[CPAP] New user, looking for tuning advice

[wkf94025]

Sleep study at home 1.5 years ago said I have mild apnea.  Summary results posted below.  2/3's apneas, 1/3 hypopneas.  2-night AHI around 10.  O2 sat never below 90%, which I assume is a good result?  Snoring 89% of the time kind of surprised me, though I have been a lifelong on-and-off snorer, I am told.  

So I finally got a ResMed AirSense 10, and have used it for about a week.  I discovered SleepyHead last night, and have rapidly spun up on the data, its interpretation, etc.  I also ordered a pulse oximeter that arrives soon.  I am hoping to be able to integrates its data alongside the CPAP data.

I have posted four graphs below (or in subsequent post, due to limit on # of attachments)

• full spectrum of worst night so far (AHI=9.9)
  
• zoomed in on a typical event from that night
  
• full spectrum graph of best night so far (AHI=1.6; awake and disconnected for one hour at 3:30am)
  
• zoomed in on a typical event from that night
  

I have also posted the summary stats from SleepyHead for the 7 nights I have used the machine thus far.

With machine currently set to 4cm-20cm range, EPR=3cm, and ramp enabled, I am mostly experiencing central events.  Few OSA's.
I am not yet to the point where I am sleeping much more than 3 to 3.5 hours with mask on, but I am patient and hoping that I will grow into the system as time marches on.  On equipment, I arbitrarily chose the N20 nose mask, but am about to try the nose pillows during my provider's 30 day trial period.  I might also try the full face mask.  I very much believe in experimenting with gear and settings to find optimal setup.  To that end, my primary questions are whether my pressure parameters are good, and how one can judge that from existing data, or trends in the results as I would tweak the settings.  At times my instinct is to take the entire pressure range lower, and see how it feels and how it works at lower pressure ranges.  Only a few times have I felt the urge to pull the mask off.

Prior to the CPAP, my sleep wasn't great, with key points as follows:

• Typical night is ~5 hours, sometimes as little as 4, rarely more than 6.5
  
• I can nap anywhere, anytime, and enjoy a good nap, but with few nighttime hours, a nap is often necessary
  
• I have occasionally used Ambien, though very rarely, and typically only a 2mg sliver.  I prefer to avoid meds altogether.
  
• Fit, swim a mile daily, low resting pulse, healthy diet, and for the past 7 months, zero alcohol.
  

My hope for CPAP was improved quantity and quality of sleep.  Though it's early days in terms of getting used to the mask, hose, etc, I'm not encouraged that quantity of sleep is going to materially improve.  If so, I will happily take improved quality, and simply nap as needed if I continue to get < 5 hours often.

Tuning suggestions very welcome here.  I've only been reading this forum a few hours, but love the science behind all this, and appreciate the support of the experts here that assist noobs like me.

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[wkf94025]

Stats from 7 day summary by SleepyHead:

Average Hours per Night    3:51
AHI                                  3.86
Obstructive Index              0.26
Hypopnea Index                0.30
Clear Airway Index             3.30
Average Leak Rate             4.17
95% Leak Rate                  18.00
Average Pressure               5.55
95% Pressure                    7.08

[JoeyWallaby]

You mean OSCAR? SleepyHead is deprecated.

First thing, raise your minimum pressure. I suggest 6.

[DeepBreathing]

G'day wkf94025. Welcome to Apnea Board.

It would help if you could post your Oscar / SleepyHead charts showing the full left sidebar details, not the events list. Please see the directions here: http://www.apneaboard.com/wiki/index.php...ganization

I agree with Joey that a minimum pressure of 4 is too low for most people, and a feeling of air starvation can occur. Setting you minimum pressure to 6 or 7 is likely to be more comfortable.

However the central apneas are potentially an issue. Your sleep test doesn't discriminate between central and obstructive apnea, which is a serious shortcoming. We don't know whether the centrals were pre-existing or treatment-emergent. For the moment we'll take a conservative approach and regard them as treatment-emergent. This type is often sensitive to EPR, so I suggest you turn EPR off and raise your minimum pressure to 6. No need to change the maximum pressure as the machine isn't going anywhere near the maximum.

Please post a daily chart (all night) showing the left side bar as discussed above, and also one after you have changed pressure and turned off EPR.

I discovered SleepyHead last night

SleepyHead has been superseded by Oscar, though both programs are very similar in appearance and operation. May I ask where you discovered SleepyHead - I was under the impression most sites now link to Oscar.

[jaswilliams]

Do you think you were awake between 00:10 and 00:30 those ca's could be drifting in and out of sleep. I agree with the raised of minimum pressure to 8 4 is way too low. Your machine won't do anything about CA's so let's just monitor for now. On your next graphs leave the left pane showing the statistics not the event list as there us valuable information there. Follow the graph posting guide in my signature.

[wkf94025]

Thank you all for rapid replies.  I will raise the minimum, and disable EPR.  I just woke up after ~5 hours, and will try to attach last night's summary graphs and details from original sleep study, first night.  [I just realized I need to delete original attachments to attach new ones.  Hmmm....]

In the original sleep study details, of 59 events, 37 were classified OA's, and 20 as Hypopneas, with 2 unclassified.  I *think* that means zero CA's before CPAP, but welcome the interpretation of experts here.  

In last night's sleep, I was awake and restless for a good 20+ minutes, and I am guessing that was at ~1am.  Summary graph attached, with details on left panel.  

I haven't yet clicked on the link as to how to graph better summaries, and in fact am going to try to go back to sleep now.  Thanks all for quick input.   I will try OSCAR when I am more awake.

Original Sleep Study, Night #1 details:

   

Last night's summary from SleepyHead:

   

EDIT:  last night was more leaky than typical for my first 7 nights.  Overall I believe my mask fit and adaptation to the new gear is going okay, though I will be picking up nose pillows to try that setup as well.  Any observations about the possible causes of the leak data would be appreciated, though I am not terribly concerned about those, unless they become a pattern.

[JoeyWallaby]

You can upload images to an image-hosting website (I use imgur) and embed them instead of attaching them, if you'd like. In your next post, please upload a few close-ups of your flow-rate and the events you're suffering (in addition to usual summary view).

[wkf94025]

Thanks Joey. Will do on both fronts later today.

[Gideon]

Welcome to AB

Seeing your charts I have the following, slightly different from Dave's
Your centrals are not really bad, thus I suggest EPR=1 to keep some pressure relief in there if we can and nim pressure of 6 or 7. I may even choose to drop EPR to zero after seeing results.

[DeepBreathing]

wkf94025, once you have a few more posts under your belt the allowed number of attachments will increase and you won't need to delete old images. However if you are comfortable using a service like Imgur that's fine too.

The sleep study clearly shows that your apneas were obstructive, and therefore the centrals that are now showing up are treatment-emergent. That's good, as there are some fairly simple techniques to address these, starting with careful adjustment of your pressure and EPR.

Fred, perhaps you didn't see the original (now deleted) attachment, but the central index was much higher - thus confirming your saying that central apnea is consistently inconsistent. By the way, who's Dave?