First Week CPAP results - help with results

[Pugsy]

Sounds like a good plan to me. You may just have to compromise a bit and let a few snores happen with the trade off being no belly issues which is quite important.

[Ajalt911]

Hi. I’m new to this (2weeks) with a ResMed AirCurve 10 ASV. The “inflation” is my only significant issue. Which pressure is it that I can reduce? Is it always max EPAP?

[zonker]

Hi. I’m new to this (2weeks) with a ResMed AirCurve 10 ASV. The “inflation” is my only significant issue. Which pressure is it that I can reduce? Is it always max EPAP?

welcome to the zoo!

please feel free to start your own thread. it's considered rude to hijack someone else's thread to ask your own question.

see my link below to the newbie post. this will have good info on how to get started.

good luck!

[jwalsh126]

Can anyone help with these results? I tried a cervical collar and lowered pressure range by 1 on each end down to 9-13. Cervical collar fixed the dry mouth and I woke up without chapped lips. While I only had 1 obstructive apnea, I had 11 clear airways and a ton of vibratory snores (I figured it would go up, but have to imagine apneas are worse). I want to get more nights in, but does anyone have recommendations for adjustments based on this data? EPR or flex relief is set to 1.

Note: I was having aerophagia issues which prompted me to make some of these changes.

[Pugsy]

How did you sleep last night? Very many wake ups? I see at least one at around 4:30.
How's the belly issues?

The reduction in the minimum to 9 caused the increase in snores. The centrals we ignore for the moment.

[jwalsh126]

I am going to set it back to 10 minimum for tonight. Should I go back up to 14 max? Sleep quality seemed overall good outside of the 1 wake up. The belly was not super bloated at all, but I believe I did have some minor bloating at that 4:30 time when I woke up. I definitely don't feel completely rested though.

[Pugsy]

I don't know how much of a difference both in terms of snore reduction and aerophagia issues letting the machine go higher (it clearly wants to) might make. I think I would keep the 13 max for the time being. Make only one change at a time so you can better gauge which change seems to be making the biggest impact both on snores and aerophagia.
You are going to be walking a fine line between optimal apnea prevention and keeping the aerophagia monster away.

It's entirely possible that 6 months from now aerophagia might not be such a problem and you could revisit the settings again later.
Some people who start out with aerophagia at first find that later it isn't as big of a problem later. I can't guarantee it but it's not impossible either.

[jwalsh126]

yeah I agree with that. I also lowered the minimum from 10 to 9 and it didn't seem to cause any more OSAs. Do you think I should leave this 9-13 range for a while? Or go back to minimum 10 and leave max at 13 (previously 14).

[Pugsy]

It all depends on just how much those snores bother you what you want to do...or can do about them considering you are also having to deal with aerophagia.
It's your choice....if you are sleeping good and feeling good and increasing the pressure to kill off some snores causes problems with sleep and how you feel...I would let the snores slide for now.
The snores are early warning signals that the airway is trying to collapse. Since there aren't that many OAs or hyponea flags then we assume that the snores haven't grown up to manifest themselves as an OA or hyponea. Snores can be highly disrupting to sleep quality though even if they don't grow up to be a full grown OA. So a lot depends on how you feel in general and how you feel if you let the machine kill off the snores.

Sometimes killing off the snores causes a bigger problem than the snores caused and you have to choose which problem you are okay with having. Which is the worst devil to deal with.

You also have 0.5 cm increments you can try...doesn't have to be a full 1.0 cm change.

You also have to try to figure out which is it that is feeding the aerophagia monster....is it the minimum pressure or the max that it goes up to and stays for a period of time. This will at least give you your parameters in which to work for both optimizing therapy and keep the aerophagia monster at bay.

[jwalsh126]

Ah I see, that's a great point. Honestly I felt better with the minimum pressure at 10. I want to try the minimum pressure of 10 for a while and I think the aerophagia problem is at the upper pressure range. So I will actually try minimum pressure of 10 without adjusting the max yet and see what happens.

[jwalsh126]

I am going to wait for a greater sample size but these results are very interesting to me. I got my OAs down to 0 for the first time ever! The pressure was at a constant 10 or so the entire night and snores almost went away completely. Wow I am excited about that.

