A month into CPAP for mild apnea

WillMakeIt · Post by **WillMakeIt** » Sun Jun 10, 2018 12:01 pm

I was diagnosed with mild apnea, with 6.4 AHI and 84% oxygen.

I have been using my ResMed Autoset for roughly a month now, and pretty consistently get the AHI under 1. I still wake up at night, but mainly because of my kids. Also sometimes, about an hour after falling asleep, I will take the mask off. I will eventually wake up and discover this, so I put it back on. I sleep the rest of the night with it on. I'm not sure why this occurs.

Anyways, I might be slightly less tired lately, but I feel like I'm a little zoned out and lightheaded lately. Doctor recently said I have a little ear problem along with sinus, and prescribed me methylpresidone, but i have yet to take it.

Ive been trying to play with pressures. I was prescribed 5cm, but I have messed around with it lately. It almost always says I am at 95% of my highest setting. Anyways, please take a look at my SleepyHead data from. These are from last night and two nights ago.

What should be my next step?

OkyDoky · Post by **OkyDoky** » Sun Jun 10, 2018 1:42 pm

On your Sleepyhead you have some of your events turned off. Look at the bottom left and see the events where the LL shows a red flag. Scroll throw those and make sure they are all green. Also some graphs are more important than others. This site will help you organize your graphs. The calendar and pie chart should be turned off be turned off where the more important info below will show. https://sleep.tnet.com/resources/sleepyhead/shorganize

From what I can see you are hitting your top pressure most of the time. I have a thought on your settings but I would like to see all your events first.

Pugsy · Post by **Pugsy** » Sun Jun 10, 2018 1:54 pm

Lower left corner of the graphs where it says "Flags" expand the menu and any you see with red/black...click on them to change to green/black. Red turns the flagging off on the Events graph. You want all the flagging turned on so we can see whatever is flagged if it is flagged.

palerider · Post by **palerider** » Sun Jun 10, 2018 1:55 pm

Your machine *clearly* wants to go higher.

Will that result in better sleep? maybe.

I'd raise the max... (and the min... min 8, max 20, see what happens).

Pugsy · Post by **Pugsy** » Sun Jun 10, 2018 1:58 pm

Are you experiencing much nasal congestion to speak of or is the nose fairly clear?

The flow limitations are probably the driving force for the pressure wanting to go higher...if it is nasal congestion more pressure probably won't fix it but if the nose is clear then more pressure should reduce the FL activity. Now whether or not you will sleep better....that's unknown. Worth trying though.

WillMakeIt · Post by **WillMakeIt** » Sun Jun 10, 2018 2:28 pm

Hi folks, thanks for the responses!

I went in and changed the settings, and attached are the updated charts.

As far as nasal congestion, I have a little bit before bed. When I wake up, it is typically clear (I am guessing due to humidifier?).

One thing I am curious about is if these charts give any hints of deep sleep? Why is pressure sometimes at max and sometimes at minimum?

Pugsy · Post by **Pugsy** » Sun Jun 10, 2018 2:40 pm

WillMakeIt wrote: ↑
Sun Jun 10, 2018 2:28 pm
One thing I am curious about is if these charts give any hints of deep sleep? Why is pressure sometimes at max and sometimes at minimum?

Nothing definitive or clear cut in terms of REM sleep.
People can sometimes get an educated guess by the pattern of the respiration and the timing since REM usually come in a predictable pattern. Google sleep stages and look at the hypnograms to see the usual pattern for all the sleep stages.
Typically REM comes on 90 minutes or so after sleep onset and then as the night goes on the REM stage comes on a little more frequently and starts lasting longer with the greatest amount of REM happening in those wee hours of the morning.

Why does the pressure fluctuate...the 2 primary culprits for when we see pressure changes....sleeping position or REM stage sleep both of which it is common for our OSA to worsen and we maybe need more pressure.
For me its REM sleep. I sometimes need 6 to 8 cm more when in REM and it was documented on my sleep study that my OSA is about 5 times worse in REM. Very common for that to happen.
I did some playing around with side sleeping to see if I still would see those wide variations (built a wall where I stayed on my side all night and never changed position) and I still had them so for me the position thing wasn't the big trigger. I still had the big swings when I stayed in one position all night long.

And yes...most of the time I wake up breathing more clearly than when I went to bed even with a upper respiratory infection.
The humidity helps me...but then again a hot steamy shower always helps me.

OkyDoky · Post by **OkyDoky** » Sun Jun 10, 2018 2:49 pm

I would agree with PaleRider's suggestion of setting your machine at minimum 8 and maximum 20 and evaluate that for a few days to see how you are sleeping.

WillMakeIt · Post by **WillMakeIt** » Sun Jun 10, 2018 8:43 pm

Thank you again for the responses! I am learning a lot!

One thing that has me curious. If I make my setting 8-20cm, would that possibly lead to central apnea? I’ve read around here and other boards that high pressure can result in central apnea.

