Plebe Questions

[DetDave]

I'm a new CPAP user, got my 1st machine this past Thursday. My sleep study showed an AHI of 67. After constant fatigue for months, my hopes were very high that I would finally get a good nights sleep. The first night was difficult, learning to sleep with a full face mask. The next morning I reviewed the results. My average AHI was 80 and I was even more exhausted. Friday afternoon I had to leave work so I could take a nap - 6 hours @ ave 90 AHI. Slept another 8 hours that evening with an ave AHI 60. Saturday I was still exhausted, even after 14 hours of "sleep".

This outcome was less then I expected. I downloaded SleepyHead to explore the data and it shows a persistent state of Obstructed Airway. I begin snoring and my respiration rate/volume diminishes exponentially until a gasp. After which the cycle repeats itself. It appears the best sleep period occurs after 5 am. There is about 1-1.5 hours with minimal reports.

Out of desperation, I increased the pressure to 9.4 cm last night to gauge impact. After 8 hrs or sleep my average AHI is down to 33, but it still peaked at over 80 for most of the night and it shows a 40 min period of Cheyene Stoke Respiration. Again, the "best" sleep (and what brought down the AHI average) occurred after 5 am for about a 1.5 hours.

Are my expectations to high? I see the charts of others with great envy. Mine is one a big event. Is it reasonable to expect a CPAP machine to reduce an ave 70 AHI to something under 5?

Have others preemptively increased their own pressures - essentially titrated themselves?

Machine: ResMed AirSense 10 Auto
Mask: Amara Gel
Titration: Fixed 8 cm
Physical: Professional 52 yo healthy male, 5' 10" 190 lbs. Generally fit.

[Jay Aitchsee]

No, your expectations are not too high. Many have reduced very high untreated apnea indexes to numbers less than 5 with treatment.
And yes, many have also self titrated to achieve effective results.
Post a couple screenshots (see https://sleep.tnet.com/main for what and how to post) and I'm sure you'll receive some advice from forum members, but just from your description, it sounds as if you'll need to further increase your pressure.
Welcome!

P.S. You'll probably want to register here.

[Julie]

What do leak stats say?

[DetDave]

My leakage reports are very low - less than 5.

This is a copy of the results from Saturday night.

[Julie]

May I ask what position you tend to sleep in for the night? And what are the chances your head falls forward enough to potentially cut off (or lessen) your airway as a result?

[DetDave]

I tend to sleep on my back with a soft feather pillow.

[Jay Aitchsee]

Dave, assuming you were sleeping (or mostly so) during the period 2-6AM, I think I would change to the Auto mode with a minimum of 8 and maximum of 16 (or 20) and see what the machine wants to do pressure wise and if it is able to eliminate some of the obstructive apneas.
It's possible the OA you are experiencing are position related (like on your back) and you will need higher pressures with different positions. In the Auto mode, your machine would be able to provide those.
On the other hand, if you were mostly awake during that period, from being disturbed by the treatment or mask say, then the numbers you see may not be valid and you will have to become more comfortable with the treatment.
Some people find the Auto mode disturbing in itself, but using it could help to find a more effective pressure. Once found, you could switch back to straight CPAP, if desired.

[Julie]

Ok... while it is true that if someone who sleeps on their back but has a very low leak rate may continue to do so if all other things are good, in your case I would (until further notice) make every effort to stay off your back when sleeping - whether using foam wedges in behind, or whatever you can come up with to do it.

I would also try (nothing at all to lose) a soft cervical collar that keeps your head up, and therefore airway more open, plus keeps your jaw more closed if it tends to drop - it may not keep your lips closed if that is a problem, but at least it will help somewhat and has been shown to be pretty effective in many people.

[DetDave]

Julie and Jay,

Thank you for the ideas. My GF keeps rolling me off my back and it does seem to help. Although, I almost immediately roll back onto my back. I'm going to try sleeping with a smaller pillow to see if the obstruction is caused by head position. Not sure how to force myself to sleep on my side beyond tying me down.

Where would I get a "small cervical collar" - at this point I'm willing to try anything!

D

[Lucyhere]

Where would I get a "small cervical collar" - at this point I'm willing to try anything!

D

Take a look on Amazon... they have several. I've heard that Walmart and Target carry them also. Your pharmacy might carry them too.

[Thatgirl]

Do you have any heart or lung illnesses?

[Okie bipap]

I picked up my first cervical collar at the local CVS drug store.

[thecpapguy!]

My leakage reports are very low - less than 5.

This is a copy of the results from Saturday night.

Good afternoon DetDave! What kind of machine are you using? On your machine information it said first that you are using an Airsense 10 Autoset, but now it says your are using an Airsense 10 Elite. Depending on which machine you are using may change what a lot of the users here suggest for your pressure change. Just a heads up!
If you are using an Airsense 10 Autoset then it definitely looks that you need an increase in your pressure settings to alleviate the obstructive sleep apnea and hypopnea that the Saturday download shows and it seems you are using this machine on a "fixed" pressure setting right now of 9.6 cmH20. You should change the settings to "AUTO" and then change it to a pressure of 11-15 cmH20. Then evaluate after a day or two again to see how the mask is still fitting and how well the machine is now controlling your sleep apnea.
If you are using an Airsense 10 Elite then you will not be able to use the "AUTO" settings. You may try the machine on a pressure of 13 cmH20 and see how you fair after a night or two.

I hope this helps in some way! God bless!

[Julie]

NB - not a 'small' cervical collar, but a soft one... you don't want to end up with hard plastic thing you'd be given post whiplash, etc, there's a big diff. between them.

[palerider]

My leakage reports are very low - less than 5.

This is a copy of the results from Saturday night. ]

it'd be better, and more informative if you'd arrange your sleepyhead chart like explained here, and screenshot and post as explained on the next two pages linked at the bottom of this page: https://sleep.tnet.com/resources/sleepyhead/shorganize

however, it looks, on the surface, that your pressure is way too low.

if it were me, I'd put your machine in auto mode, min 10 max 20 and see what things look like tomorrow.