New to CPAP, need help choosing right pressure.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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kidchameleon
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New to CPAP, need help choosing right pressure.

Post by kidchameleon » Sat Mar 19, 2022 3:53 pm

I posted this on Reddit and I was recommended I come here.

Alright, so I've recently been diagnosed with sleep apnea a few months ago in january. I've been feeling endlessly sleepy for so many years. I'm a 28 year old male, somewhat fit.
For a long time I thought it was related to my hypothyroidism, so I tried a lot of different medications to no effect. I know now that my thyroid never really affected
my sleep at all. After learning about sleep apnea, I decided to get a sleep study, which I got my results for about 2 weeks later.
I really couldn't sleep well at the study, but the nurse told me they had enough information to analyze the data.
I'll post the results here
https://imgur.com/7og5Equ
https://imgur.com/ODC6rU4
After that, I decided to buy a Resmed Airsense 10 online and to try to treat myself since I have no insurance and I already paid too much for the study.
Plus, I've been reading about how people are on waiting lists for CPAPs, which could take months to almost a year to receive. I really didn't want to wait long again, it took me half a year to get my sleep study done in the first place!
Once I got my Airsense I started at the pressure that was recommended in my results: 4cm - 20cm. I read on reddit and on here that 4 is way too low so I decided to increase the pressure up by 1 cm every night. I know now that's frowned upon, but I'm really desperate. That's why I created an account here to try to get a much more clear view of what I'm supposed to do.
At first I used a full face mask, but I still felt my mouth dry in the morning (I sleep with my mouth open). So I got myself a Mirage FX nasal mask and used it with a chin strap. That stopped the dry mouth but nothing more.
I also got myself a cervical collar after reading about it here, but I've felt nothing different since using it.
I haven't felt any different since using the CPAP. I would really appreciate any help I can get.
I'll also post some graphs from OSCAR from the past few days. I wore a chin strap and a soft cervical collar.
https://imgur.com/a/UB5xjtd

I really want to know what pressures would be best for me, something to stick to and see if it works. All I'm doing right now is guessing and changing the pressures every night.

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Pugsy
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Re: New to CPAP, need help choosing right pressure.

Post by Pugsy » Sat Mar 19, 2022 4:07 pm

You are getting close with the settings from the 16th. Have you gone higher still yet???
Or was that your last change?
I would be looking at 15.6 or so minimum. You should give each setting change at least 3 nights (prefer a week) to see if any patterns develop. You can keep EPR set to 3....you are probably going to need it.

How are you sleeping? Soundly for the most part or having a lot of wake ups still yet?
Spend much time laying in bed awake with mask and machine on?

How many hours of sleep (real sleep not just laying in bed) are you getting? The 16th report shows almost 6 hours.
Is this the best you have done?

Do you spend much time on your sleeping on your back?

Your report showed a lot of arousals but not too many being respiratory related?
I take it you probably woke a lot before even the first sleep study???

Do you take any medications of any kind? If so, what?

Any other physical or mental health issues going on?

Exactly what symptoms are you having now that you wished you didn't have now that you were hoping cpap would take care of?
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kidchameleon
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Re: New to CPAP, need help choosing right pressure.

Post by kidchameleon » Sat Mar 19, 2022 5:50 pm

Right now I'm at 15.4 min. Last night I had an AHI of 5.9 and I slept about 7 and a half hours. I've been changing my minimum pressure by 1 each night, except for last night where I went from 15 to 15.4
I haven't tried keeping the same pressure for more than a day, so I'll try that starting tonight. It's always something different each night.

I sleep decently, I only wake up once every night. I just wake up and go right back to sleep. I don't wake up gasping for air or coughing. Once I'm ready to go to bed I put on my mask and go right to sleep.

I mostly sleep about 5 to 6 hours, except for days where I don't work where I sleep about 7 hours.
Once I go to bed I sleep on my side but sometimes I wake up on my back. I started using a cervical collar more than a week ago in case of positional apneas.

Before my sleep study I always remember waking up once a night. It's possible I wake up several times but I don't remember.

The only medication I take is levothyroxine for my hypothyroidism. I don't think any of this is related to that, but I could be wrong. I've gone without it for a few months and the symptoms I got have gone, like feeling cold and having a hoarse throat. I also tried taking dissected thyroid since I thought all this was related to that, but no changes.
Mentally I don't have anything wrong. I used to think I was depressed and I took some antidepressants but I never noticed anything. I think I was just really tired and sleepy. I feel like inside my mind I'm optimistic but outside it's hard to show since I feel tired.
I do have a thin esophagus, I believe it's called esophagia? I can't swallow without having trouble. I have no idea if that affects my respiration though, I haven't looked into it.

