First week on CPAP device, AHI still in teens

Hi

I had a sleep study done a couple of weeks ago where the technician determined my AHI was 18.1. On the same night she did titration and prescribed a pressure of 10cmH2O. I have had my Philips Dreamstation Pro for a week now but every night my AHI as reported by this machine is still in the teens. ( > 13). How long does it take after starting with a CPAP device for the AHI to be under 5? SleepyHead also tells me that almost half of my events are Clear Airway events. Would increasing the pressure result in more of these?

If the pressure is correct and you have the proper mask that fits properly, your AHI should be below 5 on day 1. Fill in your equipment in your profile. Download Sleepyhead software and let us look at some of your data.

s7nguy wrote: SleepyHead also tells me that almost half of my events are Clear Airway events. Would increasing the pressure result in more of these?

Yes..IF (big if) the pressure itself was the cause of the clear airway/central apnea events.

Do you have a copy of your sleep study (both the diagnostic and titration portions) so you can check to see if you had any centrals during either? If not...get copies.
Normally if you didn't have any centrals during the diagnostic portion and you developed centrals because of the cpap pressure then it should have shown up during the titration portion of your sleep study. Now maybe they did and maybe they have elected a wait and see attitude about them.

How is your sleep quality? Are you sleeping soundly or waking often? This is real important to know.
Do you take any medications? If so, what?

Please post a typical night detailed report from SleepyHead.
If you don't know how...imgur is a good place to host the image
https://sleep.tnet.com/reference/tips/imgur

and for how to organize...there's 3 pages..be sure to read them all
https://sleep.tnet.com/resources/sleepyhead/shorganize

for examples of what we like to see check out this thread. We don't need every single graph that SleepyHead produces.
We just need the basics and if we need anything else we will ask.
viewtopic/t103468/Need-help-with-screen-shots.html

If you are spending a lot of awake/semi awake time wearing the mask then it wouldn't be impossible that the bulk of your AHI is maybe the machine mistaking awake breathing irregularities for sleep apnea events. If that's the case then we work on getting better sleep first. It's also possible that obstructive apnea events are causing post arousal centrals (as opposed to the pressure causing the centrals) and if we reduce the obstructive stuff the centrals will reduce too.

So lots of possibilities out there.
Let's start with the answers to my questions and share with us a typical night detailed report.

Thanks for replying LSAT.

Here is the data from the CSV export of SleepyHead

---------------------------------------------------------------------
Date,Session Count,Start,End,Total Time,AHI,H Count,OA Count,UA Count,CA Count,VS Count,VS2 Count,RE Count,FL Count,SA Count,NR Count,EP Count,LF Count,UF1 Count,UF2 Count,PP Count,Pressure Avg,IPAP Avg,EPAP Avg,Pressure 1%,IPAP 1%,EPAP 1%
2016-12-08,3,2016-12-08T17:06:59,2016-12-09T10:32:18,10:26:11,14.948,42,67,0,47,0,2,9,1,0,0,0,0,0,0,129,9.55773,0,8.93015,10,0,9.5
2016-12-09,2,2016-12-09T20:42:29,2016-12-10T07:14:27,10:30:13,9.140,32,36,0,28,0,2,12,0,0,0,0,0,0,0,72,9.56905,0,8.94476,10,0,9.5
2016-12-10,1,2016-12-10T21:49:28,2016-12-11T06:12:37,08:23:09,8.586,28,31,0,13,0,0,9,0,0,0,0,0,0,0,28,9.78476,0,9.19424,10,0,9.5
2016-12-11,3,2016-12-11T20:58:36,2016-12-12T06:37:23,09:37:50,17.860,33,90,0,49,0,3,9,0,0,0,0,0,0,0,130,9.70521,0,9.1299,10,0,9.5
2016-12-12,4,2016-12-12T12:41:40,2016-12-13T06:45:36,10:22:02,17.073,31,93,0,53,0,1,8,0,0,0,0,0,0,0,137,9.92147,0,9.34434,10,0,9.6
2016-12-13,4,2016-12-13T21:14:35,2016-12-14T07:18:22,09:13:49,14.192,28,57,0,46,0,0,9,0,0,0,0,0,0,0,112,9.60793,0,9.08841,10,0,9.5

The CSV data is useless.
Do the screen shot thing that I explained above.

Do you have a copy of your sleep study (both the diagnostic and titration portions) so you can check to see if you had any centrals during either? If not...get copies.

I do not have a copy of my sleep study. I have requested the hospital to provide me with one.

How is your sleep quality? Are you sleeping soundly or waking often?

