First Night on APAP w/o Diagnosis - Does my OSCAR AHI of 19.27 Confirm that I Have OSA?

Thanks Robysue1, NY is a great ally to Ontario, us Easterners need to maintain a united front!!!

OP's chart seems (to me) to indicate lots of clustered events, pointing to positional apnea. I suggest considering a soft cervical collar.

For OP's info. Positional Apnea is when your body is in a position that cuts off your own airway. NO amount of pressure will solve this. Think of a kinked garden hose. If you turn up the water, no water will get through the hose. A soft cervical collar slightly elevates your jaw gently, thus opening the airway. It is possible that you are on too many bed pillows or sleeping on your back, either of which makes the problem worse. You can read more about this in the wiki.

Bento78 wrote: ↑

Fri Sep 23, 2022 9:06 pm

Thank you to all the additional people who have shared their insights. ChicagoGranny, you bring up an excellent point, I’ve been wondering how much my SA is contributing to my ADHD.. thanks to everyone’s help, I’m confident I’ll find out before too long.

Just wanted to give a quick update, I accidentally left the bottom pressure at 4 last night, and only changed the top one, to 17. On top of that my mask was leaking over 30% of the time, so I didn’t post last night’s data, (I slept for about 9 hours and had an AHI of 9 point something, down from 19 the previous night, now that the upper pressure was increased from 12 to 17). Anyway, I’ve set things properly now, and will make sure I re-fit and tighten the mask to minimize leaks, and hope to have better data tomorrow!

Till hose-heads rule the world,

Ben

So.....how'd it go Ben?

Update on CPAP progress: nights 3, and 4.

First off, thank you Clownbell, for that observation, (and everyone else who shared their insights), I'll definitely look into a cervical collar. I do know for certain that when I turn to sleep on my back, the pressure immediately increases, so now that you've pointed out that it may be impossible for enough to air get through in this position, I'll definitely look into this.

Okay, so here's my data for the 3rd (https://imgur.com/A4hTcwP.png) and 4th (https://imgur.com/xcNmkkf.png) nights.

To recap the first and second nights:

Night 1 (https://imgur.com/BGKUrAR.png) my pressure range was 4-12 cm, AHI =19.27, Large Leak=2.6%, 57 CA's, Total Time in Apnea= 48:55

-despite the high AHI, woke up feeling ~15% more "with it" cognitively, and also had ~ 15% more energy - was able to make a strategic plan for job search, which
I had been unable to do previously

Night 2 (https://imgur.com/WxdB3LN.png) 4-12 cm, AHI = about 10.2 (over the ~ 5.3 hrs I slept), Leaks 0.87%, CA = 0

- took my ADHD medication too late, and couldn't sleep till like 5 AM, so my data isn't as useful - for the hours I slept, I seem to have about 1/2 the OA events,
and almost no CA events
- felt terrible as I had about 4 - 5 hours of sleep, as I took meds too late the prev. day

Night 3 (https://imgur.com/A4hTcwP.png) 4-17 cm, AHI = 9.39, Large Leak = 31.51% CA = 1, Total Time in Apnea= 20:50

- slept pretty well straight through, for 8.5 hrs, (though it's odd there are no events from 3:09 - 3:56 AM), didn't feel much better than I do w/o out CPAP
- upon waking, I was tired, listless, normal sub-par concentration

Night 4 (https://imgur.com/xcNmkkf.png) 10-17 cm, AHI = 10.13, Large Leak = 71.39% CA = 0, Unclassified Apnea = 47, Total Time in Apnea= 20:47

- had some trouble getting to sleep, and vaguely recall waking up twice
- due to 31% mask leak over previous night, I ran the 'mask fit' function several times after getting into a comfortable position, but could never get it to maintain
a good fit, for more than a couple seconds. I tried tightening and loosing all four straps on my Airfit F20 Full Face mask, I pushed the mask into my
face, to see if really tightening the straps would solve it, but it always registered as a "poor fit", after about 3 seconds. After
fighting with this for about 5-7 min., I just made sure the straps were tight enough for the fit to be snug enough for it to seem like there shouldn't be any leaks,
and went to sleep.
- woke up not noticeably better in energy or focus than I do without CPAP

