Recently diagnosed, first week on cpap with really high AHI readings. Advice needed!

Hello everyone, I am very new here, I was diagnosed with severe OSA (AHI 32.3) just 2 weeks ago after a home sleep study.

The sleep clinic got me started on my 1 month cpap trial a week ago.
Last night was my 6th night, I am getting more used to the mask and air flow despite still struggling to fall asleep with it on. I've been using it about 3~4 hours/night before I have to take it off.

While I am making small progress on getting used to cpap, I am getting very high AHI readings on it. From what I've read on the forum, it's very concerning.
From the information I've gathered on the forum and other communities, I downloaded OSCAR yesterday in attempt to further understand the situation.

I will try my best to include as much info as I could for people to analyze.

General Health Condition:
Male just turned 40, obese. (BMI 37)
GP found higher cholesterol and fatty liver from general health checkup 6 months ago. I have been on cholesterol meds since Jan this year. Not on any other medications.
Nasal congestion since early 20s, was told by GP that it was most likely allergy since it was in my family history. Was prescribed a nasal spray to help with it for first couple months, no further examinations or treatment after that.
Don't drink or smoke.
Started exercising a few months ago, lost 15 pounds so far. (1/3 goal fingers crossed)

CPAP & Experiences so far:

Machine: Resmed AirSense 10 AutoSet For Her (Sleep clinic said it they didn't have the regular black one in stock, said they were mostly the same machine just with different color accent.)
Facemask: F&P Evora Full mask (was recommended to try full masks first by the RT from the sleep clinic after I mentioned my history with nasal congestion)

Personal experience: The mask and cpap air flow was a lot less bothersome than I was expecting. I lay on the bed awake most of the time when I have it on, I consciously pay extra attention to my breathing, only managed dozing off occasionally.
I noticed that I would swallow my saliva every so often or stick my tongue out to moisturize my lips (pretty sure I am holding my breath while I am doing these actions.) Not sure if these brief interruptions in breathing pattern would be registered as events by the cpap or not, I was told by the RT (they're explaining how the home test kit worked) that for the machine to register an event the breath needs to stop for a certain amount of seconds.

From what I've been reading, my cpap AHI numbers are very concerning and may requires adjustments or further medical attention.
I have emailed my assigned RT about this, they replied that high AHI reading in the beginning is normal and said that they can adjust the pressure if I feel needed. I have no prior experience so I have no idea what too much or too little pressure feels like.

First thing I noticed from my OSCAR data was that my cpap's mask setting was set to nasal instead of full mask, I guess the sleep clinic missed that. I have set it to full mask before sleep last night, not sure how it would affect the cpap if anything at all.
I do have a question from an observation made on my OSCAR chart. On last night's chart, at the end of the session I see a sizeable segment that is almost eventless and stable (about an hour or so). I do distinctively remember finally falling asleep for a while with the mask+cpap before I took it off this morning. Could that be an indication that a lot of these events are from my awake irregular breathing?

Home sleep study result

Oscar Chart Day 4

Oscar Chart Day 5

Oscar Chart Day 6 (last night)

I am feeling a bit frustrated and demoralized with the high AHI readings. I was just finally coming to term and motivated to get along with the cpap, but the numbers are telling me that I am getting no therapeutic benefits with it.

Thank you for reading, any comments and advice are appreciated!

While you're waiting on those who are good at data stuff, I'll just say in general that seeing a high AHI when a lot of time is spent awake is not necessarily of concern. Seeing them during sleep time is when there could be issues needing resolved. Our CPAPs can't tell if we are awake or asleep and can interpret things like holding one's breath while turning over, scratching an itch, reaching to straighten covers, etc as an event. Seen some on here talk about sleep trackers to get an idea when one was actually asleep and comparing it to machine data, but I'll let someone who has done that tell you if they thought it was worth the effort. I'm sure someone could share with you links to how to tell from your breathing in the Oscar data whether it appears to be wake breathing or sleep. Good luck going forward.