Well, I'm always really tired and sleepy. My sleepiness never goes away. I also have tons of brain fog and I have trouble processing things and remembering. I also feel really weak all the time.

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Pugsy
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Re: New to CPAP, need help choosing right pressure.

Post by Pugsy » Sat Mar 19, 2022 6:35 pm

A narrowing of the esophagus can happen when a person has GERD
https://www.uclahealth.org/esophageal-c ... -stricture
The normal diameter of the esophagus "thins" or narrows causing strictures. Definitely can cause problems swallow stuff especially down where the esophagus meets the stomach at the LES (lower esophageal sphincter).
When the LES is damaged it might also not close off when the air pressure from the cpap machine gets into the esophagus and since the LES hasn't blocked the opening well enough the air sneaks into the stomach and that's where the aerophagia can rear its ugly head.

Anyway....no matter what the cause we deal with it the same way. Try to figure out a pressure that doesn't make the aerophagia worse but can still prevent the airway from collapsing.
We might have to make some compromises.

As for your unwanted symptoms...5 or 6 hours of sleep probably simply isn't enough sleep. Maybe you just need more sleep.
Easier said than done I know but to be honest you are still having enough apnea events to be a factor as well.
You do need to try to consistently get 7 to 8 hours though.
Google "good sleep hygiene" and check for anything that you are doing that could be improved upon to perhaps simply get more sleep.
I know I feel like death warmed over if I get less than 7 hours of sleep.

Go ahead and try 16 minimum tonight with 3 EPR....see if that helps the aerophagia any.
When you evaluate AHI....always give the breakdown that composes that AHI unless you are doing a screen shot.
It's real important to be able to see what composes that AHI because the CAs/centrals we won't expect to fix with more pressure. We can only expect to deal with OAs and hyponeas with the more pressure thing.
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babydinosnoreless
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Re: New to CPAP, need help choosing right pressure.

Post by babydinosnoreless » Sat Mar 19, 2022 7:06 pm

Well, I'm always really tired and sleepy. My sleepiness never goes away. I also have tons of brain fog and I have trouble processing things and remembering. I also feel really weak all the time.
Have you been tested for hashimotos ? https://www.mayoclinic.org/diseases-con ... c-20351855

I have a lot of the symptoms you describe and I have a combination of hashimotos and sleep apnea. I've got my AHI under 1 a night thanks to Pugsy and PR and it helps a lot. Its not a magical cure though there are good days and bad days.

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kidchameleon
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Re: New to CPAP, need help choosing right pressure.

Post by kidchameleon » Sat Mar 19, 2022 8:20 pm

I wish I could remember what it was called when I had surgery. I had a balloon expand my esophagus and I could swallow fine. It came back though, but it was so long ago I can't remember how long I felt fine for.

I'll definitely try to sleep 7 to 8 hours. It's pretty easy on my days off, but it's hard on work days since my hours keep changing and I want to stay up later. But I just have to be strong and force myself, especially since I want to feel normal. And I didn't answer this, but I have slept 8 hours before on CPAP and it's still the same. It's rare for me to sleep that much though.
I'll try a minimum of 16 tonight, should I change the pressure each week as well? And should it be in small increments or a cm?
When you say give a breakdown that composes the AHI, do you mean what I do before going to sleep and what happens during?

I'm not sure if I do have Hashimotos. My TSH and T4 and T3 have been fine with Levothyroxine. I'll be sure to ask next time I have an appointment.

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Pugsy
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Re: New to CPAP, need help choosing right pressure.

Post by Pugsy » Sat Mar 19, 2022 9:13 pm

kidchameleon wrote:
Sat Mar 19, 2022 8:20 pm
When you say give a breakdown that composes the AHI, do you mean what I do before going to sleep and what happens during?
No...I want what composes the AHI itself
Like you said last night's AHI was 5.9

AHI is composed of these 3 category of events
CA/central Index
Obstructive Apnea Index
Hyponea index

5.9 without knowing the composition doesn't really tell us much.
Like was it Central...4.0 OA...1.0 and hyponea 0.9
or was it Central 1.2 OA 3.4...and hyponea 1.3
or was it Central 0.2 OA 5.3 and hyponea 0.4
All 3 add up to 5.9 AHI but what we would do for each isn't necessarily the same.

When you share the report image...we can easily see that breakdown on the left side but when you just give us a number then we don't have anyway to know what the number represents.

If your AHI was 90% CA/central....I wouldn't advise more pressure because more pressure won't help.
So we need to know exactly what we are fighting.
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kidchameleon
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Re: New to CPAP, need help choosing right pressure.

Post by kidchameleon » Sat Mar 19, 2022 10:12 pm

Oh okay! I really didn't know that, thanks for explaining. I can't check on OSCAR right now since I have to use my brother's laptop to do that, but my CPAP's sleep report has AHI, Total AI and Central AI. Last night my AHI was 5.9, Total AI was 5.7 and Central AI was 1.8. Usually my central AI is in the zeroes. I'll be sure to check tonight's data tomorrow and I'll check the other stuff.

