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[CPAP] New CPAP user failing to get through the night, in need of guidance
#1
New CPAP user failing to get through the night, in need of guidance
Hi all, 

I am diagnosed with moderate sleep apnea, I am a 34y old male with good weight - 5'10" 150lbs. I have a deep impinging overbite which my older brother also has (along with small jaw) - he ended up having severe life issues and getting MMA and is currently trying to recover. I'd like to avoid that. I am not a highly symptomatic individual but wonder if I could have way more energy than I do. On sibling's advice I got an AirCurve 10 VAuto rather than AirSense 10 and signed up here to seek advice from SleepRider and others.

I don't really know what I'm doing but I set the settings to what my prescription said. I seem to be doing terrible and have a lot of AHI. Please note that I've tried several different masks including P10, DreamWear, N30i and P30i - I seem to be settling on the latter which I have used for a bit less than half the night for the last 4 nights before waking up and ultimately taking it off.

What should I be doing here? Thanks so much.

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#2
RE: New CPAP user failing to get through the night, in need of guidance
I cannot post images because I am too new of a member. This is the best way I can provide the info for now.


Name: Murda, Be
DOB: Oct 23 1987


OSCAR   
Usage Statistics   

CPAP Statistics

6 days of CPAP Data, between Dec 3 2021 and Dec 18 2021

Details
Most Recent
Last Week
Last 30 Days
Last 6 Months
Last Year

CPAP Usage

Average Hours per Night
02:40
03:25
02:37
02:37
02:37
Compliance (4 hrs/day)
0%
14%
6%
6%
6%

Therapy Efficacy

AHI
23.25
14.14
13.76
13.76
13.76
Obstructive Index
2.25
1.09
1.21
1.21
1.21
Hypopnea Index
0.75
0.29
0.25
0.25
0.25
Unclassified Apnea Index
0.00
0.07
0.32
0.32
0.32
Clear Airway Index
20.25
12.68
11.99
11.99
11.99

Leak Statistics

Average Leak Rate
0.72
0.41
1.45
1.45
1.45
95% Leak Rate
0.00
2.40
7.20
7.20
7.20
% of time above Leak Rate threshold
1.65%
0.44%
1.28%
1.28%
1.28%

Pressure Statistics

Average Pressure
6.74
6.32
6.26
6.26
6.26
Min Pressure
5.00
5.00
5.00
5.00
5.00
Max Pressure
10.46
10.46
11.60
11.60
11.60
95% Pressure
9.92
9.16
9.12
9.12
9.12
Average EPAP
5.74
5.32
5.26
5.26
5.26
Min EPAP
4.00
4.00
4.00
4.00
4.00
Max EPAP
9.46
9.46
10.60
10.60
10.60


Changes to Machine Settings

First
Last
Days
AHI
FL
Machine
Pressure Relief
Mode
Pressure SettingsDec 3 2021
Dec 18 2021
6
13.76
0.00
AirCurve 10 VAuto (37094)
None
VPAPauto
PS 1.0 over 4.0-20.0 (cmH2O)


Machine Information

Brand
Model
Serial
First Use
Last Use

ResMed
AirCurve 10 VAuto (37094)
23212454253
Dec 3 2021
Dec 18 2021



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#3
RE: New CPAP user failing to get through the night, in need of guidance
Welcome to Apnea Board. The best way for us to start is to see what your current settings have accomplished or not. You have a great deal of flexibility to address any number of problems. I'm not familiar with MMA, do you mean TMJ? My signature includes links on how to organize your Oscar charts and attach to a post. I'm sure we can figure out what's what better after getting a look.

Edit: I see you posted summary data while I was writing a reply. Let's look at the daily details. You seem to have a very high central apnea event rate. That is not a big surprise for someone with normal weight. We might want to take a closer look at your diagnosis, as this does not appear to be obstructive sleep apnea.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: New CPAP user failing to get through the night, in need of guidance
[attachment=38139 Wrote:Sleeprider pid='426341' dateline='1639935215']Welcome to Apnea Board. The best way for us to start is to see what your current settings have accomplished or not. You have a great deal of flexibility to address any number of problems.  I'm not familiar with MMA, do you mean TMJ?  My signature includes links on how to organize your Oscar charts and attach to a post.  I'm sure we can figure out what's what better after getting a look.

