New here, introduction and some newbie questions...

[FrederickRose]

Hi all,

There is a saying that doctors are bad patients, and I definitely fit that stereotype. I am a 45 yo physician (not a sleep specialist), am obese (BMI 33), have a neck circumference of 18", snore, have some morning headaches, high blood pressure, and my wife has seen me gasp while sleeping.

I figured the chance of my having OSA was extremely high, and I know I shouldn't have done this, but after reading a lot of the great info on this site, I went ahead and just ordered some gear on Amazon and started using it a few days ago. Here's what I bought:

Respironics DreamStation 500 Auto
DreamWear Gel Pillow FitPack
Respironics Premium Chin Strap

I left the machine on APAP, min 4, max 20, but realized that 4 was uncomfortable and raised it to 6. I am not using the humidifier. Just intranasal saline at night. So far, no drying or discomfort noted.

First night I was uncomfortable, second night less so, and last night slept pretty well. Actually, today I feel better than usual. Not sure if that is the PAP or placebo effect.

My AHI has remained in the double digits, but I looked at the Sleepyhead and can see that the majority of events recorded were false positives obtained while I was awake. I'm also wondering if some of the other positives obtained over night could be false positives obtained after brief awakenings. I know I tend to toss and turn and occasional wake. And then if those are false positives, then the automatic pressure increases I am seeing in response to them may be counterproductive. Is there any way to tell from the data whether wake is likely preceding events or vice versa?

I know I should bite the bullet and get a real sleep study done in a lab .

In the meanwhile, I just wanted to introduce myself and thank the community for the incredible amount of excellent information here!

[Pugsy]

What is your elevated AHI made up of primarily?

Care to share some graphs so we can see what you are seeing?

https://sleep.tnet.com/reference/tips/imgur

how to organize
https://sleep.tnet.com/resources/sleepyhead/shorganize

examples of how we like to see things
viewtopic/t103468/Need-help-with-screen-shots.html

The machine won't increase the pressure for the CAs/Centrals...and if that is primarily what you are seeing as potential false positive the pressure increases you see aren't from these.

Using the pressure increases are from snores, Flow limitations, OAs and hyponeas and it's rare that false positive will drive the pressures up.

Before you schedule that sleep study let's see what your machine is showing you.
Oh...are you experiencing multiple wake ups during the night that you are aware of?

[FrederickRose]

Thanks for your reply! I will post the requested graphs later today. I don't remember waking up a lot overnight.

The pressure increases I saw were in response to obstructive events. I guess one thing I was surprised by was how different the automatic pressures were from one day to the next.

[TedVPAP]

Thanks for your reply! I will post the requested graphs later today. I don't remember waking up a lot overnight.

The pressure increases I saw were in response to obstructive events. I guess one thing I was surprised by was how different the automatic pressures were from one day to the next.

Welcome to the forum. With data guiding adjustments, and time to get used to your new sleeping situation, you are on the path to improvement. Solutions are wonderful.

I try to avoid sleeping on my back as it requires significantly more pressure.

[FrederickRose]

Welcome to the forum. With data guiding adjustments, and time to get used to your new sleeping situation, you are on the path to improvement. Solutions are wonderful.

I try to avoid sleeping on my back as it requires significantly more pressure.

Thanks for the welcome. I naturally tend to sleep on my side or on my stomach, so I guess I have that going for me.

a rule of thumb is
the low end should be set high enough to keep the airway open to avoid apnea

i would not bother with a sleep lab study unless you suspect central apnea or other sleep problems than OA

an auto machine will titrate as well as the sleep lab can do

Thanks, I don't suspect central apnea, and I like the idea of not bothering with a sleep lab study . I guess it will take some time to figure out what settings to use!

[AMESS]

Think since you are a doc you would want the study. You probably know someone in the field too. Just sayin'. The good news with the study-you know exactly what you have and how good or bad it is before you start with any equipment. Many folks here self treat. I do not But I look forward to other people's problems, comments and solutions, and hopefully I gain good info myself.

[FrederickRose]

What is your elevated AHI made up of primarily?

Care to share some graphs so we can see what you are seeing?

Before you schedule that sleep study let's see what your machine is showing you.

Here are my graphs from last night, which was the first pretty decent night of sleep I've had while using the machine. Click for higher res version. Thanks again for offering to take a look!

[FrederickRose]

Think since you are a doc you would want the study. You probably know someone in the field too. Just sayin'. The good news with the study-you know exactly what you have and how good or bad it is before you start with any equipment. Many folks here self treat. I do not But I look forward to other people's problems, comments and solutions, and hopefully I gain good info myself.