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Re: New to CPAP, need help choosing right pressure.

Post by Pugsy » Sun Mar 20, 2022 7:49 am

kidchameleon wrote:
Sat Mar 19, 2022 10:12 pm
AHI, Total AI and Central AI. Last night my AHI was 5.9, Total AI was 5.7 and Central AI was 1.8. Usually my central AI is in the zeroes.
Remember that Algebra we had to take in high school and wondered why and said "why do we have to learn this crap because we would never use it in real life??? " Well now we get to use it. :lol:

We can take known values and do some backwards math and figure out the unknown values.

AI is the Apnea Index....the AI is the sum of the Central Index and the Obstructive Index.
AI is 5.7...and the known value is the Central Index was 1.8...that makes the Obstructive Index at 3.9.

AHI is the sum of the Apnea Index and the Hyponea index...
If the AHI is 5.9 and the AI is 5.7....then the Hyponea index is 0.2
Now when you finally use OSCAR there may be very minor differences due to OSCAR going to the second decimal point and the machine only going to 1 decimal point but it will be very close and not enough to really matter.

So after all that the AHI of 5.9...will have a breakdown into each category of
Central Index....1.8
Obstructive Index ...3.9
Hyponea Index ....0.2

What we can't see of course is when the events got flagged but we have something to work with even if it is not detailed all that much. Hyponeas are almost always obstructive in nature. While there can be some hyponeas that are central in nature in special circumstances for the most part they are obstructive and we go with the "usual" when we don't know for sure.

Using a little bit more algebra we can figure out that your obstructive stuff (the OAs and hyponeas at 4.2) make up approx
70% of your AHI.

We know that obstructive stuff we deal with by using more pressure....assuming we were asleep when the events happened and got flagged. This is why I always ask about sleep quality because if someone reports they don't sleep so great and they known that they woke up a lot then we have to wonder how many (if any) of those events are false positive flagged events that are related to awake breathing. You report sleeping quite decently for the most part so then we assumed that the bulk of your AHI is real asleep breathing. There might be a few arousal/awake related events but for the most part most likely not false positives.
It's important to know because false positives can happen in any event category and we can't fix false positives with more pressure. Instead we have to try to fix whatever is causing the poor sleep.

I will use myself as an example. I don't sleep so great. I have lots of wake ups during the night because of pain. I know this and it is an issue that I deal with or try to deal with.
There is a way to examine the flow rate zoomed in to get a good idea if we are asleep or not.
http://freecpapadvice.com/sleepyhead-free-software
And I have done a LOT of this sort of examinations and I have learned that no matter what my AHI might be that roughly 75% of any AHI is going to be false positives or arousal related.

If/when you can use OSCAR we look to see when those events got flagged and is there any clustering of events around what might be a known awake time so that we can do more digging just in case there is a chance that some of your events are false positives....if we need to.

Your AHI from last night and the shared report from March 16 really isn't all that different.
Not enough to matter and well within normal variances that we expect from night to night.

How's the aerophagia?
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kidchameleon
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Re: New to CPAP, need help choosing right pressure.

Post by kidchameleon » Sun Mar 20, 2022 5:32 pm

Wow, thanks for all that, it's very helpful :D
I got my OSCAR data from last night and the night before. I got screenshots of all the graphs this time, maybe that'll show more helpful information about cental and obstructive indexes.
3/19/22
https://imgur.com/gallery/bVkZbwY

3/18/22
https://imgur.com/gallery/lLY6qLz

I know last night I woke up once and I remember being on by back. I always fall asleep on my side though. I only slept five hours since I was called in to work today on my day off.
My CPAP says my AHI was 4.1 but OSCAR says it was 4.21.
Total AI was 4.1 and Total AI was 1.0
Also, this'll be the last time I can use OSCAR since my brother is taking his laptop back to college
As for my aerophagia, it really only bothers me when I eat. I feel normal otherwise. It's never bothered me during sleep.

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Re: New to CPAP, need help choosing right pressure.

Post by Pugsy » Sun Mar 20, 2022 6:30 pm

kidchameleon wrote:
Sun Mar 20, 2022 5:32 pm
My CPAP says my AHI was 4.1 but OSCAR says it was 4.21.
No big deal. That just a rounding up or down thing since the machine only goes to that tenth decimal spot and OSCAR will go to the hundredths.

I am betting that when you woke up on your back it was likely around that 6:00 time frame where you see the pressure go up and kiss 20 cm. Might have also been some REM stage sleep involved at that time as well.
It's quite common for OSA to worsen and need more pressure for both supine sleeping and REM stage sleep as well...or maybe a combination of both gives you a worse double whammy.