Pugsy · Post by **Pugsy** » Sun Jun 10, 2018 8:54 pm

While cpap pressure can trigger central apnea it doesn't have to be "high" pressure. It can happen with as little as 5 or 6 cm of pressure.
It's not a foregone conclusion that everyone will get central apnea at higher pressures...yeah they might but the odds are that they won't.
Only about 10 to 15% of the people put on cpap will develop central apneas at any pressures and even a smaller number where there is a line between centrals popping up if pressures are above some level and below it they don't happen.
I routinely see my apap go to the upper teens and I never have more than an occasional normal sleep onset central.

This panic people have about centrals is unwarranted. A few centrals are normal and no big deal. If someone has enough centrals to warrant worry and concern or even treatment there are machines designed to take care of the centrals if the are a problem.

You need to effectively treat your obstructive apnea first. The machine won't raise the pressure without what it thinks is a good reason...fix what you need to fix by letting the machine do its job and worry about centrals later only if they are worth worrying about.
Fix the known problem first...then see if there are other problems and deal with them as they pop up...if they pop up.

So yeah, higher pressures can trigger centrals but only in a relatively small number of people.
If you happen to need pressures that are higher and you happen to be one of that relatively small group of people then you deal with it if it happens. Maybe make pressure limit adjustments or maybe a different machine or maybe even give it time.

But fix what you know you need to have fixed right now with what you have available and worry about the "what ifs" later.

palerider · Post by **palerider** » Sun Jun 10, 2018 9:03 pm

WillMakeIt wrote: ↑
Sun Jun 10, 2018 8:43 pm
Thank you again for the responses! I am learning a lot!

One thing that has me curious. If I make my setting 8-20cm, would that possibly lead to central apnea? I’ve read around here and other boards that high pressure can result in central apnea.

Like pugsy says, it *can*... in about 1 in 7 to 1 in 10 people...

Should you worry? Try this exercise... hold your breath for 10 seconds. was that a big deal? no. And THAT is a central apnea.

Now, pinch your nose and mouth shut, try DESPERATELY to breath... for 10 seconds... THAT'S an obstructive apnea.

Turn up the pressure.

WillMakeIt · Post by **WillMakeIt** » Sun Jun 10, 2018 9:35 pm

Thank you for the responses and the insight in central vs obstructive. Palerider, that exercise put things into perspective big time! I will increase the pressure range tonight.

At this point, would you guys say my machine is treating me effectively since it is regularly under 1 AHI?

palerider · Post by **palerider** » Sun Jun 10, 2018 9:56 pm

WillMakeIt wrote: ↑
Sun Jun 10, 2018 9:35 pm
Palerider, that exercise put things into perspective big time! I will increase the pressure range tonight.

I thought it might

WillMakeIt wrote: ↑
Sun Jun 10, 2018 9:35 pm
At this point, would you guys say my machine is treating me effectively since it is regularly under 1 AHI?

Effectively, yes. optimally? probably not, based on the machine frequently riding at your current max set pressure...It wants to go higher. Apneas aren't the only breathing disturbances.
https://www.youtube.com/watch?v=-gie2dhqP2c
You're having a fair amount of flow limitations... Try breathing through a straw for a little bit, that's sort of what a flow limitation is like. I usually want to stop and take a couple deep breaths after a minute. (and not one of those big fat boba straws, either)

OkyDoky · Post by **OkyDoky** » Sun Jun 10, 2018 9:57 pm

WillMakeIt wrote: ↑
Sun Jun 10, 2018 9:35 pm
At this point, would you guys say my machine is treating me effectively since it is regularly under 1 AHI?

Statiscally speaking yes but your flow limitations are not figured in that number. The machine looks at them as beginning flow interruptions and it will try to increase your pressure. You need to see if the pressure increase will help decrease the flow limitations and help you sleep better. It may or may not depending on where the limitation is located.

WillMakeIt · Post by **WillMakeIt** » Mon Jun 11, 2018 10:25 am

Well, I upped pressure, but I didn't go all the way. I made my range 7-15cm. I was nervous of going all the way to 20.

Anyways, last night was a wash. I was only in bed for 6 hours (I'm sure that affects how I feel in the daytime, right?), and I woke up a couple times through the night. At one point, I woke up with one of the straps off my mask, so I'm assuming thats where the large leak came from. I usually have very minimal leaks. By the way, I am wearing the ResMed full face mask.

Can you gather any information from these graphs? It looks like I'm topping out at 9.14cm, but maybe if I got good sleep it would be higher? I'm pretty sleepy, spacey, and out of it today. Also forgot to mention, blood tests came out fine, but I do need to take a testosterone test.

A month into CPAP for mild apnea

A month into CPAP for mild apnea

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Re: A month into CPAP for mild apnea

Re: A month into CPAP for mild apnea

Re: A month into CPAP for mild apnea

Re: A month into CPAP for mild apnea

Re: A month into CPAP for mild apnea

Re: A month into CPAP for mild apnea

Re: A month into CPAP for mild apnea

Re: A month into CPAP for mild apnea

Re: A month into CPAP for mild apnea

Re: A month into CPAP for mild apnea

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Re: A month into CPAP for mild apnea

Re: A month into CPAP for mild apnea