New to CPAP, worse AHI with cpap ?

Pugsy · Post by **Pugsy** » Tue Nov 06, 2018 10:46 am

tcolar wrote: ↑
Tue Nov 06, 2018 10:29 am
not sure why the machine decided to decrease the pressure back to 5 when things where going better at 9+ .....

Because that is what it does...not much was going on at 9 plus so it starts to go back down to the minimum.
So it goes down and then something happens...maybe you turn on your back or maybe REM sleep..to cause the airway to collapse at the lower pressures so the machine again as to make the trek up to try to hold the airway open.
This is why we suggest increasing the minimum...so that the machine doesn't go down below a point where the pressure is sub optimal and lets the airway try to collapse and if it happens it can fairly quickly get up to where it needs to be.
Right now the trek up and down is too long for the machine to get to where it needs to be to do a good job. They just can't move that fast.

And yes...some of the discussion about PB is scary. It really depends on how much PB a person has and mainly if there are a lot of real central apneas involved.
This much PB/CSR below is bad...and those are really centrals and not OAs...and this guy does indeed have heart issues.
Yours is nothing like this one..

tcolar · Post by **tcolar** » Tue Nov 06, 2018 11:16 am

Got it, thanks for all the info, it all makes sense and yeah it souds like increasing the min pressure would help as you pointed out before.

I'll leave the setting alone until Thursday which is when I see the sleep tech, and I'll try to see if he agrees to increase the min pressure which sounds likely since he will look at that same data, if not I might do it anyway, because I definitely need better sleep soon.

palerider · Post by **palerider** » Tue Nov 06, 2018 12:46 pm

tcolar wrote: ↑
Tue Nov 06, 2018 10:29 am
not sure why the machine decided to decrease the pressure back to 5 when things where going better at 9+ .....

Because it's a faithful but dumb machine, and you told it that 5 was the pressure to go to... and it trusted you.

That's why getting the min pressure set right is the important thing.

tcolar · Post by **tcolar** » Fri Nov 09, 2018 9:43 am

So most days have been the same, sleeping from about 12 to 3 then waking up, then unable to go back to sleep with the machine (lack of air), similar results to what I posted a few days ago (AHI around 18).

Yesterday I got the Dr to change the min pressure to 7, this did help in that I was able to wear the mask pretty much continuously from midnight to 6, without waking much (once), On the other hand the numbers don't look much better (13 AHI) ... although I know it took me a while to fall asleep and I remember turning off the machine briefly to readjust the mask, seems it was around 1:30 am. If you take out what's before that and keep ~ 2am to 6am, then I guess it's a bit better, although not great.

I feel like a slept a bit better, not waking as much helps, but I can't say I feel well rested either, light headache and tired.

The ARNP said they might bring me in : "From your download you have some central sleep apnea, this may be due to treatment and should go away within a few weeks. If they do not go away in a few weeks I will ask you to return for an in-lab titration study. If you have any questions please let me know!"

Any thoughts on the charts and anything else to try to improve my numbers ? I did get an "over the nose" mask, I might try that tonight instead of the nose pillows.

tcolar · Post by **tcolar** » Fri Nov 09, 2018 10:36 am

One more thing, is that as I was trying to fall asleep (that period before 1:30), I did feel like a woke up a few time feeling like my tongue fell into my throat, or at least that's what it felt like, something falling in the airway and making me choke, though it's hard to remember exactly while half asleep.

Should I try sleeping on my side rather than my back ? Or maybe try one of those mouthpiece things that supposedly might help with that ?

Thanks..

Pugsy · Post by **Pugsy** » Fri Nov 09, 2018 11:02 am

I would try side sleeping long before I would try anything in my mouth.
Those oral devices come with their own baggage that can and will mess with comfort and sleep.

tcolar · Post by **tcolar** » Wed Nov 14, 2018 5:15 pm

I'm still having a hard time sleeping with the mask on.

- With the min pressure of 7, I no longer have the "not enough air issue", so that's a plus.

- But now sometimes the machine decides to go way up (ie: to 14) and that usually wakes me up, in those case it feels hard to exhale which is uncomfortable too, I wish the machine kept a more steady pressure, as the chnages seem to wake me up.

- I tried a full face mask (because I'm pretty nose congested), a nose mask (over the nose), and the nose pillow. The over the nose one seem to be the "best" as far as staying asleep, even then I often can only wear it for a while, wake at 2 or 4 and can't go back to sleep with it. I sleep pretty well without it.

I sleep better without the CPAP on for sure, no clue what my AHI is then, but 6 hours of crappy sleep is better than 3 hours of crappy sleep.

