Struggling after switching to APAP from CPAP

[djb]

First time poster, long time cpap user. Background - I have been on cpap for roughly 15 yrs, previous machine is Resmed Airsense 10, pressure setting 10 cmH2O by clinical titration. Worked for 15 yrs, my AHI avg was 2-3, but over the last yr the numbers were creeping higher and sometimes 5 or slightly above on some nights. Was just switched to my new machine, Resmed Airsense 11 Autopap, pressure range set as 10 - 20. First several nights the numbers were in line, AHI around 2, pressures from the machine were 15, 14, 18, 16.8, 18.2 and 17.2 for the first 6 nights, which were higher than I expected. The concern is that the last two nights the AHI has been going up, 4.1 and 8.69 last night. My sleep has been more difficult with the switch to autpap and I seem to be getting more centrals and last night more OA, especially at the transition of falling asleep. Anyone else struggle going from cpap to apap and how can I improve so the AHI is normal again? Is apap just not going to work for me, and can I go back to cpap at the lower pressure? Does using a higher pressure for a brief period make the lower pressure less effective, so confused why I am not getting the result with autopap, any help is appreciated.

[vandownbytheriver]

You will find other opinions here, but I'm not a fan of APAP... it's useful for determining your good pressure... after finding it, I believe folks do better when switched to CPAP at that pressure.

I was originally titrated to 10cm in 2011... stayed there for a decade, then started getting involved (reading Oscar, etc) and tried APAP. I found that the fluctuating pressures did not help my O2 and that my good pressure was just slightly higher. Before I went in for a lab titration I'd moved myself to 12cm. The titration found that I responded best to 13cm CPAP and 21/17cm BiPAP (it was on a Philips machine). I obtained an Aircurve 10 vAuto and am using it in S mode, 21/17, with EasyBreathe on. AHI is consistently below 1 every night, popping zeros for days in a row actually.

Were you prescribed this setting? There's nothing like a lab titration to get to the truth of the matter. If we could see your graphs we could do more than guess and commiserate... I use both Oscar and SleepHQ. Oscar is a free application, SleepHQ is a free website, you upload your SD card into them and they allow you to examine your sleep data *in detail*, down to each individual breath. SHQ is best for sharing data here since it's just a link... the data's anonymized, you can expire the link at any time. Here's a night of mine, for instance:

https://sleephq.com/public/7e9af1e6-9d7 ... dda5ea70d1

Click and drag on any graph to zoom into the data... note the hypopnea 'H' at 12:13... the only event of the night. The 'Snore' ends up being mask farting... higher pressures can do this, the machine is in error there. Another reason I don't like APAP, the machine can make mistakes... when it misclassifies an event it can respond inappropriately... Snores, OA's and H's need more pressure, CA's do not. The mask farting would have driven the pressure even higher if allowed to, for instance.

APAP at too low a pressure requires breathing problems to happen... then the graph bounces up and down as the machine detects, solves, then forgets the problems. This can play hell with your blood O2, the partial pressure of CO2 in your blood is what causes the 'breathing drive', basically your blood pH requires acidity to tell you to breathe. When combined with EPR (a form of bi-level) you can get into a cycle of CA-like events where your CO2 is oscillating and your breathing volume goes up and down in response. Here's a Jason (well beloved here... not!) video describing the problems with APAP:

https://www.youtube.com/watch?v=DuZCByiG1nU

[ozij]

We have to see how your breathing looks through the night.
Numbers are not enough.
In the following link you will find instructions how you can get and post the needed data

Sticky:If you want CPAP help PLEASE READ BEFORE POSTING

[djb]

[djb]

For comparison here are a couple of recent nights on my old cpap resmed airsense 10, constant pressure at 10 cm H2O

[Pugsy]

Are you experiencing any nasal congestion when using cpap/fixed mode?
Or is the nasal mucosa not congested or minimally congested?

[djb]

No congestion

[Dog Slobber]

You simply cannot draw the conclusion that you are struggling because of a switch from CPAP to APAP.

You switched (at least) three things.

• CPAP to APAP
• Pressure changes - Fixed 10 to a range that typically lives between 12 and 17 but averages about 14
• You turned on EPR, where before you had none.
  Other changes that may not be represented on the graph.

Comparing Flow Limitations it is clear that Fixed 10cm was not adequate. On APAP with minimums of10cm ipap and 8cm epap that is even less adequate.

Your APAP configuration is misconfigured, and typical to many who don't like APAP, they are not able to distinguish the difference between APAP and misconfigured APAP, and draw the conclusion that it's an APAP issue.

[Dog Slobber]

Here's a Jason (well beloved here... not!)

This statement is a lie.

@op forgive me for this thread hijack, but lies should be nipped in the bud,

Jason is actually very well liked here at CPAPTalk. This poster doesn't seem to understand the difference between disagreeing with opinion and not liking someone.

A search for comments about Jason (LankyLefty27) and you will find an overwhelming number of posts that demonstrate Jason is actually well liked, and you will also find disagreement with some of his opinion.

