First month on CPAP and could use some help with dialing in my pressure and settings

Firstly, thank you for any help or guidance you can provide! Been using CPAP for almost a month now (ResMed11 - F30 facemask) after getting diagnosed with an AHI in the 14-15 range. Chief issues were dizziness, brain fog / memory problems and mild tiredness.

Here are my numbers from the first four days of using SleepHQ - I feel like I can adjust my pressure numbers (and other settings) to benefit more from CPAP therapy:

https://sleephq.com/public/351c8eee-9b4 ... 408c4bc266

Here is my data from last night as well: https://sleephq.com/public/8cff4cb8-ae3 ... a6a401c8b7

Overall, I'm sleeping ok but tired on some days when I wake up, generally for a few hours. Still waiting for some improvements in my brain fog / memory and dizziness, but that also could be a vestibular issue i am trying to solve.

It seems like my pressure tops out in the 9-12 range - so will I experience better sleep / results if I drop my max pressure?

So how is your sleep quality? Sleeping soundly for the most part or waking often?

Great question! I should've included that in the post. I'm still kinda tired when I wake up, but not nearly as bad as the first week of CPAP. I am getting a decent amount of sleep but haven't seen much improvement in my apnea symptoms.

Alorad13 wrote: ↑

Sat Mar 23, 2024 4:25 pm

haven't seen much improvement in my apnea symptoms.

What "apnea symptoms" are you wanting to reduce?

I see 5 breaks in therapy on your last night's report. Why???

What is your primary sleep position? You run along at nice lower pressures and then wham...big rapid increase.
Makes me wonder what changed.
My first thought is sleeping position and you ended up on your back.

Alorad13 wrote: ↑

Sat Mar 23, 2024 3:29 pm

will I experience better sleep / results if I drop my max pressure?

I seriously doubt if dropping the max pressure will do anything at all for anything unless it's those times when the pressure that goes up so markedly that is causing wake ups. In that case you first have to figure out what is causing the pressure to need to go up.

Pugsy wrote: ↑

Sat Mar 23, 2024 4:50 pm

Alorad13 wrote: ↑

Sat Mar 23, 2024 4:25 pm

haven't seen much improvement in my apnea symptoms.

What "apnea symptoms" are you wanting to reduce?

I see 5 breaks in therapy on your last night's report. Why???

What is your primary sleep position? You run along at nice lower pressures and then wham...big rapid increase.
Makes me wonder what changed.
My first thought is sleeping position and you ended up on your back.

Alorad13 wrote: ↑

Sat Mar 23, 2024 3:29 pm

will I experience better sleep / results if I drop my max pressure?

I seriously doubt if dropping the max pressure will do anything at all for anything unless it's those times when the pressure that goes up so markedly that is causing wake ups. In that case you first have to figure out what is causing the pressure to need to go up.

All great questions. I'd love it if apnea was the cause of my vestibular/ dizziness issues and treatment would clear that up - but other than that it's just brain fog, memory and low energy. Would love to feel more alert and sharp mentally.

Most of my machine stops are simply to scratch my nose.

Not sure what is causing that spike, truthfully I didn't notice it until you pointed it out. I only sleep on my back and with a pillow wedge to elevate my head - started using that around the same time as my CPAP.

There have been a few occasions where the air pressure is strong enough to puff up my cheeks and wake me up. I do also have a month old daughter and will sometimes wake up to help my wife out (I'm generally in the morning shift with our other two kids)

Question - are the breathing spikes a cause for concern at all?

You have 3 kids and one is a month old???? There's part of the reason you aren't sleeping soundly all night. That just comes with the "being a parent territory".

Do you take any medications of any kind? If so, what?

You've only been on cpap for about a month now. That's not very long in the grand scheme of things.
Give yourself more time and experience.

Highly unlikely that your dizziness is cpap related and thus using cpap won't help with anything that isn't related to the airway issues. Have you seen a doctor for this problem?

Your minimum pressure is your most critical pressure setting....not the max setting.
You aren't getting full benefit of EPR at 3 with the minimum set to 5 because the machine can't go below 4 cm....
If you want to change something.....change your minimum to 7 and make use of the full benefit of EPR and see what happens.

Always, always when you are posting reports....include your subjective feelings as well because they are actually more important especially when we are looking at an AHI of less than 1.0.

One more question.

Are you having much (if any) nasal congestion going on during the night?

Pugsy wrote: ↑

Sat Mar 23, 2024 5:14 pm

You have 3 kids and one is a month old???? There's part of the reason you aren't sleeping soundly all night. That just comes with the "being a parent territory".

Do you take any medications of any kind? If so, what?

You've only been on cpap for about a month now. That's not very long in the grand scheme of things.
Give yourself more time and experience.

Highly unlikely that your dizziness is cpap related and thus using cpap won't help with anything that isn't related to the airway issues. Have you seen a doctor for this problem?

Your minimum pressure is your most critical pressure setting....not the max setting.
You aren't getting full benefit of EPR at 3 with the minimum set to 5 because the machine can't go below 4 cm....
If you want to change something.....change your minimum to 7 and make use of the full benefit of EPR and see what happens.

Always, always when you are posting reports....include your subjective feelings as well because they are actually more important especially when we are looking at an AHI of less than 1.0.

Thank you for your help! I will say, I do feel happy that I've been treating the apnea and feel it will lead to more health benefits and improved quality of life over time. The first week was brutal - was absolutely exhausted all day. Since then, have only had a day or two like that.

