New OSA patient - Some questions

[MMartin730]

Okay, I am going to try and make this short but I am quite a talker, so here goes..

About 5 years ago I was diagnosed with "mild" sleep apnea when on my back.. I was prescribed an APAP machine but probably used it about 10 times then it went away into the closet. I could NOT get used to the mask. I have a deviated septum so I need a full face mask to breath comfortably and all the ones I tried wouldn't do it.. and I figured mild wasn't bad so gave up. It was the P&P Sleep Style 200 Autoset. Never inquired more about my sleep study or AHI or anything at all. 1st Sleep Study only slept 3 hours, second sleep study I never fell asleep at all (cause i had mask on)

Bringing me to today. Recently had a new sleep study done. Turns out now I am classified as "severe". I am hoping it's a bit of a fluke to be so high but the number came back as an AHI of 120 and 13 pressure setting. Freaked me out completely. Decided I needed to make a commitment to the CPAP machine. Purchased the ResMed Airsense 10, LOVE the machine but freaking out about my numbers, still not a fan of the mask.

My AHI the first day, with the machine at pressure 13 was 39.39. I have only had machine for 12 days and each day only use the mask about 3 - 4 hours a night. ONCE i used it for 6 hours!! WOO HOO! My AHI seems to hover around 6 to 13 now, but with no consistancy of how I use the machine seeing I am definitely not used to it yet.

Most of my graphs in sleepyhead show a decent sleep for about an hour/hour and half then a huge cluster of dozens and dozens of events. I am trying to figure out if I end up on my back for those times, or if I am moving the mask or doing something strange.

I read all the "newbie" posts.. experienced most of what everyone has been saying.. feeling more tired even though using the CPAP but working my sleep debt off.. but still have yet to make consecutive days of long mask use.

I am curious to know the opinion on the original 120 AHI from the more experienced, and anything to look out for as to why I would have so many clusters like that. I also get a clear airway/CA maybe ONCE every three nights so far.. was wondering if there was an acceptable amount of potentially wrong labeled events, or maybe adjustments/leaks that may be misdiagnosed?

I am going to post last night's usage. Please understand I start with the mask, end up taking it off in my sleep, putting it back on, then wife wakes me up to tell me to put it back on cause i take it off again.. etc.. I do it all subconsciously too not knowing!

I appreciate all your input, and great information on the board! I hope to become a helpful member of the forum.

-Matt

[Julie]

Hi - what are you actual (prescribed) pressure settings and is your machine programmed for those? Without that info, it's hard to be sure what's what yet, but I will say that while I know it's hard to get used to using the machine (really, the mask I imagine), until you're using it for every time you sleep including naps, and for all of the hours you sleep, you're not going to feel much better. If your mask is a problem, tell us why, and someone should be able to help. If none of it works out, you need to look at other masks - there are so many available now (look on Cpap.com for ideas) that you should be able to find at least one that works for you.

[MMartin730]

The Dr. told me that at the sleep study my AHI was around 5 with the CPAP machine on with no higher than the pressure of 12, so she prescribed me 13 to try and get me under the 3 mark.. I am using the ResMed Quattro Air. I tried the ResMed Quattro FX and the Mirage Liberty mask. The ResMed Quattro Air seems like the most tolerable one so far.. just keeps leaking at the top of my nose and a lot of times blows right into my eye, so I wake up with a dry eye. Besides that just the transition to wearing a mask.

I saw some people report they feel better instantly using the machine, others years.. got me down when I have not felt much better so felt like I wanted to join and be part of the forum!

Thanks!

[Merlin7]

Hi and welcome, you'll get lots of support and advice here.

I'm relatively new to CPAP and the best I can suggest is just to stick with it and the results will come.

Anything under a 5 AHI is considered normal, and what matters is how you feel.

Have you tried 'Nasal Pillows' as these are less intrusive and allow a more mobile sleep as they only cover the bottom of your nose. Provided that you don't breathe through your mouth and your nasal passages allow you to breathe easily then I'd give them a try.

[englandsf]

Was your sleep study AHI 120 or 5? They are world's apart.

Back sleeping is not going to help and mask selection - as mentioned - will be key. Can you breathe through your nose at all?

