Newbie's AHI higher than at sleep study

AHI only slightly lower, but less centrals. I don't know how to interpret what the pressure changes mean, having always been on fixed.

I have a question about pressure, since last night was my first night on pressure range from 5-15, rather than a set 10. In periods of being awake, my pressure on my machine would go up to 11 or 12 or so. I thought pressure increased only during sleep to control the apneas. I had very lg leaks last night, due mainly I know to feeling like I had to open my mouth to let air escape. It felt like not enough was escaping, otherwise. I was using a chinstrap. Any thoughts on this?

When we are awake, we sometimes breath unevenly. Your machine is probably picking up these differences and pegging them as either apneas or flow limits and tries to compensate for them by raising the pressure. In time, you will probably get used to the chipmunk cheeks and sleep through it. I have them all night long and to be truthful with you, I don't notice them any more. I know it's there, and for me it's just a part of my therapy.

When you wake up during the night and see the higher pressure noted on the screen it's up there because it can't drop immediately when you wake up...it takes it a little bit for it to figure out that nothing is going on and the pressure can be lowered. It can take several minutes for it to come to that realization and start reducing the pressure and even then it doesn't go down real fast...it goes down gradually.

Can you get me a screen shot of the flow limitation graph for last night?

Your OAs and hyponeas reduced a little with the higher pressures the machine went to..and the centrals didn't increase and in fact decreased. I wonder if a good number of your centrals are SWJ centrals from maybe arousals caused by the OAs and hyponeas?
I know some of them are real but maybe a sizable chunk are just SWJ and we need to ignore them.

How many times do you think you woke up last night?

I awoke I think around 8-10 times. That could be the case, Pugsy, that it's the arousals causing SWJ. Thank you for providing a possible answer. And thank you, Okie Bipap. Your answer helps me, as well, to better understand my situation.

My thoughts about wake ups/arousals is that if we remember a sizable number there's probably a good chance that there's a lot more we don't remember.

Your flow limitation graph is a bit ugly...I have seen worse but I also have seen better.

Do you by chance have a lot of nasal congestion going on?

I do have a lot of nasal congestion. This morning, especially, I am almost totally stuffed up and having to breathe through my mouth a lot. I feel as if that's how I was feeling last night, when I felt as if I had to open my mouth to expel air. I also felt that at times I was not getting enough air in through my nose, although while using the machine I do feel that it helps the stuffiness at the time.

I usually breathe steam in the past when I am stuffed up and it normally helps. I don't like to take allergy meds, as I don't like the side effects and due to my BP issues, as well.

On another note, do you think the pressures from last night, 5-15, are right for me or is it too soon to tell? From my limited experience in reading the charts, it seemed that they did not go all the way to 15 max but almost reached that at about 14.9.

HI Dori,

I don't have time to analyze your data, but I have been watching it. I think, most probably, as Okie and Pugsie have mentioned, your CA are being driven by arousals/disturbances caused by your mouth leaks. In other words, probably SWJ.

You mentioned the nurse saying you had no centrals during your study. What kind of mask did you use for that? If it was a FFM, you may not have suffered the mouth leaks you are now with the Dreamwear. As you are discovering, a chin strap does very little to prevent mouth leaks (one can still exhale through and around closed teeth).

If, by chance, you have a FFM, you might want to try it. Though I grant you, FFM are not as easy to fit as nasal types and can be disturbing as well.

j

Thank you Jay for replying. I have been reading through posts, and I have great respect and awe for your knowledge and opinions, as I do with Pugsy and Okie. With the help of you all, I will get through all this and come out a winner.

To answer you question, they used a nasal mask during my titration. It was the Airfit N10. I brought it home with me and used it a couple of nights but had large leaks with it, and began using the Dreamware. Yes, I am realizing the limited ability of the chin strap an I even tried the paper tape suggestion I was given with basically the same results, air escaping at the corners. I may try a FFM, but at the sleep study, this was what they tried first and I felt like I was suffocating, so they just put the nasal one on. I don't think we gave it enough of a time trial and possibly I could have gotten used to it, although I admit I did not like it and it wouldn't be my first choice. But I am willing to give everything a try to make this journey a success.

The ugly flow limitation graph could be from the nasal congestion.

Are you using the heated hose? If so at what setting for humidity and air temp?
If not using a heated hose..at what setting for humidity?