I wonder if I'm not able to inhale enough air at the higher pressures, to keep the CPAP from forcing leaks to relieve the pressure? I didn't feel like I was usually 'swallowing' air before I fell asleep, I was able to tolerate the pressure after the 15 min ramp, with the 3 cm EPR.

What would everyone suggest I do about the pressure in light of the leaks that increased as the pressure was raised from 4-12 to 4-17, then 10-17 cm, of course, balanced out with the observation that apnea's and 'Total time in Apnea' were lowest at the higher pressures? I'm wondering if I should try 9-15.5 cm, as 15.44 was the "99.5%" percentile when the max was 17, though I don't know if this will be enough of a reduction to stop the leaks.

Also, is there any way to make the entirety of my OSCAR data available to others, I can't see any way to even open the "backup data" that I saved as an .xml file in OSCAR, but thought I'd ask if there was, (without taking a million screen shots), in case there is, and that would be helpful.

Till hose-heads rule the world,

Ben

Do you have facial hair?

Last night I had as much facial hair as I ever do, about 1-2mm whiskers, which I shaved off today.. could that have been a significant contributor?

Bento78 wrote: ↑

Sat Sep 24, 2022 6:38 pm

Last night I had as much facial hair as I ever do, about 1-2mm whiskers, which I shaved off today.. could that have been a significant contributor?

Hi, look at sleephq.com. very easy to upload to site and post a link that allows a closer look by anyone here.

The reason peeps are saying 9 minimum is its just under the “med” pressure number. That’s the most important number as pugsy has stated somewhere on here (pretty much all of the knowledgeable folks say same).

Another consideration is sleeping on your back allows for more airway collapse. I have found for me personally that just having my chin slightly raised when I lay down has prevented tissue collapse. (i have no proof other than much improved numbers)

So there’s more to be tried. Also lanolin to help with the seal. (depending on mask)

hth

Bento78 wrote: ↑

Sat Sep 24, 2022 6:38 pm

Last night I had as much facial hair as I ever do, about 1-2mm whiskers, which I shaved off today.. could that have been a significant contributor?

That's probably why your leaks were terrible.

Oh crap, these things are so finicky.. ok thank you! Ill see how that it works now that I’ve shaved.

Okay, now I'm making some progress..

Night 5 (https://i.imgur.com/L7aASEx.png) - Pressure = 11-16 cm, AHI =9.9*, Large Leak = 2.08%

Felt better than I have in recent memory when I woke up - energy up 20%, concentration up 20%, mood up 40%

- having taken my meds a little too late into the evening yesterday, I didn't fall asleep until about 3:30 AM
- from going to bed at 11:30 to ~ 2:30 I lie awake, the pressure range was set to 7-16 cm, (Oscar doesn't show this), which I realized was too low
- turned up pressure to 11-17 cm at 2:30, and fell asleep at ~ 3:50
- taking the period I was asleep from 3:50 to ~ 8:40, AHI = 9.9
- periods with dense OA's before 3:50 were when I lie on my back (awake)
- Leak rate was only 2.08%, down from 71% yesterday!

Shaving chin stubble seemed to make a dramatic difference in the leak rate, I was able to maintain a good mask fit even when testing at 10 - 17 cm

- because the 99.5% pressure was the max (16), I could increase it to 18 tonight, leaving the bottom at 11 for now, does that seem reasonable?

My throat is very dry, and I was tempted to stop using CPAP at 2:30 because of this, but didn't.. will look into a heated hose

Can anyone advise which heated hose is the best for increasing humidity with my machine?