I do take Nortriptyline (30mg) for what has been diagnosed as vestibular migraines, but after visits with ENTs and neurologists, I'm exploring other causes (eyes, neck, heart and thyroid)

That's some good feedback regarding EPR - I'll gradually work up to a minimum pressure of 7 and see how it goes! Thank you

Pugsy wrote: ↑

Sat Mar 23, 2024 5:43 pm

One more question.

Are you having much (if any) nasal congestion going on during the night?

Only during the fist few days, not since then at all.

Okay...I just did a quick scroll through your report from last night.

Lots of evidence of arousals ( you may or may not remember those arousals) so your sleep quality is in the toilet and until your sleep quality is improved upon you aren't going to feel as good as you hoped.

It appears that the flow limitations are driving the pressure upwards.

Utilizing EPR to its full potential might help with the FLs unless you tell me you had significant nasal congestion last night and if that's the case you need to work on opening up the nose in the more traditional measures because more pressure won't reduce nasal congestion FLs.

More convinced now that trying minimum of 7 with EPR at 3 full time is a good experiment to try.

Pugsy wrote: ↑

Sat Mar 23, 2024 5:51 pm

Okay...I just did a quick scroll through your report from last night.

Lots of evidence of arousals ( you may or may not remember those arousals) so your sleep quality is in the toilet and until your sleep quality is improved upon you aren't going to feel as good as you hoped.

It appears that the flow limitations are driving the pressure upwards.

Utilizing EPR to its full potential might help with the FLs unless you tell me you had significant nasal congestion last night and if that's the case you need to work on opening up the nose in the more traditional measures because more pressure won't reduce nasal congestion FLs.

More convinced now that trying minimum of 7 with EPR at 3 full time is a good experiment to try.

This is brilliant and you are a genius at this, I truly, truly appreciate you taking the time to help me! I'll increase my pressure to 7 tonight! I was battling a minor cold earlier last week but still had no real nasal congestion. Very exited to give this a shot!

Go Pugsy!

I might add that back-sleeping is murder on OSA... your flow limitations, which drive your pressure excursions, will decrease if you can get on your side.

vandownbytheriver wrote: ↑

Sat Mar 23, 2024 7:07 pm

Go Pugsy!

I might add that back-sleeping is murder on OSA... your flow limitations, which drive your pressure excursions, will decrease if you can get on your side.

Good to know! I have trained myself to sleep on my back after having surgery on a lower disc, but can try to sleep on my side - on my back is just most comfortable for my spine, but will slowly give it a shot

About dizziness: I learned by experience that there can be significant benefits from vestibular physical therapy.

A word about back sleeping vs side sleeping and the potential impact on OSA and/or pressure needs.

While it is true that back sleeping can worsen OSA and/or cause higher pressures in SOME people it isn't always a given that it happens with everyone. It's always worth trying to sleep on our sides but it doesn't always work out so good for any number of reasons and that's why I don't go down that road immediately with my advice....I save it for later if it is needed critically.

1....when we are new to cpap therapy our sleep quality is usually crap anyway and when we try to change a habit (like sleeping on our back) often we simply can't go to sleep or stay asleep because of trying to force something that we just aren't used to. I don't want to worsen already crappy sleep quality by trying to break a long standing habit.

2...Not everyone will see that their OSA worsens dramatically or significant pressure changes just because of supine sleeping.
I am one of those people....supine sleeping doesn't really do much for worsening my OSA or cause dramatic increases in the pressure needs. Now REM stage sleep...that's a whole different story. My OSA is 5 time worse in REM and I have seen pressure increases up to 8 cm during what I assume is REM. Doesn't matter if I am on my back or on my side (which is my preferred sleep position anyway but I can't always stay on my side due to various old age aches and pains that act up when I lay down. I have done extensive experiments over the years to prove this point plus I had both of my sleep studies (diagnostic and titration) done in a lab with sleep techs in attendance. Supine sleeping wasn't a big deal for me but REM sure was.

3...A correctly and optimally set cpap machine should be able to adequately deliver optimal therapy no matter what sleeping position we end up being in.
This whole thing about sleep can be really fragile and I just don't like trying to retrain sleep position habit and potentially making sleep quality worse just to maybe lower the pressure needs a little. The poor sleep ends up being more of a problem than just letting the machine find the optimal pressure when we change sleeping positions.

Now I do know that for some people supine sleeping is a big deal and sometimes it is worth trying to learn a new habit but I save that advice for down the road when it is proven to be needed. I know someone who needs a pressure of 19 when on their back and 9 when on their side....don't blame them one bit for wanting to learn to be happy on their side.
Now me...I might need 2 cm more when I am on my back but sometimes neither one of my shoulders want me laying on them so I have to get on my back but I don't stay there long because my back/pelvis ends up hurting more than my shoulders so I have to get back on my side.

You were on your back most of the night and the pressure didn't go crazy for most of the night.
Only went a bit crazy when the flow limitations caused the pressure increases.
Makes me wonder what caused the change in FLs later during the night....was it REM??? Maybe but you had one episode with rapid increase in pressure yet you hadn't been asleep long enough to make it to REM...but later in the night the pattern could be REM related.

Again though....a properly and optimally set cpap machine should be able to deal with REM worse OSA pressure needs so I prefer to tweak the settings if needed and let the machine sort it out. It's not like we have any control over REM anyway.

Besides...often once we have that minimum pressure more optimal and the FLs reduced the pressure won't go as high anymore anyway.

So....that's why I do what I do and say sometimes. I don't always have a lot of time to go into the "why" behind my ideas but this time I made a little time to explain my thoughts.
There's always a method to my madness even if I don't always explain it in great detail.

Your sleep is already very fragile...what with the little ones and the newness of cpap....don't go doing anything that makes it harder for you to fall asleep or stay asleep...without sleep none of this stuff matters much does it???