New to CPAP, worse AHI with cpap ?

tcolar · Post by **tcolar** » Mon Nov 05, 2018 12:01 am

Hi, I was newly diagnosed with sleep apnea (although wife knows I have been snoring for ages), I'm 41.

TLDR: I picked up a machine (dreamstation), but I feel I can't breath with it and am getting even worse sleep, and very poor AHI readings (via sleepyhead)

The first night (Thursday), I only used it about 3 hours, I was using the under the nose "hamock" (not sure what it's called), and that was just not staying in place and I could not get any sleep. The machine reported no leak but an AHI of 50 and a lot of apnea.

The second night (Friday) I switch to the under the nose pillow cushions and that worked better for fit, I still did not sleep well but was able to use the machine for 6+ hours. It Stayed in place and did not leak. It still was not very good sleep, the AHI was reported to be about 13.

Last night (Saturday) I wore the mask for 4+ hours. Sleep was pretty bad again. AHI says 26.

The software shows clear airways less than half the time ....

In general I feel like I might not be getting enough air, I'm slightly congested but not to bad, I think I might typically mouth breath because I'm having difficulty not doing it with the mask on.

Questions:
- Should I maybe try a full face mask (mouth + nose) so mouth breathing would work ?
- Should I stick to it despite the poor results so far, my sleep has been worse than without CPAP and I'm getting more tired.
- a year or 2 ago, had a face xray for another reason and was told my nose was broken at some point, and i'm very often congested, can that prevent CPAP from working ?

Thank you.

tcolar · Post by **tcolar** » Mon Nov 05, 2018 12:15 am

One more screenshot .... and that was the BEST night (other 2 so far were over 20 AHI)

palerider · Post by **palerider** » Mon Nov 05, 2018 12:21 am

Please review suggestions for newbies, including how to set up your screenshots so they tell us the maximum info:

viewtopic/t172378/Sticky--Newbies-PLEAS ... 0d9229c6fe

Sheriff Buford · Post by **Sheriff Buford** » Mon Nov 05, 2018 4:46 am

The info you gave us shows a minimum pressure of 5, and you feel you are not getting enough air. Bump, the minimal pressure to a 6 or 7 to try to eliminate the "not getting enough air" feeling. If you were mouth breathing, it will show up on your leak rate, you will get a very dry mouth and your spouse may tell you were snoring. Looks like the pillows are working for you. I would stay with them, because the pillows are less intrusive than a full face mask. You have to train keeping your mouth closed while using nasal pillows.

It seems you are doing good! Keep going! You need to get used to wearing the mask all night. Over time, you will. You can speed up the time by wearing the mask while reading or watching TV.

Sheriff

LSAT · Post by **LSAT** » Mon Nov 05, 2018 5:38 am

Did you have an overnight sleep study? What was the diagnosis... Are you working with a doctor and/or DME?

Pugsy · Post by **Pugsy** » Mon Nov 05, 2018 7:21 am

I don't know what to make of those centrals/CAs.
It wouldn't be impossible for them to be related to the OA/hyponea stuff going on...as in the OA/hyponea happens and causes an arousal and the centrals are more post arousal than anything else. Especially if you aren't sleeping well.

How did you come by the OSA diagnosis? Home study or a sleep study done in a lab with tech in attendance?
Did you ever have a sleep study with cpap and mask and a tech adjusting pressures or did you just get a machine and start out to let the machine find the appropriate pressure?

All I know to offer at this point is to try to fix what can be fixed with this machine and that's the OAs and hyponeas...and see what happens to the centrals when the OAs are better prevented.
To do that you would need more minimum pressure...so maybe increase that 5 starting minimum to maybe 8 or so. I really need to see the pressure graph to have a better idea.

Also please review this thread for what to show when you share you images. What you are showing above isn't very helpful in terms of figuring out what is going on with the pressure.

