High AHI after 1 week of CPAP

[rickke]

I had AHI 78 in a sleep test last moth and got my AirSense 11 last week. I started using it since last Thursday. The best result is AHI 13 and the worst is 22. Last night my AHI is 18.62.

I installed Oscar today and checked the results. My OA seems good. Most of the time it is below 1. And CA is always high. The best result for CA is 12.24 and the worst is 18.9. Last night I got 17.54.

I attached the screen shot of last nights result. Anybody know what could be the reason? Thanks

[Pugsy]

Try turning off EPR if you can or use it during ramp only (and make used of the ramp feature) or at least reduce it.
See how things go.

[rickke]

Try turning off EPR if you can or use it during ramp only (and make used of the ramp feature) or at least reduce it.
See how things go.

Talked to my device sellor, he also suggest me to turning off EPR. I updated the setting and AHI dropped to 11.35. Will it keep dropping?

[Pugsy]

Try turning off EPR if you can or use it during ramp only (and make used of the ramp feature) or at least reduce it.
See how things go.

Talked to my device sellor, he also suggest me to turning off EPR. I updated the setting and AHI dropped to 11.35. Will it keep dropping?

Was the AHI still composed of primarily central apneas?

It might continue to drop and it might not.
It all depends on what the cause of those flagged centrals (CA in OSCAR). Multiple potential culprits that I will go into later.

How did you sleep last night?? Solidly for the most part or sleep was fragmented with multiple wake ups??

[rickke]

Try turning off EPR if you can or use it during ramp only (and make used of the ramp feature) or at least reduce it.
See how things go.

Talked to my device sellor, he also suggest me to turning off EPR. I updated the setting and AHI dropped to 11.35. Will it keep dropping?

Was the AHI still composed of primarily central apneas?

It might continue to drop and it might not.
It all depends on what the cause of those flagged centrals (CA in OSCAR). Multiple potential culprits that I will go into later.

How did you sleep last night?? Solidly for the most part or sleep was fragmented with multiple wake ups??

Yes. The AHI still composed of primarily central apneas, CA is 10.14
I did not sleep well. As I just started CPAP since last Thursday. I did not sleep well the whole week. I wen to bed at aroun 10:45pm and first wake at around 12:15am then multiple wake ups after that.

[Pugsy]

So....first of all you need to get a copy of your sleep study if you don't already have one because you need to know if you had very many central apneas mentioned on the diagnostic report or not. It's important to know if the centrals were present prior to starting cpap therapy or they popped up only after starting cpap.

The discussion on what to do if someone had too many centrals on the diagnostic sleep study is going to be different than the discussion about centrals that pop up post treatment.
For now I am going to assume that your centrals popped up after starting treatment but you need to find out for sure if that is the case.

1...treatment emergent central apneas can happen in a small percentage of people who start cpap and didn't have a problem with the number of centrals on the diagnostic sleep study. Usual first line of defense is simply time because there's a good chance they will reduce in numbers simply as your body gets used to cpap pressure. That's why doctors don't get all excited when one week (or month) into therapy the patient is seeing more centrals than we would want to see.

Remember an occasional central apnea is normal and no big deal so we ignore those. We don't normally get all excited about centrals until they are present in numbers greater than a 5 per hour average and we were for sure asleep because awake central apneas are problem related to sleep quality and not therapy itself.
When we aren't asleep we often will breathe irregularly or pause our breathing and the machine can and will mistake those awake irregularities as some sort of apnea.

2...Some people find that using some sort of exhale relief that creates a bilevel pressure situation will trigger centrals...not everyone but again a small percentage of the small percentage that find centrals popping up after starting cpap.
Extremely small number of people will have a problem with exhale relief causing centrals...but it happens.
BUT it's an easy cheap fix to try and see if turning EPR (or whatever the exhale relief might be called with a different brand/model machine) off or reducing it will help or not.

I have a good friend who has about 15 centrals per hour with a 4 cm difference between inhale and exhale but when we reduced the difference to just 3 cm her centrals essentially went away...only gets maybe one or two all night now.
She kinda needs that exhale relief because her starting EPAP pressure is 15 cm.

3...Some people just have too many centrals and they just won't go away no matter how much time we give it and not everyone has a problem with EPR so if the problem isn't from EPR then turning it off is unlikely to help out all that much.
Those people will often end up on a different machine.

Right now we don't know where you fall with your centrals...are they simple post treatment emergent and may go away on their own...or are related to perhaps just sleeping poorly and you are getting a lot of false positive arousal central flags...or did you have them prior to starting cpap?????

BTW....do you take any medications of any kind? Particularly any pain meds that might suppress respiration.
So we never know but it is worth trying. We were glad to see that marked improvement because she didn't really want to go to a different machine.

[rickke]

Thank you for your post. My sleep quality is definitely getting worse with the mask. I only get up to pee once or not before I start using this CPAP machine. I will keep EPR off for a week to see how it goes.

[Miss Emerita]

One more question to add to Pugsy's list: do you live at a high altitude?

[Pugsy]

One more question to add to Pugsy's list: do you live at a high altitude?

Good catch. I totally forgot that part of my usual questions. Kinda important.
Thank you.

[rickke]

Last night my AHI dropped to 3.39. It keeps dropping a lot in last two days. The day before yesterday AHI was 18.62, Yesterady it dropped to 11.35 and today it dropped to 3.39. First day, I turned off EPR. And the second day I changed my nasal cushion. I am using dreamwear nasal chshion mask. Earlier the size I was using is MW and I changed it to M. I do not know the cushion can make that much difference.

[Pugsy]

Did you sleep any better last night?

Have you been having wake ups during the night because of mask fit or leak or comfort issues?

[rickke]

Did you sleep any better last night?

Have you been having wake ups during the night because of mask fit or leak or comfort issues?

I never sleep well since I start to the CPAP machine last weekend. Aways wake up multiple times until I took off the mask after around 4am. So I do not see much difference for the sleep. Seems a little bit refresh this morning. But not sure if it is real.