First Week CPAP results - help with results

jwalsh126 · Post by **jwalsh126** » Wed Apr 08, 2020 4:03 pm

Hi Everyone,

I finished my first week of CPAP and would like some help interpreting my results and troubleshooting why my AHI is still above 5 every night. As a note, my diagnosis was moderate OSA and I am a back sleeper. When sleeping on my back, I had an AHI of 30 so this first week has significantly cut down my AHI numbers. I felt an immediate difference since the first night which gave me an AHI of 9 and it has slowly been decreasing.

These are my last 3 nights of the auto-PAP machine and I am happy with the results so far, but would like to narrow down how I can get my AHI levels lower. Sorry I am a newbie and greatly appreciate any help you all can give me. Thank you for your time and let me know what else I can do.

Pugsy · Post by **Pugsy** » Wed Apr 08, 2020 4:12 pm

Welcome to the forum.

You just need more minimum pressure to better hold the airway open and prevent the airway collapses.

Probably around 7 or 8 minimum, maybe 9 but I would try lower first. Might get lucky.

jwalsh126 · Post by **jwalsh126** » Wed Apr 08, 2020 4:15 pm

Wow thank you for the super fast reply Pugsy! I will try adjusting the minimum pressure to 7 tonight and stick with that for a few days.
Thank you for all the great work you are doing on here

Julie · Post by **Julie** » Wed Apr 08, 2020 4:19 pm

But if you can do anything about sleeping position (that's causing so many of those events) it could also make a big difference.

DreamDiver · Post by **DreamDiver** » Wed Apr 08, 2020 6:45 pm

Congratulations on a great first week!

It looks like you have your large leaks under control, for the most part. That's amazing! The key now is dialing in the pressure settings. Following Pugsy's suggestions will likely steer you in the right direction. Slow and steady wins this race. Try not to make too many changes at once or you won't have a handle on what change cause what result. Make a change and wait a few days. Note the results. Get feedback. Make the next change. Wait a few days. Note the results. Get feedback. Repeat...

Best of luck!

Chris

jwalsh126 · Post by **jwalsh126** » Thu Apr 09, 2020 8:17 am

I increased minimum pressure to 7 and saw an increase in AHI to 7.3. I will give it several days at this minimum pressure before making additional changes. Also, I have woken up to pee every night so far usually 1 time. Does this go away eventually? Thank you for the suggestions everyone.

Sleep Position - I am a back sleeper and I sometimes try to start on my side, but always end up rolling over to my back. Is it possible to get AHI to 0-3 while on my back? Or do you think I need to try permanently changing my sleep position?

Pugsy · Post by **Pugsy** » Thu Apr 09, 2020 8:29 am

jwalsh126 wrote: ↑
Thu Apr 09, 2020 8:17 am
I increased minimum pressure to 7 and saw an increase in AHI to 7.3.

What is the event category breakdown of that AHI? Did you spend much time with mask and machine on but you were awake?
Can you please post the detailed report so we can see when the events were flagged?

Getting up to pee during the night? It's called nocturia. Do you normally have to pee a lot during the day as well?
Nocturia is a common symptom of untreated sleep apnea and when the apnea is the only cause of the nocturia.
Now of course there are other potential reasons for nocturia and if it's caused by the other conditions then cpap won't help.

I actually don't think people should take extraordinary measures to stay off their back unless they just want to.
Optimally adjusted pressure settings should take care of supine and side sleeping events. I think that if a person has trouble sleeping on their side and they don't have trouble on their back then they should sleep in the position that offers the greatest sleep. We gotta sleep first for any of this to matter.

Now I know some people who have a huge difference in pressure needs when they are on their back and they worked hard on making a new habit of side sleeping because the lower pressures were simply more comfortable. That's fine too but it was their choice.

So it's up to you....if you can't sleep on your side for some reason but you sleep decently when on your back.....sleep on your back and we just tweak the machine so it can deal with the pressure needs that supine sleeping might bring.

jwalsh126 · Post by **jwalsh126** » Thu Apr 09, 2020 8:50 am

I attached the report from last night. I spend maybe 20 minutes with the mask on while I lay in bed falling asleep. I believe the nocturia will go away, as you said, once I stop waking up due to the apnea.

I want to try optimizing pressure to sleep on my back because for some reason my body always finds its way back. Do you think buying a CPAP pillow could be helpful? Or are there any tips for back sleepers to optimize the CPAP results? I am very optimistic with the results so far and the lack of leaks.

Thanks,
Joe

Pugsy · Post by **Pugsy** » Thu Apr 09, 2020 9:02 am

Your Clear Airway apneas (centrals) increase and amounts to the bulk of the increase in AHI.
OAs and hyponeas added together (the obstructive stuff which is what more pressure is supposed to reduce) is essentially unchanged.

What I would like for you to try tonight is turning Flex exhale relief off....that's the only new change. Keep the 7 cm minimum.
If you simply can't stand having Flex turned off...at least try reducing it.

It is just one night....how did you sleep overall? Soundly for the most part or lots of fragmented sleep?

jwalsh126 · Post by **jwalsh126** » Thu Apr 09, 2020 9:16 am

Slept soundly for the most part. I woke up consciously once, but that has happened each night so far. I otherwise feel the same as I did the past several nights.
I will try turning off flex exhale tonight and keeping pressure at 7 as you said. I will continue to update with results. Thank you for the help.

Side Question - Do I need to change the max pressure? I read posts of leaks causing super high pressure levels, but so far mine hasn't seem to do that. Is there any benefit to reducing max pressure?