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

You can't fix the centrals with more pressure though. Try to fix what you can with this machine first and then if the centrals are still numerous then we have a different discussion about the centrals.

tcolar · Post by **tcolar** » Mon Nov 05, 2018 9:43 am

> Did you have an overnight sleep study, Are you working with a doctor and/or DME

I did the home study.
Here is what was reported "Your Sleep Study shows you have mild obstructive sleep apnea (OSA) with an apnea-hypopnea index (AHI) 1A of 13.4 and 1B of 8.3 events per hour, and lowest oxygen saturation of 73%."

Yes I'm asking the same questions to the DME and will see what they say, have followup aptmt in a few weeks.

The machine is currently set to 5-20 (APAP), i reduced the ramp to 5mn (from 20) since I feel discomfort at the lowest pressure.

I attached graphs in the preferred format for the last 3 "nights".

If I read those graphs right it seems the AHI goes up as the pressure goes up, does that make any sense ?

Pugsy · Post by **Pugsy** » Mon Nov 05, 2018 9:52 am

If you want to adjust things on your own and not wait..

If you were asleep for these reports....at least for the most part.

I would suggest increasing the minimum to 8 cm...leave the max alone. One night...one change.

If the OAs and Hyponeas reduce but the CAs don't...second experiment is to turn off Flex.
Don't do both at the same time tonight though...don't increase the minimum and turn off Flex together until you try just the one change of increasing the minimum to 8.

If you don't think you really slept at all then we need to have a different discussion because until you can say you slept very much we can't trust the data given.
The machine can and will flag awake breathing irregularities by mistake and if you were awake with lots of tossing and turning then a good many of these events might not even be real.

tcolar · Post by **tcolar** » Mon Nov 05, 2018 10:01 am

Thanks. Thursday is probably throw away data as I don't think I slept much at all.

Friday was the best sleep, well still worse than without cpap, but a good chunk was sleep.

Saturday was something in between.

Might try the higher min pressure tonight unless I hear back from the doc.

tcolar · Post by **tcolar** » Mon Nov 05, 2018 1:16 pm

I'll try the 8cm min pressure tonight.

The Sleep Dr recommended trying a full face mask, but I won't get it until Thursday.

I'll check my watch, it tracks sleep, it's not super accurate but it's usually at least good at knowing if I'm awake/moving or not, so I can try to know what part of the data may be "bad" (awake)

A few more questions:
- If I mouth breath would that show up as a leak ? I'm thinking I might mouth breath but since the data shows no leaks maybe not.
- What would a "good" graph look like, would that be only black on the flow chart (no events) ? Would there be almost no events?
- It seems I get "Pressure pulse" a lot, is that the machine detecting issues, or maybe it does that more initially to "learn" ?
- What is "periodic breathing", is that god or bad ?

The centrals are definitely odd, I'm not really at risk for it, not overweight (6'1 / 190) and heart is likely fine, I coach and play hockey several times a week, which are pretty good heart stress tests.

Pugsy · Post by **Pugsy** » Mon Nov 05, 2018 3:46 pm

tcolar wrote: ↑
Mon Nov 05, 2018 1:16 pm
What would a "good" graph look like,

Around 2 or less events would be good if you could say you slept decently and felt decently.
Don't expect to never have any events....while it can occasionally happen it's not a realistic goal.

Pressure pulse are when the machine senses some kind of flow reduction and it uses the pressure pulse to figure out what kind of even is happening. You can have pressure pulses happen and not end up with any sort of flag if the airway opens back up.

Periodic Breathing is a waxing and waning of the air flow. Not necessarily a bad thing depending on how much, what kind and are there a bunch of centrals flagged in the middle of the PB so that the pattern of breathing is very defined.
You would need to zoom in the the flagged PB for use to comment further but what little you are having isn't really enough to worry about and could probably be explained away with some awake breathing irregularities going on.

Here's one of mine...not a big deal.