I am torn about the pressure...Once you go up from the 5 it never really comes down below 10 except when you turn it off. It pretty much stays up there...now it may be staying up there attacking the flow limitations because they are ugly or maybe because the airway is trying to collapse.
This question we really don't have a way to figure out an answer to with 100 % accuracy.

One night doesn't make a trend and by your own admission lots of wake ups and lots of large leaks...so it's not a really good yardstick to be using. I would think use it at least a couple of nights and see if maybe we can get a night without so many wake ups and leaks muddying up things.

You know it's possible that the original 10 cm prescription simply was not quite optimal because you didn't have a good titration sleep study for any number of reasons. I had that happen to me...came out with a RX of 8 but I didn't sleep well at all at the sleep study and got very little REM where my OSA is 5 times worse than in non REM.
I think I got 6 minutes of REM....no way to accurately titrate an optimal pressure in 6 minutes.
It was discovered after I got home and actually slept and got REM that I need up around 16 or more during REM.
Maybe something like that happened to you or maybe it's related to sleeping position (supine pressure needs are often higher)

If it wasn't for the centrals ...I would suggest you try something around 11 or 12 either cpap or as minimum on apap because the machine goes up there and stays up there anyway in response to either the FLs or the airway collapsing.
It ISN'T responding to the centrals..any increase seen near a central is purely coincidence.
The reason for upping the pressure...deal with what is known...the OAs, hyponeas and FLs and cross your fingers that if you can better prevent the obstructive stuff that the centrals are more related to the arousals from the obstructive stuff then the centrals will reduce. It's obvious that the obstructive stuff isn't optimally treated/prevented.
So I tend to think...try to fix what is obviously needing fixing and see what happens to the centrals once the obstructive stuff is better addressed.

Now that's my own personal thoughts on what I would try if I were in your shoes...whether your doctor agrees or not I can't say. Sometimes these doctors look at things differently than I do.
Whether you are comfortable with changing something yourself....that's a decision you have to make.
I would try either cpap of 11 or 12 or increase the minimum in apap mode to that...and watch the centrals to see if they increased a lot or not.
But remember I have been at this a lot longer and I am quite comfortable in making changes like this.
I wouldn't feel bad if you aren't on board for any reason. In a way I am just making an educated (past experience) WAG (wild ass guess) and going out on a long skinny limb with the idea...and I wouldn't blame you one bit if you didn't want to go there with me.

Since your machine pretty much goes up there and stays up there anyway...I don't see that making the change is likely to hurt anything but I would keep one eye on the centrals for sure and back off immediately if they got a lot worse or you see more CSR.
It's not like those are settings that your machine never goes to.
The maximum is fine...it's not like you go up to the max and stay there.

I will take your suggestion, Pugsy, and use this pressure setting a couple more nights and see if I can get fewer wakeups to see how this may change things, then if it doesn't change for the better,I will make the pressure changes you mentioned.

No, I'm not using a heated hose but I have been trying to read up on the benefits. I would have to have my dr prescribe one in order for my insurance to cover it, right?

I changed my humidity setting to 6, because the original setting of 4 by DME caused severe congestion, watery eyes, sneezing, runny nose and all that. The 6 setting sees to be a lot better. No more allergy symptoms other than the stuffiness which seems to have been a normal part of my life for a long time.

No, a heated hose shouldn't require a separate RX from the doctor for it to be covered by insurance.
Usually all that is needed is a request from you...only problem is that your insurance probably won't pay for it until the allowance period passes..probably at 3 months depending on your insurance.
They may have already paid for one hose with the machine dispensing...and won't want to pay for another one until the allowance period for replacement is up.
But your DME may not have billed separately for the hose or maybe they will just be nice and give you one if you ask for it. Sometimes they do that. Never hurts to ask.

No RX is required if you elect to purchase privately...cpap.com or whatever...of course insurance won't reimburse in situations like that. Sometimes you can find some killer hot deals on EBay or Amazon. They aren't horribly expensive though.

I don't use your model machine...wish I did...I have a spare heated hose you could just have to try. What I have won't fit your machine.

I'll call my DME Monday about the heated hose, and if no help there, will look into purchasing one through one of the sites you mentioned. Thanks for the offer of a hose to try. Sure wish it would have fit my machine.
I will report back after a couple nights trial on this pressure setting. I think increasing the minimum and allowing the max to stay as is, sounds like the right way to go, if no changes in wakeups, CAs and such.