Edit: I see you posted summary data while I was writing a reply. Let's look at the daily details.  You seem to have a very high central apnea event rate.  That is not a big surprise for someone with normal weight.  We might want to take a closer look at your diagnosis, as this does not appear to be obstructive sleep apnea.

Thank you Sleeprider. I've looked at your guide and taken some screenshots. Re MMA I am referring to maxillomandibular advancement surgery - he had a very small jaw. I don't have as big an issue as him (jaw is not as small I don't think) but I do have the impinging overbite as noted and worry about whether I could get more extreme issues as I age (he is 5 years older and had fairly sudden onset).

Screenshots below. I've also attached screenshots from my sleep tests (I had one mild then one moderate). I feel there were confounders in my moderate sleep test as I recall being somewhat awake from around 3:30am onward, which is where I am seeing a lot of activity in the chart (though without a doubt my oxygen levels have dropped at other times).

   
   
   

More posts to come.

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#5
RE: New CPAP user failing to get through the night, in need of guidance
   
   
   
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#6
RE: New CPAP user failing to get through the night, in need of guidance
Some possible considerations:

Your Central Apnea maybe are idiopathic, unknown cause, but could be treatment emergent.

Remove Ramp or change settings as this abrupt change can induce CA. 20 minutes at 4 is itself at fault for some issue. You start therapy at EPAP 4 so Ramp 4 is not necessary. You'll lose 20 minutes therapy every session start.

You might need to tighten up your pressure settings some. Starting at 4 is a pediatric pressure. I think start at 6 and either leave 20 or drop it some as well, maybe to 15.

You'll note that these Central Apnea/CA are consistently inconsistent, frequently up then down. I'm wondering if during the diagnostic test, the CA chose to be down that night.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: New CPAP user failing to get through the night, in need of guidance
Your diagnostic sleep test clearly points to obstructive sleep apnea, but expresses considerable concern for oxygen desaturation due to long duration apnea. All events with positive air pressure are flagged as central. I think we are going to try CPAP pressure and see if we can reduce these events. Turn off ramp as we won't be using high pressure. In Vauto mode set EPAP min to 5.0, PS to 0.0 and IPAP max to 5.0, or use CPAP mode at a pressure pf 5.0 with no EPR. This is going to produce a steady, unchanging pressure. This may help central apnea, however if we don't see improvement, we are going to have to refer you back to your doctor for therapy onset central apnea and consideration for an adaptive servo ventilator (ASV) like the Resmed Aircurve 10 ASV.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: New CPAP user failing to get through the night, in need of guidance
(12-20-2021, 10:39 AM)SarcasticDave94 Wrote: Some possible considerations:

Your Central Apnea maybe are idiopathic, unknown cause, but could be treatment emergent.

Remove Ramp or change settings as this abrupt change can induce CA. 20 minutes at 4 is itself at fault for some issue. You start therapy at EPAP 4 so Ramp 4 is not necessary. You'll lose 20 minutes therapy every session start.

You might need to tighten up your pressure settings some. Starting at 4 is a pediatric pressure. I think start at 6 and either leave 20 or drop it some as well, maybe to 15.

You'll note that these Central Apnea/CA are consistently inconsistent, frequently up then down. I'm wondering if during the diagnostic test, the CA chose to be down that night.

(12-20-2021, 11:01 AM)Sleeprider Wrote: Your diagnostic sleep test clearly points to obstructive sleep apnea, but expresses considerable concern for oxygen desaturation due to long duration apnea.  All events with positive air pressure are flagged as central.  I think we are going to try CPAP pressure and see if we can reduce these events.  Turn off ramp as we won't be using high pressure.  In Vauto mode set EPAP min to 5.0, PS to 0.0 and IPAP max to 5.0, or use CPAP mode at a pressure pf 5.0 with no EPR.  This is going to produce a steady, unchanging pressure.  This may help central apnea, however if we don't see improvement, we are going to have to refer you back to your doctor for therapy onset central apnea and consideration for an adaptive servo ventilator (ASV) like the Resmed Aircurve 10 ASV.

Thanks all, is there any way the machine could be reading central apneas wrong? So you are saying my brain is confused by the CPAP and stops breathing because it is preventing my obstructive apnea?

