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[CPAP] New and need some help lowering AHI
#1
Question 
So I'm brand new to CPAP therapy and I've had a rough go if it so far. I've only been at it about a month, but I've struggled a lot getting used to the equipment and have high AHI. 11.0 Untreated and range from 5-10 treated (so far). I've read lots of great information on this website and figured I'd give it a shot.

I started out with the DreamWear nasal only mask. This was quite comfortable, but since I have congestion issues it made it quite hard to breathe without opening my mouth. After a couple weeks using chin straps and tape etc my doctor switched me to the Amara View. I JUST got this mask, but the first night with it gave me the highest AHI yet. I feel like the seal was really good so I'm not sure what to do next. Need a little help.

I downloaded sleepyhead, but I'm not sure what I'm looking at with this data. I've attached some data so I might get some assistance.

Thanks in advance!
CaseyF
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Disclaimer: 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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#2
G'day caseyfontneau, and welcome to Apnea Board.

Look here to see how to manage and post your SleepyHead charts to gain most benefit: https://sleep.tnet.com/resources/sleepyhead/shorganize

Looking at your summary statistics I can see immediately that obstructive sleep apnea is either not a problem or is well treated. On the other hand, the great majority of your apneas are "clear airway" or central sleep apnea (CSA). This is a totally different condition from obstructive apnea and occurs when the "breathe now" signal from the brain to the lungs is interrupted. It can be an adverse outcome of CPAP therapy pressure, or brought on by certain medications such as opioid painkillers. In a lot of cases, however, it is endogenous. So the very first thing you need to do is examine your sleep study report to determine if you were experiencing CSA before going onto therapy. Look at the respective numbers for central apnea index (CAI), obstructive apnea index (OAI), hypopnea index (HI) and apnea/hypopnea index (AHI).

If you already has CSA before going on therapy then an autoset machine won't do you a lot of good. You may need an ASV, which is expensive. Because it is expensive, the insurance company will make you jump through hoops (including trialling a progression of more sophisticated machines) before approving an ASV. The good news is that ASV machines are spectacularly successful. The other good news is that if this CSA is not endogenous but is caused by CPAP pressure, it will likely go away after a while.

So let's look at the sleep test results and determine how much of a problem the CSA really is.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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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#3
Thanks for getting back so quickly! I've followed the instructions and attached the additional screenshot. (wow 200KB is a tough number to get to and still have legible data) Let me know what you think Big Grin


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#4
Hi caseyfontneau. Welcome to the Apnea Board. DeepBreathing makes some good points about the prevalence of CAs in your report. It is important to know as DB says whether or not you had a lot of CAs during your sleep study. The machine can induce CAs and so can your brain as you transition between wakefulness and sleep. You may see improvement as you get used to your new mask. You had significant periods without any CAs which leads me to believe that your CAs were occurring during periods of restless sleep. Keep us posted.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#5
Hey sorry about taking down the previous screenshot. I thought I had to in order to post the newest screenshot with the graphs. I had to resize and compress it in photoshop to get it under the 200KB limit, but it's up in a reply to DeepBreathing if you want to take a look. I wasn't able to see any pattern with my untrained eye, but maybe y'all can.

Thanks again for all the help! I'll get my 4 posts in asap Big Grin
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#6
Hi caseyfontneau,
WELCOME! to the forum.!
Hang in there for more assistance with interpreting your graphs.
Good luck to you with your CPAP therapy.
trish6hundred
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#7
Hey Trish! Thanks! Yea I'm pretty excited about getting a good nights sleep. Everyone here has been so great.
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#8
You just had an appointment with your doctor. Was his only concern the leak rate? It appears that putting you on CPAP pressure has replaced your obstructive sleep apnea with central or complex sleep apnea. This happens in up to 15% of patients, and CPAP just doesn't work. On the other hand, in a few people, the CA events begin to diminish and go away on their own.

If you have a means of communicating with your doctor, it would be good to let him know you have been observing your machine data and have a large number of central apnea events, such that you are not improved from before starting therapy.

Usually your first encounter discusses your use (compliance) of the machine, and how you feel. I assume you told him you weren't feeling too good, and that he didn't look at any of your results and just assumed that any problems were related to leaks. Your leaks need to be addressed, but if this AHI does not improve, you will need to discuss the next step with your doctor. It is clear you did not have a titration study to determine your therapy pressure. A titration study is likely in your future, and you will need to push to have that evaluation include bilevel and ASV. A simple CPAP titration will be of no value.

Hope you have good insurance.
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#9
Hi caseyfontneau,
Welcome to Apnea Board!

The next time you want to post data, it is easier to use a site like imgur.
https://sleep.tnet.com/reference/tips/imgur

You do have mostly clear airway events, and as DeepBreathing stated, you may need to be on a different machine. Try to get a hold of your sleep study results to see what your AHI was and if you had mostly clear airway events.

Hopefully, this will settle down in time.
Sleep-well
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

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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#10
Hey there! Yea I want to say it WAS obstructive sleep apnea at a rate of 11 events per hour, but I'll have to double check. It was a weird machine nothing like I've heard of. Chest strap device with a finger monitor and little oxygen tube in my nose that hooks behind your ears like at a hospital.

The amara view is new for me so I'm making adjustments accordingly to see about getting the leaks down. Does facial hair really make that much of a difference? Also I'm wondering if some of the leak spikes are from when I lift my mask to scratch an itch? Lol

Good tip on imgur I'll keep that in mind for the future.
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