New user, high OAs followed by waking up

[Seiru]

Hello,

I recently got my machine after being diagnosed with 15 AHI obstructive sleep apnea. It was prescribed by my sleep doctor with a set pressure of 7.0, which was strange to me considering I never had a titration study. I've since upped the pressure to 10, because I felt like I wasn't getting enough air.

Anyways, I've been having quite a bit of trouble so far. It seems like as soon as I fall asleep (which is an accomplishment in and of itself at this point), I get a very high occurrence of obstructive events (like 30-60 AHI), until I finally do one of two things:

1. If I'm wearing my Dreamwear, my mouth opens, eventually waking me up from the dry air escaping, or from air somehow getting into my stomach and causing great pain/nausea. A chin strap has not solved this, and I'm paranoid about taping my mouth.
or
2. If I'm wearing the Airfit F10, my mouth opens, and I end up waking up anyways from (I assume) discomfort with the therapy and high OA events.

Is this normal? Looking at the data, if I stayed asleep, my AHI would end up being 3-4 times as much as it is without any machine at all. Logically, it's sort of no wonder why I'm waking up. Should I increase the pressure even more? Should I set the machine to auto with a range instead? Any help is appreciated, I'm pretty upset at this whole situation. Please find attached my SleepyHead data from last night. I only fell asleep once during it, and it should be pretty obvious when it was if you look at the chart.

Thanks!

Not inlining because the image is big: https://image.prntscr.com/image/e26g4Xl ... TmIlHw.png

[ajack]

I found It will take a week or so to get use to the pressure and a couple of months to get use to cpap. fixing the leaks was the first priority. the machine has a mark fit where it blows higher pressure and bonjoure from this site linked also has good mask info.

I'd use the f10 for now and fix any leaks. I moved to the f-20 and found it better. You can leave it on fixed cpap till you adjust and feel comfortable switching to auto, I wouldn't leave it longer than necessary.

Get into the clinical settings manual and switch to auto mode http://www.apneaboard.com/adjust-cpap-p ... tup-manual

I would start at 10 minimum and 15 maximum. I finished up on 15-20 with cpap and when I woke up, I had to check if the machine was on, I didn't feel any pressure. so you will get use to it.

[Pugsy]

The leaks aren't making it into large leak territory but if they are waking you up they need to be fixed.

Of the roughly one hour that you posted....how much of it were you actually asleep?

If you were asleep for most of the hour then the pressure of 10 works some of the time but not all of the time....as to why...the 2 most common culprits for needing more pressure are sleeping on your back or REM stage sleep...or maybe a little of both.
So if you were asleep most of that hour...maybe you rolled over onto your back. It's a little too early in the sleep cycle for REM stage sleep but it wouldn't be totally impossible...but my first suspect would be you were on your back.

If it were me I would keep the minimum of 10 but go to apap (auto) mode and set the max to 20 and see where the machine wants to go. I doubt it will go to 20 because it will only go as high as it thinks it needs to go. If going higher creates a problem (aerophagia or centrals) then we re-evaluate and can hopefully limit the max and not compromise therapy.
Also in cpap mode there is no FL flagging..it's turned off in cpap mode so the fact you had no FLs flagged doesn't mean much because we don't know if they did or didn't happen since the FL flagging is turned off. Going to apap mode will turn on the FL flagging.

Don't know what to make of the green PB time....let's see if that continues to pop up and if it does we can look more closely at the respiration pattern during that time frame.

[Seiru]

The leaks aren't making it into large leak territory but if they are waking you up they need to be fixed.

Of the roughly one hour that you posted....how much of it were you actually asleep?

If you were asleep for most of the hour then the pressure of 10 works some of the time but not all of the time....as to why...the 2 most common culprits for needing more pressure are sleeping on your back or REM stage sleep...or maybe a little of both.
So if you were asleep most of that hour...maybe you rolled over onto your back. It's a little too early in the sleep cycle for REM stage sleep but it wouldn't be totally impossible...but my first suspect would be you were on your back.