I got the sleep study done because I found that I am unable to sleep for more than 3 - 4 hours at a time. Even with the CPAP device I wake up around 4 hours after I go to sleep and then I am unable to sleep for at least the
next 2 - 3 hours. I am also sleepy and tired all day long.

Please post a typical night detailed report from SleepyHead.

Please see below for the SleepyHead screenshot. I did not find the "Flow Limit" view in my version of SleepyHead.
http://imgur.com/gallery/7ZAx9

If you are spending a lot of awake/semi awake time wearing the mask then it wouldn't be impossible that the bulk of your AHI is maybe the machine mistaking awake breathing irregularities for sleep apnea events. I

This is also possible I tend to read for 10 - 15 minutes with my mask and device on before falling asleep. I have also had the device running and my mask when I have woken up in the middle of the night.

You have the DreamStation Pro CPAP machine. In cpap mode it won't flag Flow Limitations which would show up on your Events graph if it did (but it doesn't/can't in cpap mode). The Flow Limitation graph mentioned in the instructions is for the ResMed machines...so you won't have the FL graph.
We don't need the snore graph either....snores are shown better on the Events graph.

The bulk of your events seem to be clustered around known awake times. Like in the middle of the night you wake up and lay there for a while and then turn the machine off and then back on again..and at the beginning of the night too during ramp.

With your history and this report it real hard to decide if these events are real and need more pressure or if you just need better quality sleep.
I am sure that part of what is shown is very likely SWJ (Sleep/Wake/Junk) flagged because of the irregularities of awake/semi awake breathing. The machine only measures air flow and can't tell if you are awake or asleep. Awake/semi awake breathing is much more irregular than asleep breathing and easily confuses the machine causing it to flag stuff that isn't "real" in terms of sleep apnea events.
Now it is possible that some of what is shown is also real but until we can eliminate the chance of it being SWJ we really can't make a good and accurate evaluation as to what needs to be done.

Do you take any medications? If so what? The reason for this question is often meds are taken which can sometimes make SWJ worse because it messes with sleep architecture.

You need to try to limit known awake time when using the mask and machine if at all possible so that you can get a better idea what the real results are without being clouded by SWJ.
I once helped a guy with AHI in the 20s...reports were ugly for sure. Come to find out he was spending a lot of time not sleeping but using the mask and machine. Once he quit doing that the AHI dropped to around 3.
Like you he was having a large number of CAs and even OAs that were showing up.

Now it is also possible that the OAs flagged are causing arousals to a semi awake state and thus increases the chance of having either a real sleep onset central (these are normal and not usually a problem) when you go back to sleep or they are simply SWJ arousal and not real. It's difficult to know for sure without seeing the actual flow rate up real close and it's something that takes a lot of time to get a handle on using flow rate to determine sleep status.
We have a couple of threads where some examples are shown and I will go dig them up in a minute and point you to them.

My first gut reaction to this report (hearing your history of poor sleep) is that this report screams poor sleep quality and the first order of business is get more solid blocks of sleep to evaluate. Easier said than done though...I know.

We don't need the snore graphs or the respiration rate graphs.
You can resize the main graphs to make them more easily evaluated.

These graphs (on the right side of SH report) are all that we need for the time being.
Events
Flow Rate
Pressure (even though it is a fixed cpap pressure you are using ramp so it's useful)
Leak

I also wouldn't worry about the PB flagged event time until more solid sleep is reported. SWJ breathing will often get a PB/CSR flag.

A thread with some examples of SWJ breathing
viewtopic.php?f=1&t=114600&p=1110928#p1110928
and within that thread there are other thread links for more discussion about SWJ breathing.

Sometimes SWJ breathing is so obvious it just up and slaps you in the face and other times it is more difficult to figure out.
I don't know if you will be able to get much of an idea or not.
If your eyes glaze over when you read this stuff maybe we could figure out a way for me to look at your data up close.
It would involve your getting me a copy of your SD card. Do you know how to copy the entire SD card and zip it and then upload it to some place that I could then get it?

Thanks for your replies pugsy. I will pm you the zip of my card today evening

I don't know how it is suppose to work, but here is my AHI for the first few months starting with day 1 over 5 years ago:


And here is how it looked as of the end of last month:

JeffL wrote:here is my AHI for the first few months starting with day 1 over 5 years ago:

Just curious. What model machine were you using with that first starting AHI? Was it a S8 or S9 model?

Pugsy wrote:

JeffL wrote:here is my AHI for the first few months starting with day 1 over 5 years ago:

Just curious. What model machine were you using with that first starting AHI? Was it a S8 or S9 model?

The first machine was a Resmed S9 Autoset. I started using the Resmed Airsense 10 Auto set the last couple of days of November, so only a couple of days on the new machine are shown.