My second try with a CPAP

Hello everyone,

I had a CPAP about 15 years ago. I gave up after a few months. The machine was noisy, mask/headgear was extremely uncomfortable. I was unable to sleep while using it. Also, there was not much help from the medical device supplier.

The second try might be successful. I’ve had the machine for about a week. I can now sleep while using it. I’m feeling much more rested. I’ve been able to skip or reduce my afternoon nap. And, my advanced apnea monitor aka my wife says, “you don’t wake up gasping and you’re snoring much less than before”.

I can’t say that the mask/headgear is comfortable. It is much less uncomfortable than what I had before.


I've noticed some changes since I started. Can these be related to CPAP use?

The unwelcome news is that I've been waking up with a sore lower back. Not a big problem. It goes away after I'm up for an hour or two.

The good news is that my nightly bathroom breaks have decreased dramatically. Instead of four or five trips per night I’m usually going only once.



I’ve installed OSCAR and have been studying the data.

My AHI is not stable. Substantial changes from one night to the next. It also looks like a lot of “Events” are being logged. Could some of the experienced users please look at my data and give me their opinion?

I’ll have my first Dr. Appointment in a week or two to discuss my apnea therapy. It’d be good to know what questions or concerns that I should mention.



Below is a link to OSCAR data for the last six days.

The first day has only the summary data. I found that ResMed is a cheapskate and didn’t include an SD card. I had to install one.

Oscar_04_20-25_2023

You have a nice AutoSet machine. Why are you just using the CPAP mode?

Change the mode to Auto and set the pressures to 7.0 minimum/20.0 maximum. Post that night's chart, and we can see better what is happening. Your mask leak level is acceptable. Your AHI and Flow Limitation are not so good. Letting the auto mode do its work with a bit of increased pressure may take care of these problems.

Welcome!

BTW, please keep posting in this one thread.

lmester wrote: ↑

Wed Apr 26, 2023 10:27 am

Hello everyone,

first, let me saw thank very much for reading the posts for newbies. it shows in your presentation of graphs. well done!

secondly, do you happen to know why you are on fixed pressure?

and now i stand aside for the more knowledgeable folk to step in.

good luck!

Welcome! It's great you're returning to CPAP treatment, equally great that you're using your machine's data to understand how to optimize your therapy.

Someone else wrote recently about having a sore back with CPAP use. Best guess is that you're sleeping more soundly and staying in one position longer, which can cause some temporary stiffness. It's also possible, of course, that there's some unrelated cause for your back problem.

Do you know why you are using a fixed pressure? And do you know what that pressure is 8? I ask because it doesn't appear to be doing the job. Your AHI, and especially the obstructive apnea and hypopnea components, should consistently be well below 5.

If you're willing to experiment with revising your settings yourself, you can generate some more information going into your appointment with the doctor. My own recommendation would be to use the APAP mode and giving yourself a pressure range of 8 to, say, 12. Some would say you should open up the max to 20, but I'd worry you might have a bad experience dealing with higher pressures all of a sudden.

If you love your ramp setting, fine; otherwise I'd suggest turning it off or raising your ramp minimum to 7. Some people feel a bit air-starved with pressures below 7, and at 7 you'll get the full benefit of your EPR right away.

Your obstructive apnea events tend to be clustered, which suggests there may be a positional element to your apnea. Could you tell us what positions you sleep in: sides, stomach, back? And how high or soft is your pillow?

Why are you on Fixed Pressure? Seeing pressure changes, especially in response to events is some of the most valuable data available.

I'd be changing to APAP, min 8, max 14. Many advocate not putting a max, and allowing the machine to go where it needs to be. I don't, not for those new to CPAP. But, be prepared to increase.

lmester wrote: ↑

Wed Apr 26, 2023 10:27 am

I've noticed some changes since I started. Can these be related to CPAP use?

Perhaps.

I'll let you figure out why a more detailed answer wasn't provided.

Answering a few questions:

My machine is currently being rented. After two months my insurance will buy the machine if my results are acceptable to them. When the technician at my DME provider found out that I worked with electronics and network management, I was given the warning “We know that you can find out how to change your machine settings. Please don’t do that.”

Since I don’t currently own the machine, I’m not sure if it would be good to start adjusting settings. Once my insurance buys it I'll be able to do whatever I want with it. Also, I have a good relationship with my doctor. He's my GP and my sleep doctor. Running any settings changes by him first would help to keep that. He's not telling me how to write code. I don't want him to think I'm telling him how to be a doctor.


Why am I using CPAP mode fixed pressure instead of automatic? The prescription was for fixed mode.

That’s one question that I want to ask my doctor. I'll also bring the OSCAR data just in case he only has a basic summary of the data. I have no idea what level of detail is provided to him by my DME.

Your obstructive apnea events tend to be clustered, which suggests there may be a positional element to your apnea. Could you tell us what positions you sleep in: sides, stomach, back? And how high or soft is your pillow?

I have major differences based upon my sleeping position. My apnea is worse when I’m on my back. Better when sleeping on my side. I use a low pillow. My apnea is worse when my head leans farther forward, such as when resting on a tall pillow. I also have problems with my mouth opening. I have a chin strap on back order. I’m hoping it might help some of my problems.

A soft cervical collar might help keep your head up and airway less compressed - better #'s and sleep... many use one (put into search bar above and see what they say).

lmester wrote: ↑

Wed Apr 26, 2023 12:29 pm

When the technician at my DME provider found out that I worked with electronics and network management, I was given the warning “We know that you can find out how to change your machine settings. Please don’t do that.”

I would tell him in strong words that I will manage my own machine settings.