If it were me I would keep the minimum of 10 but go to apap (auto) mode and set the max to 20 and see where the machine wants to go. I doubt it will go to 20 because it will only go as high as it thinks it needs to go. If going higher creates a problem (aerophagia or centrals) then we re-evaluate and can hopefully limit the max and not compromise therapy.
Also in cpap mode there is no FL flagging..it's turned off in cpap mode so the fact you had no FLs flagged doesn't mean much because we don't know if they did or didn't happen since the FL flagging is turned off. Going to apap mode will turn on the FL flagging.

Don't know what to make of the green PB time....let's see if that continues to pop up and if it does we can look more closely at the respiration pattern during that time frame.

Thanks for the response. I fell asleep a little after 12am, right before the OAs started. I can post some data from other nights if needed, but the pattern is pretty much the same...after an hour, I'll finally fall asleep, immediately get a lot of OAs, and then wake up due to the reasons in my first post.

I'm a bit worried about higher pressures pushing air into my stomach. I did try 16 before just to see what it was like, and after 20 minutes I definitely felt like my stomach was absorbing a lot of air. I could try to open up the pressure tonight though and see what happens.

Also I don't think I'm getting leaks? I think that's just the natural leak rate of the mask exhaust. I was wearing the AirFit F10 FFM for that data, so my mouth opening wouldn't matter. When I wear my Dreamwear, it's super obvious when my mouth opens looking at the data.

[ajack]

I found the air in stomach was for a few days after increasing pressure. The main thing is getting a full night with the mask on and getting use to cpap. If lower pressures help for now, I'd do that. I found the gas settled down now, so it may be just part of the cpap journey for some, for others it may be a real issue.

[Pugsy]

Respironics reports total leak which includes the vent rate. Your total leak line is pretty much perfect...no where near large leak territory.
Top line is total leak (vent rate plus any excess leak) and bottom line is an approximation of excess only leak.
You can see the leak graph better if you omit the graphs below it and make the the other graphs not so tiny.
You don't really need the snore graph (snores are flagged on the Events graph if you have any) and Resp Rate and Tidal volume aren't particularly useful.
Now any leak that wakes us up no matter how big or how small needs to be fixed but unless leaks are waking you up...leaks aren't an issue.
Large leak territory is somewhere up around 80 L/min total leak (top line) at your current pressure and mask. It varies with pressure and mask so it's hard to give it a fixed threshold.

If you are nervous about allowing a higher pressure because of the belly issues you can back up and start small and see where the machine wants to go.
Try a 10 minimum and 13 range and see what happens.

We have to get you to where you aren't having those clusters of events which are waking you up. You are having a lot of events in a relatively short period of time...it's no wonder they wake you up.

Not surprised the 7 cm didn't work... You are going to have to do your own titration...not hard though. I did mine because the RX I was given was for 8 and it didn't work...took me about 3 nights to figured out what I needed and dial it in.

[Seiru]

Thanks for the advice! I'll give auto a shot tonight, and I also think a new mask might help a bit. I'm waiting for my CPAP supplier to get Amara Views in stock, because this F10 blows air everywhere, and I hate having a mask so high up on my nose (I feel like it's pulling/pushing my eyelids open, for some reason).

A lot of little annoyances. I'll try to handle them one at a time.

[Pugsy]

Oh...here's a hint on how to embed the images and not have them be huge.

Log on to your imgur account....go to the image you wish to share and click on it.
You should see a little box of addresses on the right (see image below) and right below the addresses are the thumbnail selections.
Click on "Large thumbnail"...the addresses will change a bit...then copy the last line in that box of addresses...I think it is called "linked bbc code"...paste that address in the body of your text here. You can click on the preview button to see what it looks like and if it is okay then click submit.
Your image will be a manageable size that we can see easily and if we need to enlarge it for some reason we can click on it and make it bigger.
Often the Large Thumbnail is sufficient anyway.
You have to click large thumbnail first though...otherwise your image will be huge.