SleepRider I will try your settings, hopefully tonight, thank you.

My first test showed positional obstructive apnea and recommended not sleeping on back. The second test didn't show this for some reason, but as I noted the second test had some confusing readings from when I was awake, not sure if that is a factor. Could it be possible if positive pressure induces central apnea that the best answer could be adjusting for side sleep or a getting a dental appliance?

Thank you!
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#9
RE: New CPAP user failing to get through the night, in need of guidance
The exact reason for your Central Apnea is probably not known. The majority of new PAP users can get a bit of CA that will be labeled by Apnea Board members as treatment emergent. This type CA will diminish in about 3 months of PAP use. This type is most likely especially if CA didn't show on the diagnostic test.

Idiopathic Central Apnea will more likely have them show on the diagnostic test. Other reasons may be high living elevation like Colorado and similar.

A Central Apnea is 10 seconds or longer, is a cessation of breath without effort, is caused by lack of the breath signal because of some imbalances in the level of CO2 in the blood. This CO2 lowered level causes the breath signal to go missing, and might be by PAP flushing out CO2 for some to most. Others like myself, will be CA pre-dominant and must have the ASV.

PS the test and doctor version of Positional Apnea normally refer to body position like back, side, stomach.

Surgeries or non PAP alternate therapy is sometimes successful, but must endure the pain of the procedure. And success rates are quite poor with most still needing PAP afterwards.

If we can't succeed with the "Avoid CA Plan" then best bet is the ResMed AirCurve 10 ASV, a specific bilevel PAP with breath backup rate.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#10
RE: New CPAP user failing to get through the night, in need of guidance
(12-20-2021, 11:01 AM)Sleeprider Wrote: Your diagnostic sleep test clearly points to obstructive sleep apnea, but expresses considerable concern for oxygen desaturation due to long duration apnea.  All events with positive air pressure are flagged as central.  I think we are going to try CPAP pressure and see if we can reduce these events.  Turn off ramp as we won't be using high pressure.  In Vauto mode set EPAP min to 5.0, PS to 0.0 and IPAP max to 5.0, or use CPAP mode at a pressure pf 5.0 with no EPR.  This is going to produce a steady, unchanging pressure.  This may help central apnea, however if we don't see improvement, we are going to have to refer you back to your doctor for therapy onset central apnea and consideration for an adaptive servo ventilator (ASV) like the Resmed Aircurve 10 ASV.

(12-20-2021, 11:40 AM)SarcasticDave94 Wrote: The exact reason for your Central Apnea is probably not known. The majority of new PAP users can get a bit of CA that will be labeled by Apnea Board members as treatment emergent. This type CA will diminish in about 3 months of PAP use. This type is most likely especially if CA didn't show on the diagnostic test.

Idiopathic Central Apnea will more likely have them show on the diagnostic test. Other reasons may be high living elevation like Colorado and similar.

A Central Apnea is 10 seconds or longer, is a cessation of breath without effort, is caused by lack of the breath signal because of some imbalances in the level of CO2 in the blood. This CO2 lowered level causes the breath signal to go missing, and might be by PAP flushing out CO2 for some to most. Others like myself, will be CA pre-dominant and must have the ASV.

PS the test and doctor version of Positional Apnea normally refer to body position like back, side, stomach.

Surgeries or non PAP alternate therapy is sometimes successful, but must endure the pain of the procedure. And success rates are quite poor with most still needing PAP afterwards.

If we can't succeed with the "Avoid CA Plan" then best bet is the ResMed AirCurve 10 ASV, a specific bilevel PAP with breath backup rate.

Thank you both for your insights. I tried SleepRider's consistent settings last night. Not seeing much improvement I guess? Perhaps you can tell me. Attached the graphs.

I had a lot of difficulty falling asleep without ramp and with lower inhalation pressure, as I felt it didn't give me quite the air I wanted for a large breath to avoid any mask anxiety. I forgot to mention earlier but I had a septoplasty and biturbinate reduction a few years ago, as I had a deviated septum and was waking up in the night unable to breathe. Anyway I felt I didn't sleep very deeply, but I did feel a bit better this morning than I would have expected to after feeling like I didn't get much deep sleep.

This was my first night where I kept the mask on all night. Pretty sore nostril on one side, I'll have to adjust.

What should I do next? Thank you!


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