First thing...lets change the mode you are in.
You are in the for Her Auto mode and it looks like your pressure needs are up where the for Her mode runs into some trouble.
Change it to the other Auto mode.
If you don't know how this manual explains things.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

That's the only thing I want you to change right now...just the mode to the other Auto mode. I don't remember if it is called plain Auto or AutoSet but you have 3 choices in modes
1.CPAP
2.Auto for Her
3.and either Auto or Autoset...can't remember exact words.

And yes...the machine can and will mistake awake breathing irregularities as some sort of apnea event. Common to see false positive central flagging but it isn't limited to centrals (CAs on the Oscar reporting) and we can have awake breathing false positives in the OAs and hyponeas as well. It's not always easy to spot false positives in the flow rate but it can be done. If you are up to more education you can watch the videos here to get an idea what to look for.
http://freecpapadvice.com/sleepyhead-free-software

It's common to have issues falling asleep and staying asleep when we first start cpap therapy. So it's common to also have some ugly reports that are mostly awake breathing irregularities. I don't know for sure that we can blame awake breathing for all the ugly in your reports but there is likely a good chunk that is going to be false positives.

Tell me about your nasal congestion....is it something that is chronic and significant and you just have to breathe through your mouth all night every night or is it something that happens only occasionally????

After trying again to sleep with the machine tonight after the change in mode post your report tomorrow morning.
Normally I tell people give a change a few nights to settle things in but while we might do that with you tomorrow...I want to follow up real closely.

Also always report on how you slept. If you are having a lot of trouble falling asleep and are just laying there awake counting the invisible stars in the ceiling...reach over and quickly push the on/off button to turn the machine off and then push to turn it right back on again so we can see a break in the therapy line where we know for sure you were awake.
That way we know for sure any flagging happening right at that time is for sure awake breathing false positives.

I read the sleep study report.

Tell me....did you wear some sort of restrictive device around your chest or abdomen?

I see no mention as to sleep status...I assume no leads were stuck to your face up on your forehead??? Is that correct?

Did you sleep fairly decently during the home study?

@ OP - Part of this may be the new-ness of sleeping with the mask on. Until now, you have spent your entire life without the mask -- and thus need to become familiar with it. I suggest wearing during the daytime while reading, watching TV, or whatever. If you will do that for several days, the mask becomes more normal and less foreign and less threatening. It may well become easier to sleep with the mask on. This takes time. Persevere.

kteague wrote: ↑

Wed Jun 15, 2022 2:26 am

While you're waiting on those who are good at data stuff, I'll just say in general that seeing a .......

Thank you for your reply!

Pugsy wrote: ↑

Wed Jun 15, 2022 6:02 am

You are in the for Her Auto mode and it looks like your pressure needs are up where the for Her mode runs into some trouble.
Change it to the other Auto mode.

That's the only thing I want you to change right now...just the mode to the other Auto mode. I don't remember if it is called plain Auto or AutoSet but you have 3 choices in modes
1.CPAP
2.Auto for Her
3.and either Auto or Autoset...can't remember exact words.

Thank you so much for your very informative answers and advices Pugsy!

I did noticed the "Auto for Her" when I first imported my data into OSCAR. I am not sure if that was intended or an oversight by the sleep clinic (I would assume the latter since the mask type was wrong as well).
I will definitely change it, hope it will help!

Pugsy wrote: ↑

Wed Jun 15, 2022 6:02 am

Tell me about your nasal congestion....is it something that is chronic and significant and you just have to breathe through your mouth all night every night or is it something that happens only occasionally????

After trying again to sleep with the machine tonight after the change in mode post your report tomorrow morning.
Normally I tell people give a change a few nights to settle things in but while we might do that with you tomorrow...I want to follow up real closely.

Also always report on how you slept. If you are having a lot of trouble falling asleep and are just laying there awake counting the invisible stars in the ceiling...reach over and quickly push the on/off button to turn the machine off and then push to turn it right back on again so we can see a break in the therapy line where we know for sure you were awake.
That way we know for sure any flagging happening right at that time is for sure awake breathing false positives.