Good luck tonight.

[Seiru]

Thought I'd post this since I was brutally awakened anyways: I tried auto pap at 14-20, fell asleep around 12:45am or so, and then had the familiar experience of being disturbed awake again. Here's what SleepyHead shows:



I wonder if maybe everything above 10 pressure is too high? Could too high a pressure actually cause OA events? Maybe my doctor was right and I should just try 7 pressure.

[palerider]

I wonder if maybe everything above 10 pressure is too high? Could too high a pressure actually cause OA events? Maybe my doctor was right and I should just try 7 pressure.

it just doesn't work that way.

looks like you rolled over on your back, or possibly it was REM related, and your pressure requirements just went up... you'll notice the events started before pressure wentup.

[Seiru]

I fell asleep right as those OAs started happening, I was awake before then. I also stayed in the same position throughout my short 20-25 minutes of sleep.

Could these OAs actually be CAs? I have no idea how accurate the machines are at distinguishing between the two.

Just grasping at straws here

[Pugsy]

I think maybe you should be getting with your doctor and getting set up for a formal sleep lab titration since you didn't have one.

In the meantime let's look at 2 or 3 of those events up close and zoomed in.

Do this please....go to the Events tab right above the statistics on the left.
Click on it so you see the event categories and then click on the Category "obstructive apnea".

Highlight and click on one of the flagged apneas around the 00:57 or 00:58 time frame.
The graphs below the events graph will change and be zoomed in on the events around the one you clicked on along with hopefully 2 or 3 on either side.
Get a screen shot of the detailed report at that level of zooming (clicking on the one event) and post it please. Don't try to zoom in further or out further to get more events. I need the scale that the clicking on the one event brings.

[Pugsy]

Why did you jump to a 14 minimum starting point? Why didn't you do 10 to whatever max?
I thought you were nervous about the max being higher?

[Pugsy]

Could these OAs actually be CAs? I have no idea how accurate the machines are at distinguishing between the two.

It wouldn't be totally impossible for these to be CAs but it's extremely rare that the machine gets fooled.
I don't see in pressure pulse tic marks which is what the machine uses to help it decide between central and obstructive...so wondering why or why not.

You don't inadvertently have the pressure pulses turned off so they don't show up do you?

I wonder if maybe everything above 10 pressure is too high? Could too high a pressure actually cause OA events? Maybe my doctor was right and I should just try 7 pressure.

There's nothing magical about "above 10 cm causing centrals" I see pressures in the high teens every night and I don't get any more than a rare normal sleep onset central.
It's not just "high" pressures that can cause centrals....it's any pressure. So maybe it's 6 cm that causes centrals or maybe it's 16 that causes them.....it doesn't have to be a high pressure.

In the olden days 10 cm seemed to be a magic cutoff point that the medical mafia would use probably because statistically more people would have problems with centrals above 10 than below...but maybe that is because more people use 10 or more than use less than 10.
At any rate we don't know for sure that is what is going on with you but it wouldn't be impossible. The machine wants to increase the pressure so it thinks those events are obstructive but I have seen one case where the person developed complex sleep apnea and the the machine was flagging stuff as obstructive when it was central.

[Seiru]

Thanks for your responses. Here's the picture you requested:



I bumped it up a bit because it seemed like I was getting apneas right as I fell asleep at 10, so if I could get used to falling asleep at a higher pressure, at least that might give me good data to look at.

Also, I do see one pressure pulse around where I got a single CA. You can see pressure pulses are listed on the left side in my previous image. I don't really understand why the machine wouldn't need those to identify the other OAs, but I'm somewhat new to this. I'll definitely speak to my doctor if things don't get better...I didn't have a titration study done because my insurance wouldn't cover it. Apparently a lot of insurances will pay for an APAP to save on the costs of a titration.