AHI creeping worse using CPAP few years

I received today F&P Sleepstyle Auto CPAP SPSAAA from the clinic.
I asked for APAP machine so I guess this is one even name has CPAP on it.

I just went Clinician menu and found it was set still CPAP mode at 10.
I'm planning to change it to automatic mode, it suggests min pressure 4 and max 18.
Are those good values to start in automatic mode?
I have had so far 10 at static value.

Since you have clusters that even 10 is not handling, you should put the minimum at 10.

Thanks ojiz for advice.

I had first night with Auto mode with min 10 and max 18.
Results were not as good as I was hoping.

I replaced also mask and strappings, mask started to make in early hours blasting or buzzing sound.
I tightened strap a bit but it still continued. I think it was mostly when I was laying on my back.
I have tennis ball in my back to prevent sleeping on my back but sometimes during the night body feels restless and needs laying on back so I remove it.
I breath then quite surely with my mouth, I have AirFit F20 mask size M.

There are quite many apnea events in early hours. Does that mean I need tweak max value more than 18?
Leak also has increased same time not sure if its related?
Maybe most important I feel sleepy.

I'm again very grateful for any pointers/comments.

ack_241 wrote: ↑

Tue Feb 21, 2023 3:20 pm

I tightened strap a bit but it still continued. I think it was mostly when I was laying on my back.

The fitting of any mask should be done when you're lying down. Even though many videos show it done when you're sitting.

ack_241 wrote: ↑

Tue Feb 21, 2023 3:20 pm

I have tennis ball in my back to prevent sleeping on my back but sometimes during the night body feels restless and needs laying on back so I remove it.
I breath then quite surely with my mouth, I have AirFit F20 mask size M.

Does your chin drop when you're on your back? Can you try to fit the mask (before you sleep) with an open mouth? A full face mask should keep its seal even when you're jaw drops - sometimes, it's a question of placement, not of tighness. And an FFM is not a replacement for a chin strap.

ack_241 wrote: ↑

Mon Feb 20, 2023 6:54 pm

I received today F&P Sleepstyle Auto CPAP SPSAAA from the clinic.

What does SPSAAA stand for?

Please post your OSCAR graphs from the new machine.

Does your chin drop when you're on your back? Can you try to fit the mask (before you sleep) with an open mouth? A full face mask should keep its seal even when you're jaw drops - sometimes, it's a question of placement, not of tighness. And an FFM is not a replacement for a chin strap.

I will test this properly but think it drops.

ack_241 wrote: ↑

Mon Feb 20, 2023 6:54 pm

I received today F&P Sleepstyle Auto CPAP SPSAAA from the clinic.

What does SPSAAA stand for?

Difference for prev machine is that this does automatic pressure adjusting and has modem to send data automatically.
I think thats for the A's

Please post your OSCAR graphs from the new machine.

I added pic to forum but doesnt seem to appear.
Here is link https://ibb.co/F8bH9Kc

Added also pressures stats https://ibb.co/k4qtpS6

The difference between the "good times" and the "bad times" is truly dramatic.

ack_241 wrote: ↑

Tue Feb 21, 2023 3:20 pm

There are quite many apnea events in early hours. Does that mean I need tweak max value more than 18?
Leak also has increased same time not sure if its related?

I'm guessing the dramatic change in your breathin is when you're on your back
No, I don't think you have to raise the max, because you're rarely there, and you don't stay there for long.
The problem - for the machine and for you is the dramatic difference between times when 10 is enough, and times when it isn't.
Apparently you can spend half your night at a pressure of 10 - but once you're on your back, 10 isn't enough to keep events from happening.
I think you have two ways of going about improving your therapy:

• Make sure you never ever sleep on your back. I would even consider getting up for few quiet moments and sitting on an easychair, in the dark, instead of removing the tennis ball and dropping off to sleep on your back. Then, get to bed on your side again
• The alternative would be nudging your minimum pressure upwards (leaving the max as it is) until you find a minimum that keeps those clusters from starting.

Look at the way the pressure dropped from about 14 to 10 (at 04:00) and the way it had to shoot up again. Based in this - admittedly a single night snapshot - I would guess you'll be able to avoid some of those clustered apneas if the minimal pressure were above 14 or above. You don't need that pressure when you are (presumably) on your side, but you certainly do when you are (again, presumably) on your back.

Thanks ozij for thorough analysis

I slept 2nd night with tennis ball all the time.
Stats are attached, screen at laptop was small to show properly, sorry about that
2nd night a
2nd night b

https://ibb.co/n7DNXYq
https://ibb.co/nLXJg6Y

Some stats stopped recording at 1pm , must be SW glitch.
AHI was bit better.
I will try to tweak min pressure.

I have now 3 nights with APAP.
Last night I had min as 12 and max 18.

Would it useful to go Min 14 to see if those apnea events between 4.30am to 7 am go down?
Or do I need to have Max more than 18?

I don't feel rested when I wake in the morning.
Also I wake few times between 4.30 -7 am because mask is having sound like blowing raspberry in the side of it.
If I put my hand on mask and push slightly towards face it disappears. I think it comes back after that but sometimes I'm already in sleep before knowing that
Strappings are already quite tight. I did positioning with mouse open and laying on side.

Not sure what to do with that? Would chin trap help with that? According stats pressure is at highest so does it mean too much pressure which tries escape from the sides?
I need to check next night do I breathe with mouth that time, I suspect I do.

Attached stats from last night.

ack_241 wrote: ↑

Thu Feb 23, 2023 2:54 pm

Would it useful to go Min 14 to see if those apnea events between 4.30am to 7 am go down?

Yes. And do it as gradually as you need to.

Or do I need to have Max more than 18?

No
CPAP pressure needs to be high enough to keep the airway from collapsing. It can never "blow through" a collapsed airway. Which is why, based on the data you've shown us, there's no reason at all for you to raise the max.

When a machine is set on Auto mode, it raises the pressure after it sees evidence of the airway being fully, or partially collapsed. It basically goes through "uh oh, that pressure wasn't high enough, maybe if I raise it there will be not further problems". And then after a while is goes through "oh goodie, now we can go back down". And that happens again and again if your minimum pressure is too low. That's a cycle you want to avoid.