TropicalDiver · Post by **TropicalDiver** » Mon Nov 05, 2018 11:44 pm

As others have noted, one change per night (at most) is the way to tweak. And, to be clear, I am not a medical professional nor a true subject area expert.

That said, I just switched to a Dreamstation from a S9 and encountered some initial issues that seem much better after tweaking -- all related to the ramp in. First, I turned the SmartRamp feature off. Second, I upped the ramp pressure up a few (I went from 4 to 6). Third, I made the ramp five minutes (versus something like 20). I felt like I was getting reduced air partway through an inhalation and then felt like to was increasing air flow just as I was trying to exhale.

When I started with the S9, It was a bit of a journey to find the best mask solution for me. I have found two that work very well for me...and found many more that did not. My favorite mask became that only after I tweaked the straps a bit. YMMV.

tcolar · Post by **tcolar** » Tue Nov 06, 2018 9:48 am

Thanks @tropicalDiver, yeah seems similar to what I experienced.

I'm going to see the sleep tech on Thursday, so I decided to not tweak anything until then, even though I think Pugsy's recommendation would help, seems to match the data I see.

Last night was again pretty poor, but it was odd, it actually started decent, from ~ 11:45 to 1:45 I got a couple hours of what felt like decent sleep, sleepyhead shows the data improving during that time span. I'm not sure why I woke at 1:45,

One thing I notice is that the data looked the best when the pressure was 9+. However after 1:20 it seems the machine dropped steadily from 10 to 5, why did it do that ???

From 1:45 to 2:20 I was out of bed, from 2:20 to 3:30 tried to get the mask on again and it just would not cooperate.it felt not right in many ways compared to earlier in the night:
- Felt like not enough air, it would blow air but cut it off (switch to exhale pressure) before I felt I had enough
- If I opened my mouth it would not always blow air, or not right away, or only if I opened way wide. Usually it blows air as soon as I open my lips even just a little.

One thing is when I went back to bed and put the mask on it auto starts (it seems to auto detect when I'm trying to breath), should I have manually press the "start" button, maybe this "auto-start" mode is different somehow ??

Does "periodic breathing" means I did not take a breath for that long, some of those show several minutes, that seems pretty crazy, should I be worried bout those ?

Pugsy · Post by **Pugsy** » Tue Nov 06, 2018 10:17 am

tcolar wrote: ↑
Tue Nov 06, 2018 9:48 am
Does "periodic breathing" means I did not take a breath for that long, some of those show several minutes, that seems pretty crazy, should I be worried bout those ?

No. Has nothing to do at all with not taking a breath.

All it means is that your breaths had a little different pattern to them...you didn't stop breathing at all.
Zoom in up close on the flagged green areas and you can see you didn't stop.

No...nothing to be worried about at all.

If it bugs you...ask your doctor when you see him in a couple of days.

tcolar · Post by **tcolar** » Tue Nov 06, 2018 10:29 am

Ha ok, that's good, I had seen some various definition of "periodic breathing" and some sounded bad.

So I guess my sleep was indeed decent from ~12:45 to 1:40 when the pressure was higher, not sure why the machine decided to decrease the pressure back to 5 when things where going better at 9+ .....

New to CPAP, worse AHI with cpap ?

New to CPAP, worse AHI with cpap ?

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Re: New to CPAP, worse AHI with cpap ?

Re: New to CPAP, worse AHI with cpap ?

Re: New to CPAP, worse AHI with cpap ?

Re: New to CPAP, worse AHI with cpap ?

Re: New to CPAP, worse AHI with cpap ?

Re: New to CPAP, worse AHI with cpap ?

Re: New to CPAP, worse AHI with cpap ?

Re: New to CPAP, worse AHI with cpap ?

Re: New to CPAP, worse AHI with cpap ?

Re: New to CPAP, worse AHI with cpap ?

Re: New to CPAP, worse AHI with cpap ?

Re: New to CPAP, worse AHI with cpap ?

Re: New to CPAP, worse AHI with cpap ?

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