[MMartin730]

I should revise some of my original post...

Original AHI from sleep study was 120/hr
My AHI now is between 7 - 39 (I believe the 39 was me sleeping on my back which was no good!)
No Nasal pillows because of deviated septum, mouth breather.

After reading a lot about the cpap and all.. I wasn't sure if the big clusters (as shown on my screen shot) were from maybe my positioning or maybe REM sleep? Is there a way to tell when REM sleep is?

[Julie]

What is the full name and model # of your machine? The model # is often underneath, but empty humidifier water before turning it over! Do add any wording on top as well. You apparently are on straight Cpap (at 13) vs Auto?

[MMartin730]

It's a ResMed airsense 10 auto cpap.. but set on "CPAP mode" not auto at 13... I have the ramp up for pressure which is the curve you see when i first put mask on

[Pugsy]

The fixed cpap pressure of 13 is not sufficient to prevent those clusters of OAs and hyponeas.
The 2 most common causes of these clusters where the pressure is not sufficient are supine sleeping or REM stage sleep or maybe a combination of both.
There's no real sure fire way to tell if this is REM sleep from the data that the machine gathers but the time frame is spot on for probably REM stage sleep. It's fairly common for OSA to be worse in REM sleep and even to need more pressure sometimes in REM.
First REM stage normally comes in around 90 minutes after sleep onset and then as the night goes on REM comes more frequently and will last longer.

Google "sleep stage" and look at the various hypnograms that show the sleep cycles and you will see what I mean.

So you need more pressure if you are going to use cpap mode (and I don't know how much it might be a little or it might be a lot) ...or consider changing to apap mode and allow the machine to go a little higher to try to prevent those OAs and hyponeas (and it will try). Probably something around 11 or 12 minimum and maybe 15 or 16 maximum if in apap mode. Your clusters are fairly significant meaning there's a truck load of events happening in a short period of time and they are ugly enough that they could be a factor in why you aren't feeling so great. No guarantee that if the clusters get broken up that you will feel as good as you hope to feel but it's possible that the clusters are impacting your sleep as they are right now.

[MMartin730]

Thanks for the response.

I want to try that.. but I know my insurance needs to see me using the machine for 3 months prior to it being "purchased".. Wasn't sure if me changing the pressure like that would screw anything up like that.. I have played around in the clinical menu before just to snoop around and see what can be set but I did not change anything other than the ramp time..

I am desperately trying to see if I can get my wife to somewhat verify my sleep position compared to those clusters because that was only one of at least 5 or 6 nights (out of 12) i had clusters similar to that..

On a side note I was excited because my Dr. was mentioning that once I get things back on track it potentially will help my overall quality of life and help my metabolism and maybe make weight loss easier.. would be curious to other people's experiences with their overall quality of life and potentially their health in general, seems like sleep is linked to so many different health issues!

[Julie]

Don't be afraid to change your pressure or mode... just change it back before you bring in the machine.

[Tatooed Lady]

I was hesitant to change any settings, too, because non compliance in my case means unemployed. HOWEVER...compliance (to DME is same as hours, not effective therapy) means being comfortable enough to USE it. Sometimes it's easier to deal with discomfort and force ourselves to keep the darned mask ON if we can see results. In your case, if using apap settings like Pugsy suggested helps break the clusters up, and gets results that help you sussessfully use it more...who is the doctor to complain?
Write down all the current settings, THEN putz a little. That way, if you find in a couple days that the new settings don't work better for you, you can change back. If they DO help, you can tell the doctor that you tweaked things based on what therapy was doing for you, and what you were shooting for. If you know what you're changing and WHY, the doc should be supportive.

[palerider]

If you know what you're changing and WHY, the doc should be supportive.

and if not, you can change that too!!! *lol*

[MMartin730]

I agree 100% about the changing of the settings. The thing that sucks is it's a WHOLE day before you know the results. I am going to have my wife try to watch me and note the time and position if possible. She probably wont which will lead me to change the pressures. I appreciate all the help!

Thanks!!

[Greg Riddle]

Why not ask your dr to change the rx to apap mode. If your worried about any compliance issues.