Newbie - Diving in head first !

Seastrike · Post by **Seastrike** » Sun Jan 12, 2020 9:08 am

Edit to original post.
Thanks Pugsy, updated file attached.
Feeling a bit more rested/awake/alert but only marginally. Still awakening throughout the night-no improvement in this area yet.
I'll adjust the min. pressure you stated. Anything else jump out at you as areas for concern/ investigation ?
Thanks to you and all.

Hello to all. Another newbie to the CPAP world here.
Started on CPAP back in late Nov 2019 after home sleep study diagnosis of "mild sleep apnea".
Initial AHI: 9.6, causing tiredness, fatigue, loss of focus/attention, etc...
I'm wearing the gear 95% of the nights for 7-8 hrs per night.
I've tried a full mask, but find the lack of comfort and nose itching to be a constant issue and tend to use the pillows P10 more often.

Since treatment started I've experienced a few rare nights with AHI down <3, but most are still >5.
Ignoring the reports, I think I'm feeling marginal improvement, but clearly the treatment is not yet as effective as it should or needs to be and still reporting a significant # of events each evening.
A major plus, my snoring is gone completely, so my wife is getting a better night sleep !
I've a follow-up appointment with my Dr set for Feb 7 but I'm diving into this amazing forum and appreciate all the entries and information you have all provided.

Recent results of an average recent night are attached. I'd greatly appreciate any insights, ideas, comments anyone cares to offer.
Signed - Eager to have that Great night sleep I keep reading about...
THANKS.

Pugsy · Post by **Pugsy** » Sun Jan 12, 2020 9:17 am

Welcome to the forum.

Please review this thread
viewtopic/t158560/How-to-post-images-for-review.html

But from what you did show I suspect you need a higher minimum pressure as a baseline.

The AHI is about 50 % central (clear airway) and those won't necessarily respond to more pressure....are you sleeping soundly for the most part or are you experiencing a lot of awake time with mask and machine one?

Seastrike · Post by **Seastrike** » Tue Jan 14, 2020 11:47 am

Hello. I increased the min pressure to 6 and saw a significant increase in AHI to 10+.
As you stated most events are Clear Airways events, which I believe the machine and higher pressure won't cure.
I believe the # of combined OA+UA+H+RERA events all look somewhat respectable. If I can get the CA events down, I suspect I'll see and feel more rested, Yes ?
Any other adjustments suggested for further improvement ?

Thanks again.

Miss Emerita · Post by **Miss Emerita** » Tue Jan 14, 2020 4:38 pm

There's a fair amount of clustering in your events. An easy experiment to try is to get a soft cervical collar to see whether that helps. I'm not sure why, but people sometimes see improvement in CAs with a collar as well as with obstructive events. (With obstructive events, the theory would be that chin-tucking restricts the airway.)

And where do you tend to sleep: on your sides, stomach, or back?

Pugsy · Post by **Pugsy** » Tue Jan 14, 2020 4:57 pm

When you increased the minimum to 6 cm did you also turn EPR on and set it to 1?
According to the settings that is what it looks like you did.
If so, try turning EPR back off and lets see what happens in terms of those CAs/centrals.

How did you sleep? Spend much time awake with machine on or sleep soundly for the most part?

Seastrike · Post by **Seastrike** » Wed Jan 15, 2020 9:24 am

Thanks for your response Miss Emerita and Pugsy. These are interesting inputs.

Miss Emerita - I sleep on both my back and right side. Now that the CPAP therapy has stopped my snoring (yeah!), I find sleeping on my back to be a much most pleasant position and I'm no longer getting the elbow to the ribs from my wife.
I'll try a collar as you suggest or cut one

Pugsy - Yes, In addition to increasing pressure to "6", I also set EPR to "on" and "1". Tonight, I'll reset EPR to "off" and try that.
Unfortunately, I did have a # of awakenings and tossing and did not feel rested yesterday, but rather felt tired all day and thus had absolutely no problem falling asleep last night.
Note: I think I'm actually gotten "comfortable" with the Airfit P10 mask and now using only the Airfit P10 mask no longer with the full face mask.

On a more positive note - I actually feel pretty good today, despite the Resmed myAir iPhone app showing 7.6 events/hour last night. I'll download that data tonight and review it after work.

Thanks again for the suggestions and feedback. I find it very helpful.

Pugsy · Post by **Pugsy** » Wed Jan 15, 2020 9:38 am

EPR or any form of exhale relief sometimes can cause central apneas to pop up when otherwise we wouldn't have them in numbers enough to worry about. The people who have this happen....a very small subset of people using cpap...it's not particularly common

Now I don't know if this was what happened in your situation or not...I have no way to know at this stage of things.
The easy way to know...don't use EPR or exhale relief and see if not using it causes any dramatic change in the number of centrals.
If it doesn't then we can go back to using EPR if we need to or want to and not worry about them being a factor in the centrals.

