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[CPAP] Should I continue CPAP?
#1
Should I continue CPAP?
[attachment=26341][attachment=26341]
Hi, everyone.  I'm looking for advice on whether I should continue (resume) CPAP, given that:
  1. My original diagnosis seemed to be mild to moderate.
  2. CPAP has not resulted in any real-world sleep improvement that I can tell.  That is, my AHI looks reasonably good on OSCAR, but I don't sleep longer or wake more refreshed.  If anything the extra headgear seems to make it harder for me to fall asleep sometimes.
Long-story-long, my history:
  • I saw a sleep doc in 2017 for insomnia.  Among other approaches (such as CBI), she wondered about sleep apnea and put me through a sleep study (PSG).  Her main reason for wondering this was apparently my palate shape.
  • The results were 13.1 AHI, 18.8 RDI -- concentrated mostly in REM.  She called this "moderate" apnea, presumably because of the aggregate RDI > 15.  However, I see some sources (including OSCAR) seem to focus more on AHI; by AHI it would be "mild".
  • In the sleep study, she said my sleep duration was fine -- she could not confirm insomnia or tie the apnea events to waking.  Nevertheless, she prescribed CPAP on general principle based on the RDI; I understand there are cardiovascular implications.
  • I posted the results to this forum, bought an Airsense 10 ("for her" but I've yet to use the "for her" feature), and started wearing the AirFit P10.  
  • Due to the insomnia, I frequently fall asleep out of bed or don't manage to hook up the machine, but I used the AirSense as much as I could in 2018.  From OSCAR it seems I succeeded maybe half the nights of that year. 
  • However, I never saw any difference in wakefulness the next day between the CPAP and non-CPAP nights; it was just one more thing to distract me when I was trying to sleep.  So in 2019 I tapered off my usage further, and I find myself using it rarely in 2020.
Anyway, before just tapering off completely, I wanted to give this some more thought.  On the one hand, the PSG is considered the diagnostic "gold standard".  On the other, I'm reluctant to stay on (resume) a fairly obtrusive treatment for the rest of my life without seeing any obvious benefit.

I started wondering if there's a way to use the data from the AirSense to confirm or deny whether I need the AirSense.  So I fired up OSCAR today and started looking through the charts.  The first things I notice:
  • I'm having large leakage a lot of the time, a lot of the nights.  Clearly if I continue CPAP I need to work on that.  Smile
  • Nevertheless, the reported AHI shows as pretty well controlled, < 5 most nights.
  • I have the pressure set to 6-12 and it does occasionally ramp up to 7 or 8, even on rare occasions 9 or 10.
So my questions for you guys:
  • Is there a way I can tell from the AirSense data if I need the AirSense?  Or am I reliant solely on the PSG for that?  (If so, I think I will get a second opinion from a new PSG, or at least a home sleep test for perhaps a different and cheaper perspective.)
  • What other lessons should I be learning from the attached OSCAR Daily Report?  I attached one of the longer and less-leaking nights, in case that data may be more reliable (yes, for me 5 hours represents one of the longer nights).  
Many thanks!


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#2
RE: Should I continue CPAP?
apnea doesn't go away with cpap use. It's still there. when you don't use cpap you're stopping breathing 13 times an hour. don't overthink things. get the cpap out and use it every night. people that quit usually show up at a later date wishing they wouldn't have quit.
First Diagnosed July 1990

MSgt (E-7) USAF (Medic)
Retired 1968-1990
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#3
RE: Should I continue CPAP?
If you're napping (regardless of WHY you're napping) without using your machine, you are doing yourself a disservice.  Over time, it might add up.  It's certainly not improving your disposition toward the machine.  It could explain why you think your return on investment is poor.

I wish I had an answer to add even 45 minutes to your nightly sleep duration.  I don't.  I am a good sleeper, but like you, I am almost always up prior to the 6 hour mark.  That is, I do sleep well, with several dreams, and don't have to rise to void at all (and I'm a whopping 68 already!).  It's just that I can't seem to get a full six hours.  You're worse off, and I sincerely wish I could offer you something.

Do you walk, cycle, skate, paddle at least 30 minutes at least four times each week?  If not, you need more exercise.  It helps to bust stress response hormones and it helps immensely with brain health.  Going without sleep means rising cortisol, and that brings on a host of problems, not the least of which is weight gain.

You may have other habits you know are not helping you, but which you are loath to give up.  Or, you aren't aware that some habits severely hamper sleep onset.

Have you tried a sleep coach?
Serial Tapist
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#4
RE: Should I continue CPAP?
As greatunclebill posted, apnea is not cured by CPAP use. It's a treatment not a cure. To answer one of your questions, however, you can use your CPAP and Oscar data to determine how much benefit your getting. Simply set the pressure at a constant of 5 and see if your AHI increases. I suspect it will. Most of your events are hypopnea and the pressure increases appear to correlate with slight increases in flow limitations, both of which could be reduced and possibly eliminated by the use of EPR. I suggest you maintain your present pressure settings and turn on EPR at a setting of 2. EPR should improve comfort and minimize the pressure increases that are probably disturbing your sleep.
Download OSCAR

Organize Charts
Attaching Charts

Mask Primer
Soft Cervical Collar

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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#5
RE: Should I continue CPAP?
OK, if we were to say you had the 13 events an hour mentioned above and if these were evenly spaced over that hour, you're having an event every 4.6 minutes. Yes that's without the PAP therapy. Therapy is a way to minimize the negative effects of apnea, and is not a cure. Your choice to continue or quit, but the potential is pretty high your apnea will get worse in the future without the PAP therapy.
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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#6
RE: Should I continue CPAP?
I question my own need for CPAP (other than I now have to use it to stay compliant with my professional driving licence endorsements).