The most frustrating thing is that no matter what mask I use and for how long, my AHI stays in the 13-30 range (awake or asleep), and basically the CPAP does not seem to have a positive effect ?

Any ideas on what could be going on or what to do ?

Pugsy · Post by **Pugsy** » Wed Nov 14, 2018 5:35 pm

On the left side down below the Statistics...see the session information?
For the sessions where you know you were awake click your mouse on those sessions to turn it from green to red.
This turns off the known awake sessions and removes any data from the statistics and will make your graphs easier to read.

We don't need the AHI graph to evaluate your reports.

Roughly half your AHI is clear Airway/central apnea events. I suspect a lot of those are just sleep wake junk false positive events getting flagged and perhaps even some of the other events as well.
Now it wouldn't be impossible for those centrals to be real and if that's the case we probably need to have a different discussion but it's really hard to know for sure when people admit to being awake a lot during the night.
It also wouldn't be impossible for the OAs happening to be causing arousals and those centrals related to the arousal.

You need to try to figure out if those events are real or not. Read and watch all the videos.
http://freecpapadvice.com/sleepyhead-free-software

Since the changing pressures are a problem at this time...how about backing up a bit and see if you can sleep more soundly first.
Try 8 cm minimum and 12 cm maximum. One night only. I know the machine wants to go higher but for now it's more important to get you to sleep more solidly so that we can get a better idea just what pressure you need. The potential awake false positives are muddying up the waters.

tcolar · Post by **tcolar** » Tue Nov 20, 2018 9:50 am

Thanks Pugsy, I've learned a lot more about sleepyhead.

Sleep is still not great but I have been able to at least get more sleep (~6 hours) with the machine on.

However my AHI are still in the 11-20 range (lots of events). I have been playing with the settings a bit, but if I set to about 7-12 I definitely sleep better (well I should say I don't wake up in the middle of the night as much).

A few questions:

1) I noticed my tidal volume is very uneven(last screenshot), does that mean I'm not sleeping well, or that my breathing is irregular or such, on the 17/11 screenshot you can see a part between midnight and 00:30 where it's very steady with no events, but rest of the time it seems much more irregular than other people screenshots I have seen here.

2) I noticed that a lot of the stuff that gets labeled as hypnoea or CA, If I zoom in It seems I often take a large breath just before (seen in flow rate and tidal volume) and then, then I go longer without a breath after that, I don't think that's good, but that might be more of an irregular breathing thing that actual hypnoea/obstruction ? I mean If I had a large intake of air maybe it's ok I don't breath for longer ? Would like some feedback on those.

3) Pressure settings don't seem to have a lot of effect on the number of events, is keeping around 7/11 fine, or should I try higher low/max or something else ?

Pugsy · Post by **Pugsy** » Tue Nov 20, 2018 10:07 am

tcolar wrote: ↑
Tue Nov 20, 2018 9:50 am
3) Pressure settings don't seem to have a lot of effect on the number of events, is keeping around 7/11 fine, or should I try higher low/max or something else ?

If you try anything you could try higher minimum. Changing the maximum doesn't really do much unless the machine is pegged out at the maximum very often. If it doesn't want to go past 10 for some reason it doesn't matter if you have it at the 11 or 20 or even 100 if the machine would go there. It only goes to where it thinks it needs to go and if it doesn't have a reason to go higher...it won't.
If those flagged OAs and hyponeas aren't real though...more pressure won't necessarily help. They very well could just be irregular awake/semi awake breathing getting flagged by mistake since you are report crappy sleep quality.
On the other hand some of the arousals could be related to the airway...it's really hard sometimes to figure out which came first...the arousal breathing or the arousal because of the airway restriction.

tcolar wrote: ↑
Tue Nov 20, 2018 9:50 am
1) I noticed my tidal volume is very uneven, does that mean I'm not sleeping well, or that my breathing is irregular or such, on the 17/11 screenshot you can see a part between midnight and 00:30 where it's very steady with no events, but rest of the time it seems much more irregular than other people screenshots I have seen here.

Doesn't really mean much of anything and it's normal to have a wide variance in tidal volume numbers.
I suspect that you still have a lot of bigger breaths (think like sighs) just from the irregular breathing you have with the crappy sleep quality. But even people who sleep soundly for the most part all night will still see a wide variation.

tcolar wrote: ↑
Tue Nov 20, 2018 9:50 am
2) I noticed that a lot of the stuff that gets labeled as hypnoea or CA, If I zoom in It seems I often take a large breath just before (seen in flow rate and tidal volume) and then, then I go longer without a breath after that, I don't think that's good, but that might be more of an irregular breathing thing that actual hypnoea/obstruction ? I mean If I had a large intake of air maybe it's ok I don't breath for longer ? Would like some feedback on those.