If you don't have aerophagia issues during the night or first thing in the morning but instead later on in the day and only after a meal....maybe you could handle a bit more pressure and give 17 cm minimum a try. See if the aerophagia gets markedly worse or not. If it does...try splitting the difference at 16.4 or 16.6.

Most people will sleep on their backs at least sometime during the night despite starting out the night on their side and thinking they stay on their side. Most people will move around a lot more during the night than they think they do.
It's normal and it's really hard to try to force yourself to stay on your side unless you try doing some extraordinary measures that don't always work anyway. I know I prefer sleeping on my side because when I end up on my back I have really bad back pain that wakes me up...and I have to roll back onto my side to ease the pain and go back to sleep.
I have tried a gazillion things to keep me off my back...sometimes I have some success but most of the time nothing really is sure proof. I just decided a long time ago to accept it and not worry about it and let the machine sort things out.

While we could like to have the AHI a little lower...remember we can really only maybe help reduce the OA and hyponea numbers....you are going to have to also consider what the pressure increases does to your belly issues.
We don't want to go causing significant aerophagia or belly issues with more pressure just to reduce the OA numbers.
Remember....we can't do much about the centrals anyway.

Your OA index was about 4 one night and about 3 the other night...I don't know if your belly will stand enough pressure to get those numbers cut in half.
As far as the centrals go....there's a chance that they are arousal related and the OA event itself caused the arousal and if you could reduce the OAs then the centrals might also reduce because the cause of the arousal got reduced. That' ONLY if the OAs are causing the arousals and the centrals are arousal related.

Work on getting more sleep still yet. Even if your AHI was 0.0 last night the fact that you only got 5 1/2 hours of sleep could be enough to feel like crap today. Lower AHI doesn't always guarantee much of anything except a good excuse to pat yourself on the back.
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kidchameleon
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Re: New to CPAP, need help choosing right pressure.

Post by kidchameleon » Sun Mar 20, 2022 7:25 pm

My aerophagia doesn't really affect me much, only when I'm eating. I don't really feel anything while sleeping, so I'll be sure to do 17cm tonight and increase it every week.

I haven't had any belly problems either. The highest I've ever gone is 17.2cm and I don't remember what that felt like. But I'll be sure to take note of how I feel while getting that much in me.

Yeah, I'll be sure to sleep earlier tonight. At least maybe 7-8 hours.

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Re: New to CPAP, need help choosing right pressure.

Post by kidchameleon » Sat Apr 02, 2022 10:41 am

Hi, I've been following your advice and stayed around 17cm, changing it every week. I still haven't noticed any difference good or bad. I was wondering if maybe I should switch from Auto to Fixed pressure. I read that Auto changes the pressure too much every time you move and I do move around quite a lot apparently. I read some people find fixed pressure to work much better. If so, should my pressure be up to 17cm or more? I slept last night with fixed pressure, 17.2cm and slept the same as usual with an AHI of 3.6.

Also, I don't have aerophagia I have dysphagia, I got confused with those words.

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Pugsy
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Re: New to CPAP, need help choosing right pressure.

Post by Pugsy » Sat Apr 02, 2022 11:28 am

kidchameleon wrote:
Sat Apr 02, 2022 10:41 am
I read that Auto changes the pressure too much every time you move and I do move around quite a lot apparently.
I have never read that nor do I agree with it. Sounds like something that someone who doesn't like auto mode wants to say to justify fixed pressure mode.
Moving around doesn't cause the pressure to change when in auto mode.
What causes the pressure to change are snores, Flow Limitations, OAs or hyponeas. Moving around by itself does nothing to the airway so the pressure won't change just from movement itself.
Now sometimes we change position and end up on their back and OSA can worsen when we are supine in SOME people (not all people) and the pressure needs may need to increase but it is the worsening OSA (if that happens) that will cause the pressure to need to increase.

By all means you could try a fixed pressure if you wish though.
As for what choice....I have no idea since you didn't provide anything to show what was happening with current new minimum pressures.
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Re: New to CPAP, need help choosing right pressure.

Post by palerider » Sat Apr 02, 2022 1:54 pm

kidchameleon wrote:
Sat Apr 02, 2022 10:41 am
I read that Auto changes the pressure too much every time you move
Whereever you read that should be put on your list of places to ignore stuff from, because that's garbage (and untrue).
kidchameleon wrote:
Sat Apr 02, 2022 10:41 am
and I do move around quite a lot apparently.
Which is a sign of inadequately treated OSA.
kidchameleon wrote:
Sat Apr 02, 2022 10:41 am
I read some people find fixed pressure to work much better.
You've apparently been reading a lot. You can find anything out on the internet to support any theory if you look long enough.

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