Dog Slobber · Post by **Dog Slobber** » Thu Apr 09, 2020 9:32 am

jwalsh126 wrote: ↑
Thu Apr 09, 2020 9:16 am

Side Question - Do I need to change the max pressure? I read posts of leaks causing super high pressure levels, but so far mine hasn't seem to do that. Is there any benefit to reducing max pressure?

Probably not. There can be valid reasons to limit one's maximum pressure, but you haven't shared you're experiencing them.

Right now your maximum is 20, but your machine has not gone above 11.

Let's say we reduce your maximum to 18, what will change? Nothing.
Let's say we reduce your maximum to 14, what will change? Nothing.

If we were to cap your maximum pressure at 10, then there might be an occasion where you machine needed to go to 11, couldn't, resulting in greater, flow limitations, hypopnea and OAs.

The rule of thumb many here advocate is; unless there is a compelling reason to limit your maximum pressure, don't. Let the machine go where it needs to go.

jwalsh126 · Post by **jwalsh126** » Thu Apr 09, 2020 9:34 am

Dog Slobber wrote: ↑
Thu Apr 09, 2020 9:32 am

jwalsh126 wrote: ↑
Thu Apr 09, 2020 9:16 am

Side Question - Do I need to change the max pressure? I read posts of leaks causing super high pressure levels, but so far mine hasn't seem to do that. Is there any benefit to reducing max pressure?
Probably not. There can be valid reasons to limit one's maximum pressure, but you haven't shared you're experiencing them.

Right now your maximum is 20, but your machine has not gone above 11.

Let's say we reduce your maximum to 18, what will change? Nothing.
Let's say we reduce your maximum to 14, what will change? Nothing.

If we were to cap your maximum pressure at 10, then there might be an occasion where you machine needed to go to 11, couldn't, resulting in greater, flow limitations, hypopnea and OAs.

The rule of thumb many here advocate is; unless there is a compelling reason to limit your maximum pressure, don't. Let the machine go where it needs to go.

Makes perfect sense to me - thank you! I made the changes Pugsy described above and will check the results tomorrow. I will stick with this for several days unless it seems to be worse.

DreamDiver · Post by **DreamDiver** » Thu Apr 09, 2020 9:53 am

jwalsh126 wrote: ↑
Thu Apr 09, 2020 9:16 am
Slept soundly for the most part. I woke up consciously once, but that has happened each night so far. I otherwise feel the same as I did the past several nights.
I will try turning off flex exhale tonight and keeping pressure at 7 as you said. I will continue to update with results. Thank you for the help.

Side Question - Do I need to change the max pressure? I read posts of leaks causing super high pressure levels, but so far mine hasn't seem to do that. Is there any benefit to reducing max pressure?

About a third of us have trouble sleeping all through the night. Part of that is because we naturally used to have multiple sleep sessions in a day. Siesta in some cultures is a holdover of that. But in the Middle Ages, people used to get up in the middle of the night and visit with neighbors or play cards for half an hour (or be indiscreet with the neighbor spouse) and then go back to sleep. They had a first and second sleep period. Matins prayers at 2am in monasteries was a nod toward the tendency. The social "requirement" for sleeping all through a night only became prevalent when electric lighting and time keeping became the norm. Many people who might normally sleep in a two-period night adapted so they could work their 8-hour day shift. Others of us seem less adaptable.

https://www.sciencealert.com/humans-use ... ould-again
https://www.medievalists.net/2016/01/ho ... ddle-ages/
https://www.sleepadvisor.org/history-of-sleep/

Briefly waking up in the middle of the night is for many of us entirely normal. Don't get the impression that your body is misbehaving. Not everybody sleeps a full 7.25 hours through in a single sleep session, so there's no use punishing yourself for what may be a normal behavior. You could try to read, meditate or play cards for fifteen minutes to half an hour, and then go back to sleep.

Probably best not to watch TV or do social media on the phone because it's easy to get trapped in that and forget you were supposed to go back to sleep. Also blue light from phones can disrupt normal circadian rhythms.

Bottom line, you could try adapting to a single long sleep session without being frustrated if your body refuses. If your body does refuse, try going to bed earlier so you can add in that half-hour early morning Solitaire session between two sleep sessions.

Hope this helps.

Miss Emerita · Post by **Miss Emerita** » Thu Apr 09, 2020 10:13 am

You're do very well, and I see you didn't need to get up last night to pee! About sleeping on your back: do you think your chin drops down toward your chest while you sleep? If yes, you might try a pillow that provides neck support. (I have in mind pillows that are thicker across the bottom where your neck rests.) If no, I got nuttin!

jwalsh126 · Post by **jwalsh126** » Thu Apr 09, 2020 10:24 am

Miss Emerita wrote: ↑
Thu Apr 09, 2020 10:13 am
You're do very well, and I see you didn't need to get up last night to pee! About sleeping on your back: do you think your chin drops down toward your chest while you sleep? If yes, you might try a pillow that provides neck support. (I have in mind pillows that are thicker across the bottom where your neck rests.) If no, I got nuttin!

I was just thinking about this. I feel like my chin does drop down. I wanted to try a different pillow. The one i'm using now is kind of bulkier and on the firmer side.

First Week CPAP results - help with results

First Week CPAP results - help with results

Re: First Week CPAP results - help with results

Re: First Week CPAP results - help with results

Re: First Week CPAP results - help with results

Re: First Week CPAP results - help with results

Re: First Week CPAP results - help with results

Re: First Week CPAP results - help with results

Re: First Week CPAP results - help with results

Re: First Week CPAP results - help with results

Re: First Week CPAP results - help with results

Re: First Week CPAP results - help with results

Re: First Week CPAP results - help with results

Re: First Week CPAP results - help with results

Re: First Week CPAP results - help with results

Re: First Week CPAP results - help with results