Recent changes: (Moved, New job, Back to Night shift, New machine). I was an Indiana resident, and moved to South Dakota in February of this year (2021). I have been using my Phillips Respironics System One RemStar 60 since 2012. My AHI has been 1-2 while on this machine, so I have been pretty happy and have not changed machines. After moving to South Dakota, and returning to night shift after 2 years of dayshift work, I noticed my AHI increasing. Now 5-6. I did a 30 day APAP test, which showed my 95% pressure of 12.6. I increased my pressure from 12-13, just to see if it makes some difference. AHI improved to 3-4 briefly, but then started drifting to 5-6 range. Increased pressure from 13-15, but there was little change in AHI, and I am feeling tired. Sleeping 10 hrs per night, and still exhausted much of the time. I was on cpap.com to purchase a new mask, and noticed I had bought my machine in 2012. Manufacturers recommend replacement every 5 years. Maybe my machine was just at end of life. Also, saw the recall. Okay, new machine time. Asked my PCP to write for APAP, so I can have some auto adjusting. APAP is strongly recommended by my medical director, who is a pulmonologist and certified sleep specialist. I purchased Resmed Airsense 10 Autoset, which was delivered on 7/14/21. Set it up, and started using it.
Machine settings: Initial settings for my APAP was 4-20 cm H2O. This was my doing, and I should have known better. Since I couldn't breathe at 4 cm pressure, and AHI was 11.2. This took me back to my early days, where I fought against my machine, which severely affected my sleep quality. I quickly changed the settings to 10-20. I could breathe better when falling asleep, but noticed my AHI was 15.0 for the first night. That's not what I want, and I thought APAP would be better at reducing AHI than my old CPAP, due to the ability to alter pressure. Average pressures were around 13 per my APAP, so I decided to change my settings to 13-20. The higher pressures have never bothered me, and figured I should set the lower pressure to around my 95% pressure from APAP trials. AHI events worsened??? Off to CPAPtalk.com.
AHI: AHI has been increasing. 11.2 -> 15.0 -> 20.3 -> 19.0 -> 30.7. Remembered Oscar and sleepyhead software would provide much more detail than the myAir app, or the machine's info screen. But of course the new machine didn't come with SD card. I placed the SD care from my old machine, and picked up an SD card reader. My AHI was even worse last night, now showing 30.7. I downloaded and ran Oscar. I will embed screenshot below. But from my view, I had 262 CA events, and 16 obstructive events in 11 hrs. From my knowledge, 16 obstructive events in 11 hrs equals an AHI (If only using obstructive) of 1.45, which I would be very happy with. But why do I have 262 clear airway events??? My old machine never showed central apneas, and I had 0 central apneas on my sleep study and 0 on my titration study (11 years ago). Obviously these clear airway events are driving my AHI up. Based on my data, I don't think I need to have the minimum pressure so high, but since it doesn't bother me, I may just leave it alone.
How do I feel: I sleep too long, and am pretty tired compared to how I felt last year. I was night shift for 10 years, went to dayshift last 2 years, and now back on night shift for the last 5 months. This could be part of my tired feeling, but I expect to feel better after 10 hrs of sleep. I am not falling asleep at work, or behind the wheel, so I am still better than i was prior to CPAP therapy. No longer falling asleep behind the wheel was one of my most noticeable changes when starting CPAP 11 years ago. Last night I fell asleep around 30 minutes. My time putting on mask and falling asleep has been rough with the new machine, but last night was the best time so far. I usually fall asleep in less than 20 minutes when on my previous machine. I am thinking too much about the therapy, and can't wait until my Pur-sleep refills come in. Pur-sleep helped so much on my initial CPAP start, so hopefully will help some here as well. I don't always use these oils, but they are helpful when congested or when something is weighing on my mind. FYI, I am a non-smoker (never smoker actually), but have had allergy induced asthma. I am very overweight. My weight is near it's high point, but no recent significant weight gain over last year or so. Obviously felt better when my weight was down, and am actively working on it.
Questions:
1. Are clear airway events the same as central apneas? I am not familiar with clear airway events. Searching the term on google states it is the same as central apnea, but there are some vague answers about sleep cycles effecting this.
2. Could the machine be misreading central apneas compared to my old machine?
3. Could higher pressures drive up my central apneas? My minute volume is pretty high based upon my Oscar readout. Expect 5-8, but I am averaging 10. This can drop your CO2 levels, which are a strong driver in your respiratory rate.
3. Any suggestions on changes to make, or to seek an updated sleep study?
- I am planning on getting PFTs soon, as I have been having increased asthma symptoms since moving to South Dakota. Higher elevation vs new allergies. My PCP recommended PFTs, due to these changes, as well as concerns with the Phillips foam recall. Would be really strange timing if the foam was involved, but still probably worth the look.
4. Machine related question. I added EPR last night. Noticed some popping when I took in deep breaths. The popping occurs at the end of the deep breath, and I could feel pressure bursts in my nasal pillows. Could this be the EPR? And any recommended adjustments to prevent it.
As always, thank you in advance for your advice and recommendations. I have a lot of trust and respect for everyone on this site. Providing an open group support setting was essential to my success on CPAP. I rarely post, but when I have, I have always felt welcomed and supported on my journey.
I try to keep my posts short (not my forte) while providing enough detail to get the answers that I need, please let me know if there is anything else that would help answer my questions.
I just added machine and mask to my profile, but not certain if it will show up, or if I need to add to my signature. Just in case:
Mask: AirFit P10 nasal pillow
Machine: Resmed AirSense 10 AutoSet (13-20 cm H20)
Oscar screenshot: I zoomed in on my last night of sleep. I am a night shift worker, so sometimes my sleep sessions bleed onto the next day. I adjusted my machine date and time, so hopefully will not split my sleep sessions going forward. Please let me know if i can zoom in on any time period to give more data. There are a lot of CA events. Last night was natural sleep, no meds (benadryl or melatonin are my occasional go to when needed), no alcohol.
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