ChicagoGranny wrote: ↑

Wed Apr 26, 2023 3:34 pm

lmester wrote: ↑

Wed Apr 26, 2023 12:29 pm

When the technician at my DME provider found out that I worked with electronics and network management, I was given the warning “We know that you can find out how to change your machine settings. Please don’t do that.”

I would tell him in strong words that I will manage my own machine settings.

Remind him that in the USA, you have the RIGHT to do exactly that!

lmester wrote: ↑

Wed Apr 26, 2023 12:29 pm

Answering a few questions:

My machine is currently being rented. After two months my insurance will buy the machine if my results are acceptable to them.

Chances are the only thing your insurance really cares about is usage. They don't want to pay for a machine that you do not use.

When the technician at my DME provider found out that I worked with electronics and network management, I was given the warning “We know that you can find out how to change your machine settings. Please don’t do that.”

The CPAP police don't really exist, but at the same time I understand you don't want to piss people off unnecessarily.

Also, I have a good relationship with my doctor. He's my GP and my sleep doctor. Running any settings changes by him first would help to keep that. He's not telling me how to write code. I don't want him to think I'm telling him how to be a doctor.

Start there. Since you do have a good relationship with the doc who prescribed the machine, tell him that your treated AHI is still too high. Ask if he'd like to see the data himself.

That's not telling him how to be a doctor. To build on your analogy of writing code: Telling your doc that the current settings are NOT consistently keeping the AHI under 5 is like the user reporting a serious bug in the code that must be fixed before the user can use the code.

If I were you, I would also politely ask the doc if a change to APAP for a weeks worth of titration would be useful. Again, that's not telling the doc how to do his job; it's reminding him that you have a machine with the capability of providing the doc with a lot more useful data than he currently has concerning what pressures you actually need. If the doc agrees with you, he can order that pesky DME of yours to change the settings.

Why am I using CPAP mode fixed pressure instead of automatic? The prescription was for fixed mode.

That's because many (most) docs will just automatically write a script for fixed pressure, particularly if a titration study with a CPAP was done.

That’s one question that I want to ask my doctor. I'll also bring the OSCAR data just in case he only has a basic summary of the data. I have no idea what level of detail is provided to him by my DME.

Your doc may very well reject looking at the Oscar data for the simple reason that Oscar is NOT an official software product that has been approved by your CPAP machine's manufacturer for analyzing the data.

Since your APAP is a Resmed machine, the DME is using Resmed software to do whatever analysis of the data they actually do. If they're a typical DME, all they really look at is the usage data: Are you using the machine at least 4 hours on at least 70% of the nights? They care about that because they only get paid by your insurance if you are using the machine enough. And "using the machine enough" typically means using it for at least 4 hours on at least 70% of the nights.

A better quality DME might also look at leak data: Lots of large leaks means ineffective therapy. And lots of smaller leaks means there's a good chance the person is tossing and turning and fighting leaks all night rather than sleeping.

A better quality DME might also look at the summary AHI and notice that yours is not consistently staying below 5.0.

But only the best quality DME would be interested in analyzing the flow data itself in ResScan and only the best quality DME is likely to notice that your remaining events are occurring in clusters, which could easily be broken up and prevented by allowing the machine to increase pressure when a few events occur in rapid succession.

Your obstructive apnea events tend to be clustered, which suggests there may be a positional element to your apnea. Could you tell us what positions you sleep in: sides, stomach, back? And how high or soft is your pillow?

I have major differences based upon my sleeping position. My apnea is worse when I’m on my back. Better when sleeping on my side. I use a low pillow. My apnea is worse when my head leans farther forward, such as when resting on a tall pillow. I also have problems with my mouth opening. I have a chin strap on back order. I’m hoping it might help some of my problems.

The fact that many people's apnea is worse when sleeping on the back or in REM is precisely why APAPs were invented: APAPs allow the machine to provide the extra pressure you need when you are on your back (or in REM), but don't force you to use that higher pressure setting all night long when a lower pressure setting can do just as good of a job of preventing the events.

Now here's the thing: For some people, using the higher pressure needed to control the apnea when its at its worst doesn't create any problems with getting to sleep, staying asleep, controlling leaks, or triggering aerophagia. But for other people, the higher pressure needed to control the apnea when its at its worst DOES create problems. And using an APAP in an appropriate range minimizes those problems.

In your case, an appropriate APAP range needs a minimum pressure of at least 8cm. We know that's high enough to control a significant portion of your apnea, but it's not enough to control everything. Changing to APAP would allow you (and your doctor) to find out just how much pressure is needed to control your apnea when you are on your back.

I recently obtained a copy of my sleep study. If I'm reading it correctly I had an AHI of 69.1 before treatment and an AHI of 0.7 with CPAP and 8 cmH2O pressure.

Sleep Study

The OSCAR data is showing an AHI much higher than 0.7.


Oscar Data

I have a Dr appointment coming up. If the Dr decides not to turn up the pressure I may do it myself. If I don't like the results I can just turn it back down.
The good news is that I'm still using the machine. I feel much better and usually don't need to take an after work nap. Hopefully i'll feel even better if I can get my AHI down a little lower.

It's hard to know why your titrated AHI in the lab was so much lower than your AHI at home. Your AHI at home, however, is clearly unacceptable. It also continues to appear to be positional in nature, along with your snores and maybe your flow limitations.

If your doctor doesn't recommend raising your pressure, ask why. Also ask why you are on a fixed pressure when your obstructive events come in clusters. If he seems unlikely to budge, you might say, as robiesue1 suggests, that you will be raising your minimum and providing yourself with a pressure range in APAP mode so that more data will be available to optimize your settings.

In general, most people on this site aim to see their AHI mostly below 2, which is good; below 1 is excellent.

It is indeed very good news that you're continuing to use the machine and are feeling better. Just think how much better you'll feel when your apnea is better treated!