Here's just one of many threads demonstrating as much:
viewtopic.php?f=1&t=186227&p=1435075

And here's his response, specifically mentioning some prominent CPAPTalk posters. Reenforcing a mutual, positive relationship.
https://www.youtube.com/watch?v=xj6ty4CmP50

So no, you're statement about him not being liked here is a complete fabrication.

[djb]

Dog Slobber, appreciate your comments. I don’t mind using cpap or apap, my preference is whatever adequately treats my apnea. It was time for a new device and the Dr perscribed the apap with the settings, using my previous cpap pressure pf 10 as the min. In retrospect I probably need to go for a titration. I didn't set the EPR either, and I am for the first time looking at my own data using Oscar and learning alot from this board that has been very helpful!
Seems like you think I should be running the apap at 12-17 instead of 10 - 20, but I am not sure I can just change that without going to the Dr first.
What would you use as a cpap pressure based on my apap chart?

[Pugsy]

Were you sleeping great and feeling great when using the fixed cpap settings?

Your Flow Limitations want/need more pressure but if they weren't causing you any problems then going killing FLs with more pressure or adding in some EPR (a lot of time adding in EPR helps reduce FLs) may not be all that critical of a thing to be doing.

The reason I asked about nasal congestion was sometimes the machine thinks nasal congestion is causing the FLs and when that happens we have to go about dealing with the nasal congestion in the more traditional nasal ways and not try to deal with the FLs with pressure changes.

But if you were sleeping great and feeling great then maybe the FLs aren't a problem and thus don't necessarily need to be nuked.

[djb]

Pugsy, I was sleeping fine and feeling fine on the cpap, perhaps starting to notice a slight difference, but really nothing major, not tired or sleeping during the day, everything was fine. Switched to the apap machine when it arrived and I haven’t been sleeping as well, waking and not getting enough sleep except for the first 2 nights which seemed ok. AHI is rising last 2 nights as noted in original post. The other poster seemed to think 10 cm H2O was insufficient on my old machine, which I thinknis right, just based on the higher numbers with the apap, not really sure what to do. Perhaps I canntry my cpap machine at a higher pressure since I was doing ok with it?? But looking at the Oscar data, it's not that clean and my AHI would fluctuate nightly.
Traveling to CO in a few days, so not ideal timing....

[Pugsy]

I am thinking that the higher AHI is just awake/arousal flagging going on because you aren't sleeping so great so I am thinking that once you get back to sleeping more soundly those flags won't happen. I think that the bulk of the flagging (especially those at the beginning of the night) is more from SWJ (sleep/wake/junk) than the flagged events being the cause of the poor sleep quality.

I would bet my last dollar that if we could zoom in on those flagged events that the bulk of them you weren't sound asleep when they got flagged.

I am more concerned with your crappy sleep.

Do you like EPR?

The flow limitations are what is driving your pressure upwards and it wouldn't be impossible for those pressure changes themselves to be a factor in the crappy sleep. I don't know how much of all that is related to sleeping position either (like at times were you on your back which can cause a need for more pressure to deal with stubborn obstructive apnea/hyponeas that we see. Two ways to deal with FLs....adding EPR is one way and increasing the baseline pressure is another way.

But again....I don't know just how much of a factor those FLs really are or how badly do we need to kill them.
They were really ugly when you were using fixed cpap at 10 but you say you were sleeping good and feeling good.....
do we really need to go killing them??? What harm is there in going back to the exact same settings you were using with fixed mode???? I dunno.

Sleep itself (not numbers of anything) has always been my number one priority because without sleep none of this really matters much.

What are YOU wanting to do? What problem are YOU wanting to fix at this time?

Where in CO are you going....at what altitude?

I have some thoughts as to various pressure settings to try but what they are depends on what you want to accomplish.
and how much time you want to devote to experimenting....and how much you want to use EPR or just higher pressures.

[djb]

Just want to return to a good night sleep with the AHI in the normal range below 5. EPR, I did feel like the apap with the EPR was easier to use, but I would prioritize normal sleep over the EPR and seems like I wasn't using it with my old cpap for many years. In Colorado will be staying around 7000 ft elevation, which I know can increase apnea, specifically centrals. Think I saw some posts about turning off EPR to control centrals??
Was considering trying my cpap tonight at higher pressure, around 14??

[Pugsy]

Think I saw some posts about turning off EPR to control centrals??

That works ONLY if using EPR was the cause of the centrals. It's actually a very small subset of people who have a problem with EPR causing centrals.

Was considering trying my cpap tonight at higher pressure, around 14??

If you do that.....use EPR at setting of 3.
I am hoping that with a higher minimum as well as EPR.....that the FLs will reduce and then the machine won't need or want to go to the high teens and not move around so much.

And remember....some people just do better with fixed pressures (with or without EPR) and you were using fixed for many years. Your brain/body has to get used to new settings.

Another choice....fixed mode but a setting of 12.....or there's always fixed mode at 10 cm and no EPR because that's what you used for years.