Still kind of tired after two years of CPAP

[stevehenryy]

Hi all! I've been a CPAP user for two years now and have seen moderate benefits compared to my pre-treatment symptoms. (I had an AHI of 15 during a sleep study).

However, up until last weekend I was using a full face mask, which often leaked, and could rarely get my AHI below 5 or 6. I just switched to a nasal mask and increased my pressure by 1 (from 5 to 20 originally to 6 to 20 now). I was able to lower my AHI to 3.8, but it then went up to 5.9 and feel like I'm missing something. I am using a Eson™ Nasal CPAP Mask with a DreamStation machine and got the attached SleepyHead results.

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Also attached is a screenshot of my better, first night with the nasal mask and increased pressure (5 to 6) (3.78 AHI).

Screen Shot 2018-05-21 at 7.41.10 PM.png (670.12 KiB) Viewed 6809 times

Any advice? My guess is that my minimum pressure is too low but it's just a guess. Also attached is my overall statistics.

Screen Shot 2018-05-21 at 7.45.32 PM.png (324.9 KiB) Viewed 6809 times

[Pugsy]

Yep, minimum pressure needs to be increased a bit.
Maybe try 8 minimum if you are comfortable with it and see how it goes.

[TedVPAP]

That is unfortunate that you have been under treated for so long. As Pugsy said, you need more pressure. Up the minimum to 8 and report back in a few days.

[stevehenryy]

Thanks, everyone! I upped the minimum pressure to 8 and got the following two nights. I feel like I do on my best CPAP nights so far but still a little tired by the end of the day.

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[Pugsy]

The increase in minimum cleaned things up a little but not enough to suit me.
If it were me I would now try 9 cm minimum and see how much more stuff gets cleaned up.

[stevehenryy]

Thanks so much. I upped the pressure to 9 cm and took a 90 min nap, and the graphs look much better with an AHI of 0! It's still only a 90 minute sample size (and I woke up half way through), but I've taken a lot of naps and gotten high AHIs so I think this is a positive sign.

[zonker]

Thanks so much. I upped the pressure to 9 cm and took a 90 min nap, and the graphs look much better with an AHI of 0! It's still only a 90 minute sample size (and I woke up half way through), but I've taken a lot of naps and gotten high AHIs so I think this is a positive sign.

that's fantastic news! please let us know how you did over night.

it's always good to hear positive feedback.

[Pugsy]

Some people just report sleeping a bit better, maybe more soundly for some reason, at pressures probably a little higher than is technically needed for the apnea event prevention.
Don't ask me why...I don't know why except that enough people do that I don't doubt them.

Good quality restorative sleep can be so fragile in some people that sometimes just some off beat little something can make a big difference in sleep quality and how they feel.

I don't know for sure if cleaning up some of that stuff on your report will equal feeling better or not but it sure is worth trying.

[stevehenryy]

Very interesting. The trend does seem to indicate I needed a higher pressure. Here is my full night with 9 cm:

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[TedVPAP]

Still too much OSA. Need to continue to increase the min. It looks like 11 will do the trick (try 10 first). In my experience, setting the minimum pressure within 2 of the 95% IPAP is what's needed for this machine.

[Pugsy]

I don't like to use the 2 cm within 95% numbers in general written in stone guide...if we did that then I would have been using 15 cm as a minimum with my Respironics machine and 10 cm did a bang up job for me.
Now sometimes it can end up that the person is going to need to end up using with 2 cm of the 95% number just because it works out that way.

In this situation it looks like it might well work out that a minimum within 2 cm of an overall 95% number is going to end up to be the best choice.

I do agree to work up slowly though. Sometimes just a little more minimum does a bigger/better job than we think it will.

[stevehenryy]

Thanks! I will go to 10 tonight and see what happens. I was hoping 9 cm would’ve done the trick but I guess more pressure isn’t a bad thing.

[Pugsy]

One little cluster of OAs isn't the end of the world but I would prefer to have the cluster broken up a bit if it were me.
I saw this happen with my therapy early on...and my OSA is worse in REM.
If you have a problem with the 10 cm minimum...letting one little cluster slide by probably isn't the end of the world but if it were me I would at least try to break up the cluster...maybe not totally kill all of it but break it up so not so many events back to back. And occasional event here and there is no big deal but a dense cluster with a bunch of them happening back to back within a short time frame can lead to problems.

More pressure isn't necessarily a bad thing. You would be surprised at what people can use.
I had a machine once that I had to use 12 EPAP and 16 IPAP (fixed pressure bilevel machine) all the time to deal with my OSA and using the apap machine I have now I can get by with essentially 7 IPAP and 4 EPAP. 16/12 was a bit uncomfortable at first but didn't take long to get adjusted to it.

If you are scared of "more pressure" because of the chance of "higher pressures causing centrals"....quit being scared.
It only happens with a relatively small percent of people and we deal with it only if needed. The odds are that more pressure won't do anything but hold the airway open better. Go with the odds.

[palerider]

In my experience, setting the minimum pressure within 2 of the 95% IPAP is what's needed for this machine.

That's fine for someone that doesn't understand the way to properly set up a machine for a patients needs.

[stevehenryy]

I don’t have access to Sleepyhead this weekend, but I’m down to a 2.2 and 2.1 AHI the past few nights using 10 cm as the minimum. I’ll stay at 10 for now and post the charts shortly.