First night, high AHI

[stefan]

Hi all,

New CPAP user. I have an Airsense 10 auto, climate line tubing and P10 mask. The night went fairly well, mask was a little uncomfortable, but something I think I could get used to. No leaks were reported. I was really surprised to see the machine report an AHI of 39, and central AH of 38.1 (not sure of the difference). Pressure avg was 8.1. I was really expecting to get down to under 5 AHI. Is this a case of machine learning and to keep up at it, or is there something i need to change? My initial sleep tests were AHI 55.

I also have a F10 full face mask that I could switch to, but really wanted the less intrusive pillows to work. Should I keep at it for now or something I need to change?
Thanks!

[Julie]

What are your pressure settings?

[stefan]

What are your pressure settings?

Hi, min 6 - max 18

[Julie]

Can you download Sleepyhead and link results to this thread so we can see what's going on? Your min. pressure is certainly on the low side, but without more info it's still surprising that your AHIs are so high.

[49er]

Hi all,

New CPAP user. I have an Airsense 10 auto, climate line tubing and P10 mask. The night went fairly well, mask was a little uncomfortable, but something I think I could get used to. No leaks were reported. I was really surprised to see the machine report an AHI of 39, and central AH of 38.1 (not sure of the difference). Pressure avg was 8.1. I was really expecting to get down to under 5 AHI. Is this a case of machine learning and to keep up at it, or is there something i need to change? My initial sleep tests were AHI 55.

I also have a F10 full face mask that I could switch to, but really wanted the less intrusive pillows to work. Should I keep at it for now or something I need to change?
Thanks!

I agree with Julie's advice to download sleepyhead and post a screenshot to the forum so experienced members can help you decipher what is going on. If you feel the F10 would provide better comfort, by all means switch to it. But downloading the software and posting a screen shot for review is the first step you need to take. You can use the links in my signature to do this.

[WindCpap]

Central AI means that machine pinged your lungs with pressure, and your airway was open. Essentially you voluntarily stopped breathing 38 times per hour for 10 seconds or more. Give it a few nights before you even bother to look at data. A straight cpap (auto-titrating or otherwise) won't help a genuine central apnea problem, so if after a week, you continue to have more than 4 centrals per hour, and you know you were sleeping most of that time, go back to your sleep doctor. I doubt you have a problem with central apneas or your doctor would have you on a different machine.

[stefan]

Hi all.

Thanks very much for the input. I will post a sleepyhead screenshot here if maybe someone has some input, but i'm happy to continue using it for a few nights before I try to start understanding the data. I was wondering, would mouth breathing with nasal pillows cause this effect?

Thanks!

[WindCpap]

Mouth breathing with your nasal pillows could definitely cause a false central (or a false obstructive for that matter). This is why looking at your data will be pretty useless until you start actually sleeping for a several hours. Mouth breathing when you are sleeping causes a high leak.

[Pugsy]

You might want to get a copy of your original sleep study and see what the primary diagnosis was.
Did anyone ever mention centrals to you?
If there was a truck load of centrals on the diagnostic sleep study then these centrals you are seeing now are unlikely to go away.

Did you have an in lab sleep study where they used the machine to find the right pressure?

Do you take any meds that might suppress respiration...like pain meds of some sort?

If you are sleeping well and not have large amounts of awake time with the mask and machine on then the number of centrals you are seeing is something to for sure be talking to the doctor about.
If we can't explain them away with awake/semi awake breathing you need to be talking to your doctor about them.
One night doesn't mean panic mode but this number of centrals does mean we sit up and take notice and keep a definite eye on them.

[stefan]

Hi,

Both initial reports here

Sleep study - http://imgur.com/oxBoIla
Titration test - http://imgur.com/xAsql9b

No centrals reported during the sleep study. During titration I came down to AHI of 8. For the test I was using a nose mask (as opposed to pillows).
Later this evening after kids are asleep i'll download the data to sleepyhead and post that.

Thanks everyone, appreciate it.
Stefan

[Pugsy]

Was the titration sleep study done with a live human in attendance?