Adding EPR also effectively lowers the overall average pressure a bit...so if we increase the pressure a bit (to deal with the obstructive stuff) but also add in exhale relief then we effectively haven't really increased the pressure.

Remember Science 101...when doing experiments keep your changes or variables to a minimum so you have a better idea what may have brought about a change.

Some of those flagged events might be false positive flagging....awake/arousal events getting flagged by mistake.
Watch the videos here
http://freecpapadvice.com/sleepyhead-free-software
While it is talking mainly about central apneas it really can happen with any of the event categories. False positives aren't limited to just centrals. I have personally seen false positive OA flagging happen and it was so obvious I was awake at the time that a blind person could see it on the flow rate graph.

Seastrike · Post by **Seastrike** » Wed Jan 15, 2020 10:10 am

Excellent, Thanks again for the information and education.

I'll try the EPR setting "off" tonight.

Enjoy your day.

Seastrike · Post by **Seastrike** » Sat Jan 18, 2020 7:14 am

Quick update.
As suggested, I increased the Min pressure up to 6 the last few nights (have not tried a collar yet) and AHI's dropped to 4.9 which means my total # AHI's are now 50% reduced from my baseline.
Oddly, I see better results with EPR set to ON.....it's early now but I feel rested this morning.
I like that, but further improvement is needed. I'm still seeing nearly all AHI's are attributed to CA's and Hypopneas, though the # OA's and UA have reduced to nearly 0 !

I using a 10 minute Ramp from 4 to 6 pressure, do I still need to use this feature after 60 days on CPAP ? Is it doing anything to help me ?

Also, I record most of my CA's early in my nights sleep or as I begin to wake. Is there a message I can take from this ? and how to defeat ?

Thanks again. The journey for great sleep continues.....

Pugsy · Post by **Pugsy** » Sat Jan 18, 2020 7:35 am

To use the ramp feature is strictly personal choice. If you don't need the lower pressures then don't use it. All it does is delay the beginning of therapy pressures.

If most of your events are related to awake breathing false positives....they should reduce as you start sleeping more soundly...less awake time wearing the mask and machine.

Seastrike · Post by **Seastrike** » Tue Jan 21, 2020 3:42 pm

Got it- Thanks again.

When I review OSCAR data, I see a correlation between # and frequency of CA events and times of increased leak rates.
Does this make sense and if so, what's the theory ?
I assume, during periods of higher leak rates the CPAP capabilities are compromised and the therapy is losing some effectivity during this time ?

Pugsy · Post by **Pugsy** » Tue Jan 21, 2020 4:43 pm

CA or clear airway apnea events are open airway cessation of breathing....central apneas.
They are different from obstructive apneas where airway tissue is blocking the airway.
The leaks probably are not a cause for the CAs unless the CAs are false positive awake breathing flagged by mistake.
The leaks might cause you to wake up and increase the chance of a pause in breathing while awake that the machine flags.

If the machine was having trouble sensing something you would see a UA flag and not CA flag.
Watch all the videos here.
http://freecpapadvice.com/sleepyhead-free-software

Seastrike · Post by **Seastrike** » Thu Jan 23, 2020 4:34 pm

Thanks again. Now for todays questions if you would, please.
I always see the frequency of my CA's increase as I begin to awaken from a night "sleep"...wishful thinking anyway !!

Is there a way, in OSCAR, to recalculate AHI for only a portion of the night's data ?
In the attached example, Can I recalculate last nights AHI using data only from 21:51 to 4:30 and see what that looks like ?

Pugsy · Post by **Pugsy** » Thu Jan 23, 2020 4:43 pm

Seastrike wrote: ↑
Thu Jan 23, 2020 4:34 pm
Can I recalculate last nights AHI using data only from 21:51 to 4:30 and see what that looks like ?

If the machine had been turned off and back on again there would be a separate session you could turn off and the AHI would be recalculated but otherwise...no..can't be changed on a permanent basis but you can do a temporary recalculation by just highlighting only the time you want to see and look at the bottom of the Events graph on the left in teeny tiny letters the AHI is recalculated for only the highlighted time frame.
It's right under the lower left corner of the Events graph and starts with Duration...and then you can see AHI.

Seastrike · Post by **Seastrike** » Thu Jan 23, 2020 4:54 pm

Got it.
Pugsy, You know your stuff - Thanks again.

Newbie - Diving in head first !

Newbie - Diving in head first !

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Machine	Mask

Additional Comments: Started CPAP Nov 18, 2019

Machine	Mask

Additional Comments: Started CPAP Nov 18, 2019

Machine	Mask

Additional Comments: Started CPAP Nov 18, 2019

Machine	Mask

Additional Comments: Started CPAP Nov 18, 2019