Just started CPAP, and my AHI has skyrocketed, advice?

Greetings all! Thank you to anyone taking the time to read this.

I recently was diagnosed with mild sleep apnea via an at-home WatchPat test with an AHI of 7.4 and an o2 low of 92. I've been very symptomatic (extreme daily fatigue, exercise intolerance, emergent anxiety disorder after sleep ceased to be restful) but I understand these numbers to be quite mild compared to moderate or severe apnea sufferers.

My doctor ordered a further in-lab sleep study, but its a month or more away, and I was impatient for some kind of relief. So he gave me the OK to rent a machine from a third party (the CPAP box) while I wait for the study to see if insurance will cover a machine for me.

The first night was rough, but I was still adjusting to the mask and I woke up feeling OK but not great, with an AHI of 6.7. The second night was wonderful, I had the most detailed dream in recent memory and felt better rested, but my AHI crept up to an 8.28. Hmm strange but I felt alright so I just shrugged it off as getting used to the machine. Fast forward to last night, and It was the worst sleep I can remember having in weeks, I really felt like I was fighting the machine to breathe and when I woke up and got the data surely enough it was reflected in an AHI more than double my original diagnosis at 17.78.

I noticed that the vast majority of my events where something labeled in OSCAR as Clear Airway, so I did a bit of research, and to my horror found out that it stands for central apnea events. It was at this point that I almost wished I had waited for the in lab study as I'm fairly certain the Watch PAT was unable to distinguish between central and obstructive and therefore it could be hard to know if the central apneas where there before or not.

After some further research on sleep apnea on Reddit and elsewhere, it seems to me what makes the most sense is treatment-emergent central sleep apnea. My machine's pressure is rather low, but it still seems it is tricking my brain into sending too few signals to breathe at night. I've read that these can go away on their own, but a high AHI like 17.78 scares me. What should I do? Do I counterintuitively need more pressure? I titrated max pressure down to 4-7 as the first night did not go above 7 hardly at all.

Here is an Imgur link to the OSCAR data for the three nights: https://imgur.com/a/TZwCoXH

Thanks again!

Are you sleeping soundly without wake ups during the night or are you having a lot of wake ups?

What are you settings? Using EPR? If so, at what setting?

ChrisDotson wrote: ↑

Sat Nov 09, 2024 2:08 pm

Greetings all! Thank you to anyone taking the time to read this.

I recently was diagnosed with mild sleep apnea via an at-home WatchPat test with an AHI of 7.4 and an o2 low of 92. I've been very symptomatic (extreme daily fatigue, exercise intolerance, emergent anxiety disorder after sleep ceased to be restful) but I understand these numbers to be quite mild compared to moderate or severe apnea sufferers.

I'm new to this myself, but was tested with an AHI around 15 in a sleep lab + home test (technically mild?) w/ O2 drop off into high 80s, and feel exhausted most of the time. So not sure if mild/moderate is a whole lot different... guess it depends on the person.

As for the centrals stuff, I think that's normal, unless you get back crazy numbers? And I'm not even sure it's really central apneas or just how the machine is reading some sleep oddities. I just started this recently and have the same .... getting a couple of centrals each night. But I just figured that was par for the course and nothing to really be worried about.

Experts will have to chime in though, as I'm new to this myself ... still at the 'trying to find the best mask' part of this.

Appreciate the replies!

I slept fairly soundly for the first half of the night, despite taking a particularly long time to fall asleep. Then something seemed to wake me up, and I was in and out of sleep, tossing and turning for the rest of the night. In hindsight, that seems to align somewhat with the data showing a crap ton more CA events in the second half of the night.

As for my settings, I'm on 4-7 pressure on APAP mode, no EPR. If I'm figuring correctly, EPR can't go any lower than the machine's minimum pressure settings, and since my pressure is set so low, I did not think it would help much. Humidity is set to a 5, can't go any higher or I get rainout. Hopefully, a heated tube will help things. Currently running a full nasal mask, but just ordered a nasal pillow mask because the bridge of my nose is protesting.

Also, have some raw watch pat data from my at-home sleep test if it's helpful as an AHI baseline: https://imgur.com/a/LZ0JOSg

You can discount all the CA's that recorded while you're tossing and turning - they are a misinterpretation of how you breathe while you're awake, and the machine has no idea if you're awake or asleep.

Your watchpat data records a Respiratory Disturbance index of 21.7 - adding that to your Apnea Hypopnea Index of 7.4, means breathing disruptions are snapping you out of sleep at the rate fo 29.4 time in every hour of sleep. No wonder your symptoms are so bad.

Three nights, three different pressure setting in definitely not a good way of getting used to CPAP. Choose the setting in which you slept best, and stick to it for a week or so.

And please present your charts in the future as instructed here: How-to-post-images-for-review.html.

Welcome to the forum!