Let's see what your machine is actually reporting. When you have time post the image of the detailed report.

We don't need all the graphs that SH offers...just the basics for now.
Examples here
viewtopic/t103468/Need-help-with-screen-shots.html

on the left side...hide the calendar and pie chart so the statistics also show up along with the AHI bar graphs.
On the right side...these graphs..
Events
Flow rate
Pressure
Leak
Flow limitation graph only if it shows much activity.

You can hide the unneeded graphs by going to the lower right corner where it says Event flags and click on the green bar to turn it red. That way you can get the needed graphs in one screen shot. Makes for much easier evaluation. You can also resize the graphs by hovering the mouse on the bottom line until you see a little short double line then click and drag to resize.

I don't know that we can explain away 36 centrals per hour but let's cross that bridge later if it is still there and needs crossing.

[Heart Jumping]

stefan, obviously we don't know yet and I'll let the other experts comment once you provide more info, I'm also on my first month of treatment so I can provide a little feedback on that front. Sleep test showed around 40 AHI. When I started I was seeing some nights at 10 AHI. Last night after about a month I had my first night under 1 AHI.

So while you obviously want to see that number going down, I wouldn't worry too much, a lot of things could be causing those initial ratings and you'll likely see them improve as you proceed. Some of those may be false alerts, some of it may involve mask or machine adjustments and some of it may just involve getting more and more used to sleeping well with the machine.

Bottom line, I'd be damn happy that you tolerated the first nights sleep pretty well! Good luck!

[stefan]

Hi Pugsy (and others)

Sleepyhead report - http://imgur.com/tuMgOKA

The titration test was done alone over 2 nights with a Devillbiss auto and nasal mask.
The centrals do seem very strange. Looking at the graph I now remember the gap where i did take the mask off (was hurting a bit) and put it back on at like 5am

[Pugsy]

Is there any chance you were awake either fully or partially during the time frame from 22:30 to 01:00 when the mask was removed?
Your report looks great from 20:30 to 22:30...so 2 hours...were you asleep those 2 hours?

I am assuming for sure awake for a period of time when you put the mask back on at 4 AM....any idea about how long were were awake at that time?

These machines can and will mistake awake/semi awake breathing irregularities for some sort of apnea event and when they do they often will flag centrals (CAs on SleepyHead) but while flagged they aren't considered "real" in the sense of being a central that is troublesome. Our awake breathing is highly irregular and it's normal to us but not to the machine.
If you are having awake/semi awake breathing irregularities getting flagged....they aren't figured into the overall evaluation of the therapy.
If you were most definitely sound asleep...then we have to consider them "real" and thus not pooh pooh them off.

Often when people first start cpap therapy there is a lot of awake/semi awake breathing going on while masked up. It's common and it's normal but it can make for some really ugly reports that can on the surface be alarming.
If you know that you didn't sleep well and/or had a lot of wake ups during this ugly time...we can probably explain away a good chunk of those centrals with "awake/semi awake breathing or SWJ sleep/wake/junk" .
If that's the case then as you sleep more soundly these centrals should reduce in number.

For some people cpap pressure can actually cause an imbalance in breathing or instability and the centrals come because of that instability. We don't know that is what is going on here....usually when that happens we see it all night and not just part of the night.

For now concentrate on just adjusting to the mask and machine and getting good sound sleep.
Make note if you think you spent much time awake fiddling with the mask or waiting for sleep as those times whatever is flagged doesn't really count in therapy....awake breathing doesn't count.

If the centrals persist in these numbers and you know for sure that you were sound asleep when they were flagged....talk to your doctor about them sooner than later.
How long to wait till talking to your doctor if they persist in these numbers....I don't know...2 to 4 weeks maybe if you are sleeping soundly.

[Pugsy]

I don't know if the Devilbiss Auto you used for the titration even flags centrals...so the lack of centrals on a report from that machine may not mean that they didn't happen.

Did you also have a home sleep study? If you did...did you wear a chest belt?