Mille Grazie,

Ben

Bento,

Thanks for the detailed history about what's going on in terms of leaks and settings.

Yeah, it may be your facial hair is not playing friendly with the mask. (My hubby does have a full beard and has no real problems with leaks with his full face mask, but he also needs a lot less pressure than you apparently need: His APAP runs from 7-10 and he really doesn't hit 10 very often.)

You write:

Bento78 wrote: ↑

Sun Sep 25, 2022 11:05 am

Okay, now I'm making some progress..

Night 5 (https://i.imgur.com/L7aASEx.png) - Pressure = 11-16 cm, AHI =9.9*, Large Leak = 2.08%

Felt better than I have in recent memory when I woke up - energy up 20%, concentration up 20%, mood up 40%

- having taken my meds a little too late into the evening yesterday, I didn't fall asleep until about 3:30 AM
- from going to bed at 11:30 to ~ 2:30 I lie awake, the pressure range was set to 7-16 cm, (Oscar doesn't show this), which I realized was too low
- turned up pressure to 11-17 cm at 2:30, and fell asleep at ~ 3:50
- taking the period I was asleep from 3:50 to ~ 8:40, AHI = 9.9
- periods with dense OA's before 3:50 were when I lie on my back (awake)
- Leak rate was only 2.08%, down from 71% yesterday!

So it's reasonable to discard everything earlier than 3:50 as sleep-wake-junk. Did you know you can temporarily turn a session on/off in OSCAR by just clicking the appropriate session bar at the bottom of the left side bar of the Daily Data window?

I mention this because turning off the first two sessions (the ones before you reset the settings at 2:30) would give a more accurate picture of what was going on in your actual sleep this night, particularly after you adjusted the pressure settings.

Shaving chin stubble seemed to make a dramatic difference in the leak rate, I was able to maintain a good mask fit even when testing at 10 - 17 cm

If you really miss the chin stubble or shaving right before bed increases the chances of having a difficult time getting to sleep, you might want to try a mask liner. Sometimes that can help.

- because the 99.5% pressure was the max (16), I could increase it to 18 tonight, leaving the bottom at 11 for now, does that seem reasonable?

If you think you can handle it, I'd be more inclined to increase that bottom pressure up to 13. The idea is that you really want the minimum pressure to be high enough to prevent most events so the machine is not chasing events by increasing pressure after the fact in hopes to prevent more events. I'm not sure I'd increase the max pressure setting yet: Changing too many things at one time can make it difficult to tease out what is working and what might be triggering additional problems.

My throat is very dry, and I was tempted to stop using CPAP at 2:30 because of this, but didn't.. will look into a heated hose

What is your humidifier set to? How much water did you go through?

If your humidifier is not set to its maximum setting, first try increasing the humidifier setting. Also make sure the water tank is full at the beginning of the night. And if you wake up with a dry mouth or throat, it's worth looking at the water level: If it's already close to empty, refill it: There is nothing worse than running out of water when your nose, mouth, or throat is craving more humidity.

Heated hoses by themselves don't really help fix dry mouths and throats; they do help with rainout. If your humidifier is not set on its maximum setting because you get rainout when it is, then adding a heated hose can allow you to use the humidifier at a higher setting without triggering rainout problems.

One thing to keep in mind is that CPAP humidification is designed more to keep the nasal cavity from getting dried out. It doesn't always fix dry mouth and dry throat problems.

clownbell wrote: ↑

Fri Sep 23, 2022 11:37 pm

For OP's info. Positional Apnea is when your body is in a position that cuts off your own airway. ...Think of a kinked garden hose.

No, that's not it. Here is the correct definition of positional obstructive sleep apnea.

According to the American Academy of Sleep Medicine (AASM) definition positional obstructive sleep apnea (OSA) can be defined as a lower AHI in the non-supine position than in the supine position. In practice positional OSA is defined as an AHI at least twice as high in supine position as in other positions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298770/