Concerns by a new CPAP user (Gary Aikin)

[GaryAikin]

I'm new to using CPAP and am a 70 years old male. For most of this year I've been waking up many times each night (5, 6 or more), which I thought was because I had to go to the bathroom to urinate. Often on returning from one of my visits to the bathroom I was unable to go back to sleep. This in turn led to a major depression, for which I am still being treated (currently 6 mg of Lexapro each day). Eventually I began seeing a (very good) psychiatrist, and on one of my early visits with her, she recommended that I undergo an overnight sleep study to determine if I might have sleep apnea. (Twice I had asked my family physician to refer me to a sleep medicine specialist, but he didn't want me to do so, instead suggesting that I see a psychiatrist).

In response to my psychiatrist's recommendation, I met with sleep medicine specialist Dr. Thomas Kirk on October 2nd of this year, and underwent an overnight sleep study on November 4th/5th. I was overjoyed when early in the morning of November 5th the sleep study technician came into my room, said "Welcome to the rest of your life", and put me on CPAP. Finally the root cause of my sleep problems and likely of my depression had been discovered!! I had obstructive sleep apnea for which treatment (CPAP) was available!! I quickly adjusted well to being on the CPAP machine and slept much better for the rest of the study. A couple of weeks later I obtained a copy of my raw sleep study results (without any interpretation by Dr. Kirk). The raw results showed that before being put on CPAP I had an AHI of 65.7, and that my AHI went way down after I was put on CPAP.

In a December 4th meeting with Dr. Kirk's physician's assistant (PA), the PA indicated that Dr. Kirk had diagnosed me as having severe sleep apnea and had recommended that I be put on a BiLevel CPAP (BiPAP) machine. A prescription for the BiPAP machine and a mask was sent to a local DME provider.

On Friday December 7th I obtained my equipment from the DME provider (a company that specializes only in CPAP machines and accessories) and was given instructions in its use. I was given a ResMed AutoCurve 10 VAuto BiPAP machine and a Fisher and Paykel Eson 2 nasal mask. I started using the equipment the next night, Saturday December 8 and have continued using it all the following nights. Last night was my sixth night. Each night I use it all night until I get up in the morning. I had no (conscious) trouble using the BiPAP -- the mask doesn't bother me and the pressure doesn't bother me. The pressure levels on my BiPAP machine are 11 mgH2O inhale and 8 mgH2O exhale.

Over the course of the past few days I've experimented with three different nasal masks. The first mask (the Eson 2) was the mask prescribed by my sleep doctor, and likely was prescribed because it was the same mask I used during the sleep study (or similar). However, when talking with one of the RRTs at my DME company (who himself has been on CPAP for six years), I mentioned that the Eson 2 was leaving severe marks on my face. (The RRT had fitted the ESON 2 mask for me when I first picked up my equipment.) He recommended that I switch to a ResMed AirFit N20 nasal mask. I tried this for one night, but didn't like the N20 because the N20 vent is very noisy. Based on a recommendation from another CPAP user, I then got a Philips Respironics Wisp nasal mask, which I used last night and the previous night. The Wisp mask has worked well for me -- few marks when adjusted properly and very comfortable. I had no leakage problems with any of the three masks.

Having been on my BiPAP machine for six nights the machine has already helped me somewhat. My AHI values have been much better than the 65.7 in the pre-CPAP portion of my sleep study, on the first couple of nights I got up less frequently (this was not true last night), I now have no difficulty falling back to sleep after returning from the bathroom, and I do feel more refreshed after getting up in the morning. Each morning I look at the sleep summary on the Aircurve 10 display panel, and I look at my results on ResMed's myAir Website. I also use the SleepyHead software program on my PC to view the detailed results from my AirCurve 10 SD card

Based on the myAir results, and on how I feel during the daytime, I have some concerns.

My concerns are (1) my AHI values perhaps are higher than they should be after starting my CPAP/BiPAP (4.3, 7.2, 4.4, 3.5 and 5.5 for the past five nights), (2) on three of the past five nights my air leakage values have exceed ResMed's 24 L/min threshold (leakage values of 29, 23, 35, 28 and 23 for the past five nights), even though the indicator on my AirCurve 10 has shown a yellow smiley face for leakage every morning, and (3) on some of the past several days since starting use of my CPAP/BiPAP I've felt very drowsy/sleep during the day.

I've never heard any leakage from any of the three masks. I ran the AirCurve 10 Mask Leak test with my Wisp mask and it constantly showed a yellow smiley face. To the best of my knowledge I breathe only through my nose, not through my mouth. However over the six nights of using my BiPAP machine I observed that several times each night when I was awake, I briefly separated my lips a bit which let air out of my mouth. (I might be doing that when I'm asleep as well, but I have no way of knowing since I'm asleep.) Perhaps this is the cause of my high AHI values? I'm meeting with the RRT at my DME company this afternoon to discuss my concerns. I might ask for a chin strap in the hope that the chin strap would prevent or minimize the separation of my lips.

Are my AHI values reasonable for having started CPAP (BiPAP) six nights ago?

Are my leakage values reasonable or unreasonable? Would a chin strap help? What are the downsides, if any, to using a chin strap?

Is it reasonable that my starting CPAP (BiPAP) would cause me (for a while) to be be drowsy/sleepy during the day?

Thanks in advance for any and all comments.

[Pugsy]

Welcome to the forum.

Mr Smiley shows up for leak management until you spend 30% or more of the night in large leak territory.
So while you may have some large leaks occurring...not for 30% of the night.
Are the leaks causing the higher than you want AHI? Doubtful but we really need to see when those events are happening in relation to when you are having the large leaks.
This is where posting the detailed image so we can see what you are seeing is helpful.

Chin straps...all they do or are supposed to do is a gentle reminder to keep the mouth shut. They aren't supposed to be vise tight...that would hurt and sleep would suffer because of pain.

Before going to a chin strap I would instead take a hard look at the leak graph itself. Numbers don't always tell the whole story especially that 95% number (which all it means is you were at that OR BELOW for 95% of the night). It's often easily elevated by relatively short periods of time at higher numbers. How deep you go into large leak territory is also important...is it 30 L/min or 50 L/min.
Your machine can easily record, respond and do a good job even when leaks are around 35 L/min. That 24 L/min red line...ultra conservative.

As for your higher than you want AHI....need to know what it is composed of first and then decide what might be going on and how to fix it. ...again that's where the detailed reported comes in.
What to do depends on what kind of events your are seeing.

[Okie bipap]

Welcome to the forum and the wonderful world of hose heads. I have been using my machine for around 3 1/2 years, and my wife has been on hers for 1 1/2 years. We are a few years older than you and both of us have gotten used to the idea of using the machine every night. As Pugsy said, the type of events you are having will determine what action needs to be taken even if the appropriate action is to wait and see what develops. You have only had your machine for about a week, and it takes a while to get used to sleeping with that alien thing on your face.

[GaryAikin]

I've been on CPAP now for 8 nights (see my posting that started this thread). I've tolerated the mask and pressure very well, and my numbers are good (according to the Registered Respiratory Therapist at my DME company). In some ways I see that the CPAP has helped me (for example, with one exception I've had no problem going back to sleep after getting up three or four times each night to go to the bathroom). However, since starting my CPAP, during the day (especially in the morning) I seem to feel worse than before I started on CPAP -- sometimes drowsy, a jittery feeling, some nausea. Are these symptoms of starting CPAP for some people? If so, typically when will they go away?