However, the machine registered more clear airway apneas and a few hypoapneas, but mainly a big rise in CAs. All I did was change the minimum pressure back up to 10 from 9 and I continued using my cervical collar (I really am starting to see the collar work in terms of preventing mask leak and dry mouth by stopping chin drop).

Should I continue to give it like a week with these settings before I start messing around with adjustments or CAs?

[Pugsy]

I think before you starting worrying about centrals/CAs you maybe should try to figure out if they are asleep centrals or awake/arousal centrals.

Watch all the videos here.
http://freecpapadvice.com/sleepyhead-free-software

[jwalsh126]

Update: I was seemingly sleeping good enough (AHI 2-3ish) for a few months with a pressure range of 9-13. After some time, I started getting worse aerophagia issues and recently my sleep doctor recommended I reduce minimum pressure. After testing many options (both setting changes AND sleep posture changes) I need help and am at a loss. I meet with my sleep doctor tomorrow to discuss next steps. For context, I am 6'4 190lbs and I sleep supine as my preferred position. I was diagnosed with a home study with 30 events/hour (most frequent occurred while on my back, but I do roll on both sides for small periods). The nights that I feel most "rested" are when I sleep continuously 1 session throughout the entire night. For the last 2-3 months I have been waking up at least once, but 2-3x even.

My thoughts for next things to try: I want to try sleeping supine with optimal neck position to allow for the airway to open (i'm thinking cervical pillow). I currently use a cervical collar to prevent chin-tuck. I also have a sleep wedge, but if I sleep on it with my hips upward, my back hurts. I am now trying to sleep at a slighter incline, but with some neck support, however, I may need a better pillow to feel comfortable and support my cervical spine. If I have "optimal" position for my airway (almost like CPR position but less extension), and I am still having OAs/Hypopneas, then I know I need to increase minimum pressure to see if that reduces those events.

My question for everyone (p.s. you have all been so helpful to me over this difficult time), has anyone sufficiently treated their sleep apnea while sleeping supine? For example, have you managed to optimize your CPAP/APAP settings + whatever additions you need (Wedge, cervical pillow, collar) in order to get the AHI low enough (2-3) while waking up feeling "rested" most of the week? My other question is, with my body type and no deviated septum/other physical reasons for obstruction, is it simply that my supine sleeping position is contributing to most/if not all of my apnea problems? Am I better off long-term by trying to retrain myself into a side sleeping position, even though it does not feel natural yet?

I attached some recent nights with various settings to show what I'm dealing with at the moment. The best night of "rest" I had was definitely 2/25/2021. I am talking with my sleep doctor tomorrow with my ideas and will report back. (I am also considering trying the Resmed Airfit F20 FFM to see if it seals easier than my simplus which I am having problems with recently).

[Julie]

It's well known that sleeping supine provokes many more apneas and hypopneas than otherwise, but whether or not someone else changed it sometime is not meaningful as their condition(s) otherwise may be very different. It seems you need to try and sleep differently so maybe put your energy there instead.

[jwalsh126]

Thank you Julie.

The doctor told me that being on CPAP should allow for supine sleeping, but I don't think this makes total sense. Specifically why someone with my phenotype (almost none of the risk factors; tall, skinny, young, etc...) is having apneas. I'm buying a cervical pillow to keep my neck in optimal neutral position for breathing. I will test supine with a slight elevation and a neutral spine for 1-2 weeks to see what the AHI looks like and see how I feel. Then I think I am going to try to train side sleeping. If 1-2 weeks of side sleeping produces better AHI and/or feeling then I guess that confirms that my specific condition is worsened from supine position. Of course an alternative possibility is some form of complex apnea, but i'm not so convinced yet.

Aerophagia problems at higher pressures (9-10 which isn't even too high) were getting aggravating and I couldn't stand it. Even though my AHI was 2.5-3.0ish, I certainly wasn't rested from the bloating and other issues. I wanted to post this so that there is a record of my thoughts and what I will try next and so anyone who is willing to help me can share any thoughts on my approach.

I also use a FFM and never tried a nasal mask, so i'm curious to see how side sleeping might go with the FFM. I also want to go more by "feel" as I saw Pugsy post somewhere, rather than obsess over AHI numbers, but since i'm still so new to CPAP and there are a lot of variables to sort out, I definitely have some optimizing to do.