead software seems kind of high, considering I was not all that high to begin with. In the 12 days I've had a high night of 4.83 a low night (my second) of 2.52 with a 7 day average of 3.95. A typical night is few if any OA half of the events most nights are Hypopnea sometimes associated with periodic breathing and about one quarter each RERA and Centrals.

I know these "problems" are minor compared to others but I am wondering about how to reduce the Hypopneas. I tried raising the pressure to 7.5 but that was just a couple days ago. Should I start experimenting with APAP or should I give it a week or two to get really used to the whole process?

[Pugsy]

RERAs are not normally counted in the AHI. SleepyHead lets you do it if you want to but in a sleep lab the AHI they give you doesn't include RERAs. A sleep lab might include the RERAs in a RDI number but not the AHI.
AHI is strictly for Apneas (obstructive and central) and Hyponeas.
Unless you specifically told SH to include the RERAs then it won't. SH does go ahead and show it on the bar graphs though and it might look like the AHI is including it.
Add your clear airway index, your obstructive apnea index and the hponea index and see if it adds up to the AHI.
Now if you specifically changed SH reporting to include RERAs then that is no big deal. Just be aware that when most of us mention AHI we aren't including RERAs and ResMed machine users don't even get RERAs flagged. That is only a Respironics data point.

Obstructive apneas and hyponeas are what respond to pressure.
Centrals or clear airway events the airway is already open and you can't expect the pressures to reduce those.
RERAs that are related to Obstructive apneas and hyponeas should reduce if those are what causing the RERAs.
A RERA of 1 or 2 per hour...nothing to worry about unless you are also reporting frequent awakenings and we try to fix them not with pressure but by trying to fix what is causing the frequent awakenings. They aren't a critical data point to watch unless you are seeing a large number of them.

An AHI of 3.0 with 1.0 Clear airway index...leaves us a 2.0 per hour event average (OAI plus HI). We remove the CA index mentally because we don't treat it with pressures with this type of machine. That's whole different machine needed because of a whole different diagnosis.

That 2.0 is acceptable and quite decent especially for a newbie. It takes time for the body to adjust to all this.
Often the AHI will reduce just with time and the body getting use to having this stuff stuck on our face.

I don't see any urgent need to do APAP...the obstructive component is already quite low. Also no urgent need to increase the cpap pressure. Though it doesn't hurt to go from 7.0 to 7.5. If that is what you want to try...give it at least a week before you think about trying something else. You are at the point that minor changes aren't going to make huge difference initially and larger changes simply aren't needed.

Are you sleeping through the night pretty well? Feeling decent?

If it were me I would leave things as they are for a few more days. If you want to try APAP later just to see how things go, then try it. You may or may not even like it. I don't think changing to APAP is going to make the dramatic change that you think it might because your AHI isn't all that remarkable now. If you do want to try APAP...try something close to what you are using now with a modest range. See if it ever maxes out and make adjustments if it does.
Don't go making any huge changes...there are lots of people who would kill to have your AHI as it is right now.

[jweeks]

The CPAP seems to have stopped my snoring as far as my wife is concerned.

Bill,

Welcome to the forum. You might want to edit your profile and add in the type of mask and machine that you are using.

If nothing else, curing the snoring is a major victory. It is frightening to think of how many people out there are not getting good sleep because of a partner that snores. Even if the CPAP doesn't do anything at all for you, it is probably doing your wife a world of good. That is reason enough to stick with it.

As far as the AHI goes, I'll second what Pugsy is suggesting. Give it a bit of time before making any adjustments. The thing of it is that you didn't get here overnight, so you are not going to get better overnight. Your body is very used to the OSA events and your brain has adapted to messed up sleeping. It is going to take a bit of time to unlearn the old habbits and for your body to essentially learn how to sleep all over again. Another factor that sneaks in sometimes is that once you get adapted to CPAP, you will sleep more deeply, and for some people, that actually makes their OSA a little worse.

Give it two weeks or so, and then look at the data over a few days. In fact, post some of the graphs here on the forum.

-john-

[SnoreBill]

Thanks Pugsy and jweeks. Sounds like good advice.

Unless you specifically told SH to include the RERAs then it won't. Add your clear airway index, your obstructive apnea index and the hponea index and see if it adds up to the AHI.

It does, I didn't specifically tell it and it is not including RERA's. So on average my AHI is made up of 2/3 Hypopnea and 1/3 CA with some occasional OA thrown in.

Obstructive apneas and hyponeas are what respond to pressure.

That's what I thought from reading some of your previous responses to other questions and why I experimented with raising the pressure a bit. But I think I'll leave it there till I get some of my mask and comfort issues straight.

Are you sleeping through the night pretty well? Feeling decent?

If nothing else, curing the snoring is a major victory. It is frightening to think of how many people out there are not getting good sleep because of a partner that snores. Even if the CPAP doesn't do anything at all for you, it is probably doing your wife a world of good. That is reason enough to stick with it.

Yes it is. Overall I'm not sleeping any worse than before and I think I feel a bit better for it all.

My nasal mask irritates the bump at the top of my nose. It became a small open sore after just a couple of days. I switched from "small" to "medium" nose insert which seemed to help some and the sore healed (but now it seems to be coming back). Leaks are up a bit but controllable. However controlling them involves waking up more or taking longer to get to sleep after my early morning trip to the rest room. I've tried raising the mask up but then the larger mask support hits my eyelashes. No problem at night when I go to bed, but getting back to sleep with the combination of irratations seems to be a current issue.

Has anyone experimented with cutting out part of the support system (the part that rests on the face) on the Easy Life masks?

[wilsonintexas]

several people have had luck with a mask liners to help boith leaks and sore spots. I just ordered one form the adacheek site.

these are more single use
http://www.remzzzs.com/

there is a second one that is cloth.
http://www.padacheek.com/

I an envious of your ahi, good luck, and give it a little more time.

[Pugsy]

A bit of moleskin stuck on the offending area of the mask might help with the abrasion. You don't want a sore to develop.
No mask should ever tear up the skin. If it does..it isn't fitting well. Some people do have what I call "paper" skin...very thin and easily torn. The skin is already ultra thin on the bridge of the nose anyway and add in paper thin skin and sometimes even the tiniest of pressure or movement will tear the skin. If you are one of those people I would suggest considering a different type of mask.
Have you considered a nasal pillow mask? Nothing touches the nose except at the nostrils.
Much easier to get to seal and keep a seal and won't tear up the skin on the nose.

[SnoreBill]

I'm going to give the pad a cheek liner a try and start researching the nasal pillow masks. Seems like quite a variety out there. Thanks,

Bill