I will try and provide as much information I can for you to analyze! Please don't hesitate to tell me if I am going overboard with the details, that's always been a fault of mine!

1. I've had nasal congestion for at least the last 10 years. On any given day at least one of my nostrils would be stuffed. As for the significance of the congestion, even though they're usually stuffed up, I don't need to breath with my mouth during the day. During sleep, I am not exactly sure since I mostly sleep by myself, but I've been told that I snore from trips with family and friends, not obnoxiously loud or frequent though. As a matter of fact, I don't think I really started snoring until a 6 or 7 years ago. I do think I tend to open my mouth when I sleep because last couple of years I've noticed mouth dry. (interestingly my eyes have also started to become really dry since)

2. I will try and on&off trick to create notes in my log, that is a very neat trick! I will definitely post a follow up report tomorrow.

Pugsy wrote: ↑

Wed Jun 15, 2022 6:12 am

I read the sleep study report.

Tell me....did you wear some sort of restrictive device around your chest or abdomen?

I see no mention as to sleep status...I assume no leads were stuck to your face up on your forehead??? Is that correct?

Did you sleep fairly decently during the home study?

Ah, yes, the sleep study.
I used a apnealink with 3 lines hooked up to it. nothing on my forehead.
1. elastic strap around my chest (I didn't notice the instruction until after the test was done that women should wear the strap above their breast. I have shamefully sized man boobs , not sure if that would make any difference)
2. nasal cannula
3. finger tip oximeter

The sleep study went terrible, I was struggling to fall asleep almost the entire time, watching the clock go by 30~40 mins at a time.
The finger tip oximeter was missing plastic part where it clips on to the chest strap to prevent the cable from being tangled up.
I was extra anxious and mindful about it, making things even harder.
I tried doing different breathing exercises I've read about (long deep breaths and holding your breath for a while after each inhale/exhale to fill/empty your lung completely.. etc) to calm myself to sleep without much success.
There were a few occasions where I dozed off I believe, but not for too long.

Thank you all again for taking your time to read my post and reply to me! I really appreciate this at a time of anxiousness and distress.

clownbell wrote: ↑

Wed Jun 15, 2022 3:20 pm

@ OP - Part of this may be the new-ness of sleeping with the mask on. Until now, you have spent your entire life without the mask -- and thus need to become familiar with it. I suggest wearing during the daytime while reading, watching TV, or whatever. If you will do that for several days, the mask becomes more normal and less foreign and less threatening. It may well become easier to sleep with the mask on. This takes time. Persevere.

Thank you for your encouragement! I will definitely keep trying even though I feel I am doing worse than I am without it atm.

This was a surprise for me, well mostly the severity of my diagnosis. I understand symptoms may be different for everyone, the human body is very tricky. I don't usually have that much trouble falling asleep or getting up. I have not experienced out of breath or gasping for air, brain fog or memory impairment.
However, data won't lie. I will just have to try my best to stick with this!

Thank you for taking the time to answer my nosy questions.
I will probably have more later.
The for Her mode thing may not have been an oversight. I take it you are female and they might have thought to just try the for Her mode. I don't remember what the default from factory mode is on the machine but they changed the pressure defaults so they very well could have changed the mode.
Normally it wouldn't be that big of a deal but it looks like your pressure needs are going to be up where the for Her mode doesn't/can't do a good job.

I have some other thoughts that I will share as time goes on and depending on what tomorrow's report looks like.

If you are going to be needing these higher pressures and if you normally don't have to mouth breathe....I think a discussion about a nasal mask might be in order but we can do all that later. More on that later as well.

