Newbie on BiPap...AHI still high, itching to adjust pressure

[beachbummer]

Hello folks, thank you for reading. I'm a newb on a brand spanking new Aircurve 10S I have been on "BiPap" for a few days now. My sleep study was pretty messed up, with AHI of 63 and 68% Min 02 level. It was a split study and he was able to complete the split with no issues. Diagnosis was severe sleep apnea, based on my terrible AHI during the study.

There has been a major improvement in my AHI with the machine, and I feel much better rested. I do not have any other underlying known health issues other than some extra weight. (I'm 6'4" and 265lbs)

HOWEVER My pressure setting is 14/18 but I'm still above 5 most nights AHI as you can see below. My best night was AHI of 3.8, all others have been above 5.

Based on the numbers below (and seeing how easy it is to adjust the machine settings...) do you have a suggested pressure to try next to see if my AHI improves?

I've been tired for so long that being diagnosed with OSA seemed a positive. I;ve always snored like a chainsaw, but still slept well through the night. Since some time ago (12-18 months, hard to say) I have been sleepy during the day and feeling clogged up. My ENT saw my throat and told me I likely suffered from OSA due to gigantic uvula size + very large tonsils. She is ready for me to try some surgery which she thinks will greatly improve my situation, she described it likely I would still need CPAP but not at the high pressures I have now.

I'm willing to try the CPAP/BiPAP if it fixes me up to avoid the surgery, and results in good sleep for me.

Thanks!!!!

[Pugsy]

The clear airway/central apnea events that make up any of your AHI....you sort of have to mentally toss them out of the equation. You can't fix them with more pressure.

The Obstructive apneas and hyponeas that make up the rest of the AHI...they can be reduced with a little more pressure in most situations. I don't think you need a lot more pressure and it's EPAP that you need a little more of.
If it were me I would increase EPAP 1 cm (to 15) and leave PS at 4 so that would push IPAP up to 19....see what happens.

At this point I don't know what to make of the centrals...sometimes you have 2 or 3 per hour and sometimes not many at all. Makes me wonder if the centrals are related to arousals caused by the OAs and hypoeas. If that is what is going on then perhaps with the reduction in OAs and hypoenas the Centrals will also reduce. Worth trying.

[beachbummer]

Thanks for the suggestion. Eager to try something last night, (before seeing your suggestion) I added 1 to the low pressure and reduced one to the high pressure, in hopes of falling asleep more easily as I find the machine's pressure change to be very distracting to falling asleep. It improved a little to 4.7 (I know a night does not a trend make) I have switched the machine to you suggestion and will try for a week or so to see how I fare.

Thank you so much for taking a look.

[Pugsy]

Just remember when evaluating the AHI...that 4.7 from last night...you have to mentally subtract any CA index numbers to evaluate pressure response by the OAs and hyponeas.
Example...if all the AHI was OA and hyponea then maybe a little more EPAP and IPAP...but if 3.5 of that 4.7 is CA then that leaves 1.2 average for OA and hyponea and that doesn't warrant any change.
People tend to zero in on the overall AHI number but they really need to also evaluate the event categories too.
They need to make sure that what they are wanting to fix is fixable with what they are wanting to do.

[beachbummer]

Thank you! It seems the higher "low" pressure did help then, (if the trend holds) this would have been 1 of three nights where the OAs were lower than the CA events.

As I browse the web for the causes of CAs the common ailments associated with it seem severe. hopefully I have none of these.

Thanks again for the info

[Pugsy]

The centrals may be nothing more than post arousal centrals at this point...or maybe a handful of sleep onset centrals which are normal and don't mean anything bad at all is going on.
Not all centrals are indicators of something bad...we all have them from time to time. They are only a problem when present in large numbers, causes significant desats or a truckload of sleep onset centrals keep a person from ever really getting to sleep. At this point the number you are seeing (even if they were all the real deal and not awake/semi awake breathing getting flagged) isn't enough to worry about.

Let's face it...sleeping with all this stuff on our face and a machine blowing air up our nose does take some adjustment and you are really new to this therapy so it wouldn't be uncommon at all for a good bit of those "centrals" you see to not be "real" anyway.

[palerider]

I find the machine's pressure change to be very distracting to falling asleep.

do you have 'easy breath' turned on? if not, you should try it... for me, it makes the pressure changes almost unnoticeable

[beachbummer]

Thanks. Yes, Easy Breath is on. I overtightened my mask during the night in haste a few days ago and woke up with mask rash on the right side of my nose, so I have been trying to keep it as loose as I could for some time. The mask cushion inflating and deflating were keeping me awake for a little while. last night I re-tightened and it helped.

I do sometimes wake up 3-4 hours after going to bed and feel incredibly awake and energetic, and I need to work at falling asleep again. (It takes me only a few minutes, but in my mind it's an eternity, as I used to fall asleep immediately before. )

These are truly minor complains in the grand scheme of things, but I sincerely appreciate the info. I've only been on the machine a few days, but I can tell my sleep has improved immensely.

As a side note,managing expectations, I told my wife when the machine was prescribed, that I was sure it was going to be noisy and would make a racket, so hopefully the machine would be less bad than I described it and she would not be as displeased with this new room guest. Turns out she can barely hear the thing, and I don't snore anymore, so she has no complaints.

[palerider]

(It takes me only a few minutes, but in my mind it's an eternity, as I used to fall asleep immediately before. )

ah, the 'benefits' of being perpetually exhausted... very rapid going to sleep

[beachbummer]

I bumped my low pressure to 15 and my AHI looked much better. I noticed the machine could adjust in .2 intervals, so I got greedy and moved it to 14.6, but the AHI went back up for a few nights. I am back on 15 and so far 3/3 the AHI has been under 4, when using 15 as the low pressure.

Thanks again for the suggestions!