AHI Still High

Hello,
I have been on apap for about 1 month. Using DreamWear Nasal cushion. Using pap all night every night. My home sleep study said REI was 42.8/hr. Concerned that my apnea events remain high despite treatment. The last few nights it has been as high as 13. Last night it was a little better at 7. Centrals seem to be an issue. I spoke to my provider a week or so ago and she said she thought the centrals were related to starting treatment and she felt my numbers were already trending down but I don't see that At that time she readjusted my pressures from 5 and 20 to 8 and 14. She said narrowing the pressures would sometimes help. Could someone take a look at my charts and let me know what you think? I have another apt with the provider the first week of August. I screenshot a spot in the morning that was troubling to me. Let me know if you need me to screenshot something different.
Thanks in advance.
Tammi

1...You included graphs that aren't useful and taking up precious forum storage space. Can you remove the unneeded or useful images from your profile attachment storage?
Please read this
viewtopic/t183806/EVERYONE-PLEASE-READ- ... MENTS.html

The 2 top images not useful...the bottom image zoomed in on the CA/central cluster is useful so you can leave it.

Thank you for removing the unneeded images....this might enable you to continue to use the attachment feature or allow someone else to use the attachment feature.

2...I am unsure if the bulk of your centrals are related to maybe being awake or not. Especially when we see centrals at the very end of a sleep session where you are likely awake or half awake.
Watch the videos here
http://freecpapadvice.com/sleepyhead-free-software
to help you figure out of the flagged events are asleep flagged events or related to arousal/awake breathing and if you aren't asleep they don't count and not much you can do except to try to improve your sleep quality.

Are you sleeping soundly for the most part or are you remembering a lot of wake ups?

3...About the only thing you might try doing IF (big if) the centrals are indeed asleep breathing flags is turn off or reduce EPR. It's long shot if it will help or not. Reducing or eliminating EPR only will help reduce centrals if the EPR is the actual trigger for the centrals. In a very few people on cpap and using EPR that EPR use creates a situation where it triggers some unstable breathing and centrals are the result. We don't know if you are one of those people or not...but worth trying and see if it helps or not. Yes...sometimes people just have centrals happen because they started cpap and sometimes as the body adjusts to things those centrals will reduce or go away. So your tech is correct in that regard...sometimes it just take some time for those centrals to fade away. That's why they tell people to "give it time" because sometimes giving it time works.

4...Your OA numbers aren't horribly horrible and maybe a tiny bit more minimum pressure would help reduce them.
It's hard to say for sure because you didn't include the non zoomed in detailed image and we can't see what the pressure was doing during the flagged OAs. We can see the zoomed in central pressure but we don't know what was going on with the OAs. The machine didn't increase the pressure at all for the centrals and that's to be expected...it won't/can't because more pressure won't fix centrals.

My suggestion is reduce or turn off EPR if you can...if not comfortable there is a setting for using EPR during ramp only and you can then use the ramp feature to help you get to sleep before EPR ends or reduces. This might help reduce the centrals...might not also but it's an easy experiment to try.

When you reduce or turn off EPR that will effectively increase that minimum pressure a bit which might help reduce the OAs.

So couple of questions..
1...about the sleep quality...are you sleeping soundly or having a lot of wake ups?
2...do you take any meds of any kind? Even OTC...if so, what?

I deleted the useless images. sorry.
I could post a zoomed out image. you could look at it and comment then I could delete again to save space if you want. What charts do you want to see?

I do not feel that I am getting good sleep. I feel like I wake up frequently and toss and turn.

I am taking Lexapro, simvastatin, Zyrtec

Tammi

For examples of how we like the zoomed out images see this thread
http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

No need to immediately remove it....leave it up as long as it is useful and needed...probably for at least 2 to 4 weeks would be a common time frame.

Do go watch those videos so you can learn about false positive flagging.

Some of your meds could be affecting your overall sleep quality along with having some rather ugly side effects during the day.

https://www.goodrx.com/drugs/side-effec ... g-insomnia

https://www.aarp.org/health/drugs-suppl ... omnia.html

while those articles talk about insomnia which most people think "trouble falling asleep"....it can also mean trouble staying asleep...those tossing and turning things.
2 kinds of insomnia
1...sleep onset insomnia which is trouble falling asleep
2...sleep maintenance insomnia which is trouble staying asleep.

And you need to do a lot of research on the Lexapro side effects....
It belongs to a class of medications called SSRI Selective Serotonin Reuptake Inhibitor
and if you google SSRIs and sleep you will see it is commonly known to mess with sleep stages or sleep quality in general in addition to having some pretty nasty daytime side effects. It may or may not be a factor in your tossing and turning. It may or may not be a factor if you are having the usual daytime side effect symptoms that mimic poor sleep...drowsiness, fatigue, etc.

Even the lowly Zyrtec can be a problem with messing with sleep for some people.

Now I don't know that your meds are the entire problem...but they could sure be playing a part.
Something to have a chat with your doctor about at some time in the future.

In the meantime you can try reducing or turning EPR off and see what happens. Won't hurt and might help.
See if reducing the events equals feeling like you sleep better or not.
Do you know how to get to the clinical setup menu area to make the changes in EPR?
If not...explained in the provider manual. There is no reason you can't do this yourself.
https://media.resmed.com/sites/3/202106 ... ER-ENG.pdf

One change only at a time whenever possible...and here we want to just either reduce or eliminate EPR.

Thanks for the reply.
I will adjust the EPR and see where we are at tomorrow.

Tammi