Pugsy wrote: ↑

Wed Jun 15, 2022 5:34 pm

Thank you for taking the time to answer my nosy questions.
I will probably have more later.
The for Her mode thing may not have been an oversight. I take it you are female and they might have thought to just try the for Her mode. I don't remember what the default from factory mode is on the machine but they changed the pressure defaults so they very well could have changed the mode.
Normally it wouldn't be that big of a deal but it looks like your pressure needs are going to be up where the for Her mode doesn't/can't do a good job.

I am a 40yr old male!

My assigned RT said since I snore that means I breath with my mouth, so they suggested that I use full mask.
I don't mouth breathe during the day, I can't be certain how much mouth breathing I do when I am asleep. I have been very conscious of keeping my mouth shut when I have the mask on, might've contributed partly to my struggle to fall asleep!

I will report tomorrow! My RT wasn't too thrilled that I e-mailed them about changing the mode.
Their response was "I explained to you during our consultation that you were given the "For Her" model because we didn't have the regular one in stock, and you were ok with it. Go ahead with the change if you insist."
In my defense, I was ok with the more feminine aesthetic of the machine. However, I was talking about the cpap mode between "Auto for Her" and regular "Auto", as suggested here.

odiewest wrote: ↑

Wed Jun 15, 2022 6:10 pm

I will report tomorrow! My RT wasn't too thrilled that I e-mailed them about changing the mode.
Their response was "I explained to you during our consultation that you were given the "For Her" model because we didn't have the regular one in stock, and you were ok with it. Go ahead with the change if you insist."
In my defense, I was ok with the more feminine aesthetic of the machine. However, I was talking about the cpap mode between "Auto for Her" and regular "Auto", as suggested here.

welcome to the zoo! and you've just learned a valuable lesson. some in the medical profession seem to think they are god. good for you for sticking to your guns and making the change.

i have a feeling you'll be getting good relief for your sleep apnea soon.

Sorry about the gender error. I was assuming that you were complaining about "male boobs" which is what we females do often.

Sounds like the sleep tech person doesn't understand that there is a big difference in modes but whatever. I quit trying to second guess what goes on in their little pea brains a long time ago.
Actually probably April 2009 when one of them told me it was against a FEDERAL law for patients to have the software to see their data. Geez...what a frigging idiot. At that time all the manufacturers openly sold the software to get the reports. I don't think I would believe them if they told me the sun rose in the east and set in the west without verifying it.

If you were to read deep in the clinical manual that I gave you the link to, you would see that they mention I think 12 cm pressure being sort of a line in the sand where the for Her mode can have a problem. It's either in there or in another document I read somewhere. It's not so much that you are a male using the for Her mode either. Lots of guys use the for Her mode and do very well with it. It's the pressure you are going to need most likely to hold the airway open and the for Her algorithm just work out well for some people when the pressures go above 12. If you were a female needing that pressure you would still have a problem.

The for Her auto adjusting algorithm is different from the regular auto adjusting algorithm. Totally different and this is what some DMEs don't seem to really grasp. It's obvious the for Her way of doing things isn't doing a good job so what we do is go to the regular mode and see how it does...and go from there.

I actually think you probably slept more than you think you did but it's hard to know for sure at this point.

FWIW....I am female (age 70 now, ugh) and I thought I would need a full face mask also because I snored a lot and woke up with dry mouth ...so I must be a mouth breather I was told as well. Actually what it was that with the snoring and gasping for breaths during the night that dried out my mouth. I maybe mouth breathed a little bit out of habit from years of gasping for breaths but my nose was clear. Back in 2009 the choice in full face masks was really limited and totally sucked if you were a little bitty woman. I quickly realized that my using a FFM wasn't going to happen and I had better re-evaluate the need for FFM.
I have never ever used a FFM out of need. It was 6 years into therapy before I even tried one to see if I could use one IF I just had to. Never had to and I gave it away and I don't even own a FFM now.

So....you may or may not need a FFM but if you are going to need these higher pressures it might be worth at least trying a nasal mask of some sort because sometimes some people find that they can get by with less pressure being used with a nasal mask over what they might need with a full face mask.
We can talk about that later.