I will probably go ahead and do it at some point .

[Tovi]

Think since you are a doc you would want the study. You probably know someone in the field too. Just sayin'. The good news with the study-you know exactly what you have and how good or bad it is before you start with any equipment. Many folks here self treat. I do not But I look forward to other people's problems, comments and solutions, and hopefully I gain good info myself.

I will probably go ahead and do it at some point .

If you already know you have OSA, I'd start with a CPAP titration study. This is a study where you're on CPAP and the lab tech adjusts the pressure until s/he finds the right range for you. There are several studies that show that a narrow range of pressures gives you a better night's sleep. Sure you could eventually figure out what range of titration works for you, but there are people who do it for a living and so can figure it out in a single night.

It's possible you may also need other equipment like oxygen or bipap and personally I wouldn't want to speculatively buy expensive equipment.

[Janknitz]

Those graphs are a little gnarly. It' looks like you are "chasing" your AHI's. That happens when the minimum pressure is too low--it takes the machine some time to respond to an obstructive event, and by the time it does it has to go higher to catch it.

I'm a little rusty on this so I'm going to leave recommendations to wiser folks, but it does look like the settings are not what you said. It's not 6 to 20 but 5 to 15. I'm guessing you need to bump the minimum pressure up more to stop chasing the AHI's and raise the max pressure until you get this under control because you are spending a lot of time at the ceiling. As you get the minimum pressure dialed in and are no longer chasing apneas, you can probably bring the max pressure down.

And you need to take care of your leaks.

The arousals you mention do seem to be related to your apnea.

[Julie]

Can't imagine anyone being more than just barely adequately treated (if that) on a low pressure of 5... one above the machine's default low of 4.

[Grace~~~]

Hi FrederickRose ~~~

I will be so excited to watch your progress here and hope you continue to post and share.

I am not knowledgeable enough to help but in a way we are similar, you and I.

I did not get a study either ... just a machine ... and got all the help that I've gotten thus far - HERE, on cpaptalk!
These people are as amazing as they are entertaining!

I love the way cpap makes me feel. I can not tell you how much I love it.
I also know there is probably still room for improvement ... which is so exciting.

I just haven't committed to learning more and I am not sure of the real excuse? Laziness? Not really.

I got such a huge boost early on in how I FELT that playing with all the numbers and seeing if I can get even better hasn't been necessary. For me I am limited by complete lack of tech skills and recent loss of too many IQ points.

So it's exciting for me to learn vicariously from people like you who share and who are clearly more tech savvy and without my issues and limitations. You seem like my very favorite type. I am really looking forward to watching your success story unfold!

Good Luck!

[RiverDave]

Looking at your data, bump your minimum to 7 (so you can breathe. I don't know how people tolerate less than that) and increase you maximum above 15 (2 cm increases over 3-4 days). If you max out the machine, you are not getting the full benefits. Don't go nuts on the increase and give it a day or 3 to see a difference.

Just my opinion. others may vary. It's only air.

RiverDave

[TedVPAP]

What is your elevated AHI made up of primarily?

Care to share some graphs so we can see what you are seeing?

Before you schedule that sleep study let's see what your machine is showing you.

Here are my graphs from last night, which was the first pretty decent night of sleep I've had while using the machine. Click for higher res version. Thanks again for offering to take a look!

Thanks for posting the data. As others have said, your minimum pressure is too low to prevent OSA problems so . The auto algorithm is a great feature, but the range needs to be set near the area of interest. Your minimum is set to 5 but the mean of your data is 13.7. If your lower pressure was set closer to 13 then the machine could better manage your change pressure. You may need time to get comfortable with higher starting pressures so you may have to work your way up.

I use the same machine and my range is now set to 17-20 and my mean is 17.5. When my minimum was set at 15, my AHI was twice as high.

[Pugsy]

Your minimum pressure is too low and the maximum likely needs to be increased.

I would suggest a minimum of 9 or 10 and max of 20 and see what happens. You might end up needing a little more minimum but a 5 cm jump is fairly significant and might not be comfortable enough to fall asleep. If you aren't comfortable starting at 9 or 10 cm then maybe 7 cm and work your way up slowly and watch the data as you go up with the pressure.

Maybe you will get lucky and not need as much pressure as we first thought.

Also...if the minimum pressure is more optimal it wouldn't be impossible for the maximum pressure to actually drop and the 90% pressure to drop also. I have seen it happen often.

90% numbers...just means for 90% of the time you were at OR BELOW that number. People often forget the "or below" part of the definition and think it means where a person was for 90 % of the time.