CPAP Progress Impasse

[MickTravis]

Hi Everyone,

I've made good progress since I started using my CPAP at the beginning of May (thanks to this board!), but my progress seems to have hit a wall. My AHI on average is around 1.2, sometimes more, sometimes less. I know that's not too bad, but I feel like it could be better.

Below is a screenshot of my last night's sleep. I don't often have all of those green areas (RERAs, I believe), but I do every so often. OAs seem to be about 10 a night, never really any more than you see here, but often fewer. A handful of hypopneas, almost always. 

Does anyone have any input on what I might change? Perhaps a close-up on some of the trouble areas? Any insight would be greatly appreciated.

Thank you.

   

[Dormeo]

The two green areas in the top event row are brief stretches of periodic breathing. You might zoom in on one of them so the experts can take a look.

I’ve gathered from a lot of reading on the forum that for many people, centrals tend to go away on their own as your body adjusts to PAP therapy. So without making any changes, you may well see those starting to go away as time goes by.

With your numbers looking as good as they do, the question in my mind is how you feel, both during the night and during the day. At night, do you feel as though you wake up a lot? If so, what seems to cause the wake-ups? During the day, are you seeing positive changes in mood, sleepiness, cognition, headaches, or memory?

[MickTravis]

Thanks for your response, Dormeo. I've attached a few more screenshots as well as a FitBit sleep tracker screenshot. I know the Fitbit isn't very scientific, but perhaps it helps tell a more complete story.

I do wake up a few times at night, but I couldn't tell you why. Before therapy, I sometimes woke gasping, but thankfully that doesn't happen anymore. My FitBit usually tells me that on an average night, I'm awake for about an hour, give or take. Again, I know that's not scientific, but it might be useful for someone who knows how FitBit works in that regard. I can't say that the CPAP is particularly comfortable to wear, and it still increases my sleep onset time, but I am dedicated to using it every night. I'm sure increased comfort will come in time.

I definitely feel better during the day than before the CPAP. Do I feel 100%? It's hard to say! Some part of me feels like I could feel a bit better: more refreshed in the mornings, more energetic, etc. Perhaps that's unrealistic, or perhaps that will come with time. I do try to live a healthy life, so there's not a whole lot more I can personally change.

                     

[Marillion]

Hi Everyone,

I've made good progress since I started using my CPAP at the beginning of May (thanks to this board!), but my progress seems to have hit a wall. My AHI on average is around 1.2, sometimes more, sometimes less. I know that's not too bad, but I feel like it could be better.

Below is a screenshot of my last night's sleep. I don't often have all of those green areas (RERAs, I believe), but I do every so often. OAs seem to be about 10 a night, never really any more than you see here, but often fewer. A handful of hypopneas, almost always. 

Does anyone have any input on what I might change? Perhaps a close-up on some of the trouble areas? Any insight would be greatly appreciated.

Thank you.

Hi there.  Those are not bad results at all!  But I can understand that you might want to tweak things a little.  How long have you been using these exact settings?  I am just trying to ascertain if your body has gotten used to what you have the machine currently set to.

The only other thing I would mention is that speaking for myself...  Whenever I used a pressure support setting my CA and Hypopnea events would always increase to a relatively small extent.  Eventually I ended up turning off pressure support, which helped reduce my Hypopnea and CA events.  You might want to try that also.  But leave any changed settings in effect for a few days to let your body get used to it before making any final decisions.

[MickTravis]

Thanks for responding! 

I've been at min 9 for about a week. I had tried min 10.5 earlier, but I had a hard time getting to sleep. I've kind of gone back to using the ramp feature, which I had discontinued for a bit in an attempt to wean myself off of it. I then realized that was silly! The ramp doesn't seem to affect my sleep negatively.

I remember reducing or even eliminating the FLEX mode for a night, but I felt like I was suffocating. Perhaps I'll try it again, but change the settings. Unfortunately, it doesn't look like OSCAR tracks changes to FLEX, so I'm not sure when that was or what pressure settings I had at the time.

Below is an overall map of therapy effectiveness since I started the CPAP.

   

[Marillion]

I see the improvements you have made to your therapy since you started. Congrats to you! That's awesome.

You might want to wait for some of the more experienced members (like Sleeprider and bonjour) to come in here. I will always defer to their expertise and experience. Especially since I personally use a Resmed Airsense 10, not a Phillips Dreamstation like you do.

But my own personal recommendation would be to either drop the pressure support (maybe try that first for a few days) OR (don't do both at the same time, so that we can see what change had the most effect) decrease your starting pressure to 8.5. I would also decrease your Max to 15. There is really no need to keep it at 20 since you are not even coming close to your max setting. Perhaps a tighter range may help the machine algorithm respond better to your pressure needs, when you need it. Phillips machines can be a bit slower to respond than the Resmed machines so I think having a tighter range may help you. Certainly couldn't hurt.

Understand though that these are very small tweaks that may or may not change anything. Your results are already quite good and ultimately the real decision of where your settings should stay at should not be how ultimately low your AHI is, but instead how you feel during the day. I've seen some try so hard to get an AHI of 0 only to realize that they felt worse than before with a slightly higher AHI result! Not saying you shouldn't try these tweaks. But always keep in mind how you feel as being the prime indicator.

[SarcasticDave94]

Admittedly the numbers aren’t bad. I’d like you to answer the question “how do you feel?”. I’m not saying there aren’t areas that can or cannot improve, but if you’re receiving proper treatment indicated by feeling better than before treatment, maybe there’s nothing needed except to keep doing what you already are doing.

Regardless best wishes on success.

[Sleeprider]

There is nothing obvious I can suggest, and think your settings are pretty close to idea. There is not much pressure variation during the night, and most events are nothing more than CA from sleep transition, disruption, or movement. I consider this very good treatment, and question whether chasing AHI numbers is worthwhile. If these were my charts (and they are similar), I'd shrug my shoulders, conclude no problem, and move on.

[Dormeo]

MickTravis, I would say you’ve had a definitive answer from Sleeprider about your settings. (And to my eye, the periodic breathing interval is just fine.)

Given that you are indeed feeling better during the day, I would say just keep on keepin’ on. As time goes by, you will very likely feel more relaxed at night, as you get used to the therapy, and that in turn may well allow you to get a fuller share of deep sleep and REM sleep, with fewer wake-ups messing with your sleep architecture.

[MickTravis]

Marillion, SarcasticDave, Dormeo, and Sleeprider, 

Thanks to you all for your recommendations and support. I may try reducing flex from 2 to 1, but as you all say, it looks pretty good and I'm feeling better, so I'll probably just ride it out from here.

Thanks again.

-MT