Hello everyone I am here with a follow-up report.

I changed the cpap mode to regular Auto from Auto for her.

Unfortunately, my RT intervened with my little experiment. I did not realize this until I offloaded the new data into OSCAR this morning. The RT had turned off the EPR for last night. I did notice something different with the airflow last night but I thought it was just the mode change I made. Kinda bummed that we don't get to see the difference with just the mode change.

Sleep report:
Pretty much the same as the past few nights, struggling to fall asleep, I was awake for the majority of the time.

The changes and differences while I felt it, they weren't making my experiences last night more or less comfortable.

However, I did notice that I had a easier time swallowing my saliva last night, the EPR change might have contributed to that.

I did turn the machine off and on to create the break point in my log as suggested, I did that every time I felt I've been awake for a while. I think I did this four or five times.

Here are the OSCAR charts from the last two night. I originally did not share day 7 because it was less than 3 hours, thought it might be less relevant. However after seeing today's results, the patterns look rather similar, so it might be worth reviewing.

Day 7 (same setting as before)
Day 8 (regular auto mode, EPR off)

I see the overall reading have improved last night. I also see the events seemed to be clustered, similar to the previous night when settings were unchanged.
I am not sure what to make of it, I will rely on the more experienced users here interpret this data.

My thoughts:

Prior to my diagnosis and cpap, I normally get about 7-8 hours of sleep a night, I usually wake up once to use the bathroom.
For the past week, since I have been awake during the majority of the cpap usage, so after taking off the mask I am only getting about 3-4 hours a sleep before my alarm goes off.
The lack of sleep is beginning to take a toll on me, I am feeling more and more exhausted and have been having a headache since yesterday. This is the first time in my life I've felt the full force of sleep deprivation.

I really want to take a few nights off so my body can recover before pushing forward with cpap again.

What do you think? I know the ideal scenario would be for me to continue my effort with adjusting to this without interruption, but I am struggling mentally and my body is suffering.

Thank you all for reading!

Well crap. EPR was on my list to possibly turn off but I didn't want to do it now because you are already having a lot of trouble sleeping and I felt that turning it off now would make sleep even harder to get.

You can keep the sleep tech person from fiddling with your machine settings by putting it in airplane mode.

Until you can report actually getting some solid blocks of sleep the data the machine is putting out is questionable because we don't know if it is reporting real asleep events or awake breathing irregularities since the machine can't measure sleep status.

EPR can sometimes actually cause central apneas to pop up...but then it is also a comfort feature that we use to help us relax and go to sleep. Sometimes damned if you do and damned if you don't. Your events did decrease significantly last night.....but then you know you didn't sleep much either.
So I don't know how much of a test last night really was. Maybe you didn't have many events simply because you didn't sleep much.

I think a discussion with your doctor is in order....not the sleep tech at the DME...but your real doctor about the trouble you are having falling asleep.
See if he is okay with a night off from cpap. I can't advise it but I sure understand it.
Maybe a compromise with giving it one hour and if you can't fall asleep then taking a break. That has to be your decision though. When people have so much difficult falling asleep I always suggest that they talk to their doctor about it because sometimes it makes sense to have some short term help with the adjustment process. Maybe RX sleep meds or maybe just some sort of OTC sleep med for short term. Always best to run that by your doctor.

You know why I hate making 2 changes at one time???
Because if something changes with the results we don't know which change did what...or not.

I do think that regular apap mode is a better mode in this situation but I don't know how much of an impact not having EPR on board made for the worse sleep quality.

EPR change was on my list of things to maybe do but I felt that trying regular mode and not changing EPR was a better choice at this time.
At least the OAs reduced in regular mode even if it was for a very short sleep period....that is what I expected to see happen with regular auto mode.
I didn't know what would happen with the centrals in regular auto mode but wanted to reduce the OAs first and then see what we might need to do with the centrals.

BTW you can tell your sleep tech to NEVER make a change on your machine without first notifying you as to the change and why.