The one CA flagged...and the gulp of air preceding it....you weren't asleep so it isn't real. SWJ sleep/wake/junk.

The OA flagged....definitely SWJ...all that ragged breathing preceding the flag means it wasn't real either. More pressure wouldn't have made any difference. More pressure isn't going to fix SWJ flagged events.

Did you ever watch the videos here?
http://freecpapadvice.com/sleepyhead-free-software

I would at least try more minimum though because while the examples you showed are most likely SWJ...there may be some real ones in there and maybe if you could reduce the real ones there will be better sleep quality and thus less chance for the non real events getting flagged.

tcolar · Post by **tcolar** » Tue Nov 20, 2018 3:27 pm

Sorry I did not mean I didn't sleep, just that I did not feel anymore rested than without cpap.

Last night and Friday night I got decent nights of sleep, by that I mean I was mostly not awake as far as I know (ie: awake first 30mn, woke once for 30mn, slept most of the rest).

Even so, most of my night seems to look like WSJ : A lot of the things labelled as events, but when I zoom in most of preceded by large breath or faster breathing, maybe that's me moving in my sleep ?? With that said there are also events that seems legit, it makes it a bit hard to know what to think without looking at each event one by one.

Pugsy · Post by **Pugsy** » Tue Nov 20, 2018 3:38 pm

I would try more minimum pressure if it were me.
Nothing to lose unless more minimum happens to cause problems and if it does we step back and regroup.
It's entirely possible that some real events are mixed in with those SWJ events and the real events might be causing the arousals that end up causing SWJ.
Oh...you can have crappy sleep and not really remember the wake ups that make it crappy. If you are seeing a lot of SWJ evidence...the sleep is crappy.
Now figuring out why it is crappy isn't always so easy but you are using relatively low settings...give more minimum a go.
Worth trying.

tcolar · Post by **tcolar** » Tue Nov 20, 2018 4:04 pm

Thanks, that makes sense. Yeah I can definitely try a lower min. I tend to wake up when it goes to high (15+) or increases too rapidly (7 to14 quickly), but I can probably try a range like 10-13.

tcolar · Post by **tcolar** » Wed Nov 21, 2018 12:00 pm

Some positive results:

So yesterday I used pressure settings of 10-13 an also I used the full face mask and while I still didn't get enough sleep the result was encouraging, AHI reported around 6. but if you take out the stuff before 2am that I know was SWJ and the cluster around 4:30 which I'm pretty sure was SWJ a well then it looks quite good (ie: 1:45 to 4:30 was by far the best since starting XPAP.)

Couple notes:

1) One of the main reason I could not sleep before 2am, other than getting used to the mask, is that the machine was whistling with the 10-13 settings. Not the mask, but the machine itself, at 1:45 I moved it from the bed table to the floor (carpet) and it got better, either because it was no longer hear level or maybe because the carpet dampened vibrations ? Is it normal for the machine to make a whistle sound at those settings ? Any recommendations on that ? Maybe out a soft pad under it to avoid vibrations ?

2) Mask: I had wanted to use the full face mask before, but had terrible sleep with it (AirFit F20), I was using the large, it was probably not a good fit, had tried the L and M, and the M was feeling tight, so went with L, but now I ordered a M and it turns out to fit better. L would relax over night and get to the bottom of my chin causing leaks, also it would pull on my lower chin which was uncomfortable. The M, feels a bit tight around my mouth but it seems the silicone relaxes overnight and then it was fine, it definitely gave better results (6 AHI VS 20+ with L).

I might try the Nasal mask with 10-13 to see if the results are similar. But I think I often open my moth at night, maybe not mouth breath since I show no leaks, but to exhale / cough / wet my lips /swallow /whatever, and with the nasal that blows air though my mouth and wakes me up, so I think the full face is better for me, although more unconformable to wear.

tcolar · Post by **tcolar** » Wed Nov 28, 2018 10:57 am

Well I don't know, it's not consistant, I had a couple better nights at 10-13 but then the nights after that have been bad again (16 AHI, lots of events), No mater what settings I use I can't seem to get stable values, it varies from one night to the other.

I'm also having a harder time to sleep once the pressure reaches 13, leaks happen or the mask has to be pretty tight, or the machine makes a whistling noise at 13 or so.

For whatever reason the CPAP does not seem to have much positive effect, if anything I sleep better without it, well I likely I still have apnea but at least I stay asleep more.

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 ?

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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 ?

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