I've found that CPAP actually disrupts my sleep, and I wake feeling more refreshed when I don't use it due to not having woken multiple times in the night.. my quality of sleep seems better without CPAP.

BUT.. the longer term effects on health from not using it also come in to play, apnoea can have quite a detrimental impact on our physical and mental well-being. 

So I'd think the general consensus would be to keep using it, and look for other ways to improve your quality of sleep with things such as changed sleep hours / dietary adjustments to both food types and meal times.. and other such things (as I am trying to do) 

Sleep-well
- They are not spelling/grammar errors.. I live in Australia, we do it differently Down Under  Big Grin -
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#7
RE: Should I continue CPAP?
(09-07-2020, 11:13 PM)mesenteria Wrote: Do you walk, cycle, skate, paddle at least 30 minutes at least four times each week? 
...
Have you tried a sleep coach?

Yes, the doctor coached me on cognitive behavioral therapy (CBT) for sleep for a number of months before we tried the sleep study.  I've read several good books on the topic as well.  

Yes, I exercise outside when possible (good for the circadian rhythm), inside when necessary.  I manage to run, hike, or cycle about four times/week.

That actually relates to the question of whether I should get a second sleep study. When the doc and I scheduled the first one to evaluate apnea, I was afraid I wouldn't be able to sleep in a strange place with wires.  She said exercise, but I may have overdone it by jogging for hours on the day of the test, definitely longer than I usually find time for.  Result:  5 hrs 12 minutes of sleep, which she says is within normal range.  Diagnosis: apnea but no insomnia.  If I'd known we were evaluating the insomnia too instead of just looking for apnea, I would have exercised a more normal amount and perhaps slept less.

(09-07-2020, 10:27 PM)greatunclebill Wrote: you're stopping breathing 13 times an hour.

True.  But presumably we need a threshold somewhere of what's worth treating.  We wouldn't put someone on CPAP who stopped breathing 2 times an hour, I think?

Historically doctors have commonly used AHI = 5 and AHI = 15 as thresholds, with or without RERAs (RDI).  There's also some question whether REM events should be treated the same as others; my AHI was much higher in REM than non-REM.

I take it most on this board would treat any AHI >= 5, or something like that, without a REM exception?

It does seem to me that recent diagnostic practice may be trending that direction.  The American Academy of Sleep Medicine newly, I think, includes RERAs in their number and recommends "offering" treatment for RDI > 15, or > 5 with other symptoms.  Arguably my borderline, undiagnosed insomnia and light snoring are "other symptoms".  So it may be that I am now more firmly in the target group for CPAP than I was two years ago and should revisit this.

It does seem like if I resume CPAP I need to keep it on through the early morning hours when REM is prevalent.  That can be hard for me, because if I'm up in those hours I have a very difficult time getting back to sleep, and CPAP is just one more thing to deal with.

(09-08-2020, 12:03 AM)Melman Wrote: you can use your CPAP and Oscar data to determine how much benefit your getting. Simply set the pressure at a constant of 5 and see if your AHI increases. I suspect it will. Most of your events are hypopnea and the pressure increases appear to correlate with slight increases in flow limitations, both of which could be reduced and possibly eliminated by the use of EPR. I suggest you maintain your present pressure settings and turn on EPR at a setting of 2. EPR should improve comfort and minimize the pressure increases that are probably disturbing your sleep.


Great, thank you for the tips.   Sounds like the "constant 5 experiment" (or 4 even, if not too constrictive) will be the best way to get OSCAR's input on what kind of benefit I'm getting--will give it a shot.

Many thanks, everyone, for your replies.
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#8
RE: Should I continue CPAP?
4 may be too restrictive. Whatever you try please post the OSCAR data.
Download OSCAR

Organize Charts
Attaching Charts

Mask Primer
Soft Cervical Collar

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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#9
RE: Should I continue CPAP?
(09-09-2020, 06:30 PM)Melman Wrote: 4 may be too restrictive. Whatever you try please post the OSCAR data.

Do you mean too restrictive for comfort or for therapy (in the sense of reducing AHI)?

I attach a night that should be the constant 5 pressure, EPR 2, that you suggested.  (The Pressure chart shows Pressure 5.00 / EPAP 4.00.  The "Machine Settings" seem to disagree--they list Pressure Max as 4.00--but I'm thinking the explanation may be that I changed the settings later in the day, after waking.)

This night has a few extra CAs vs. my previous post that used pressure 6 / 12.  But it's hard to know if that's significant without averaging over more nights.  If I continue to see extra CAs, would those be due to the reduced pressure or the EPR?

I'm also not sure what to conclude from the fact that even at Pressure 5, EPAP 4, my AHI here is significantly better than the sleep-study AHI of 13.1 (non-REM 7.6):
  1. Pressure 5 is enough to treat most of my events?
  2. Or the sleep study was an anomaly--a bad night--and my typical AHI is low enough to not really need treatment?
  3. Or the sleep study and the AirSense, using different sensors and measurement techniques, are counting events differently?
So I'm still perplexed whether it's possible to learn from the AirSense whether I need the AirSense?

Thanks again!


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#10
RE: Should I continue CPAP?
(09-12-2020, 08:54 PM)North Star Wrote: . . .
So I'm still perplexed whether it's possible to learn from the AirSense whether I need the AirSense?

Thanks again!

Technically, no.  Even fixed pressure of 4 may be enough to treat some events.  If you're still perplexed, see about a Home Sleep Test.  May be a better option than an in-lab study in the midst of Covid.

Also, you wouldn't be the 1st to say they can't feel any difference.  Even my brother-in-law, a PHD Physicist, was prescribed a Bipap, and doesn't use it for the same reason.  I would say to him or anyone:  They invented EKG tests because people can't feel what's going on in their cardiac systems.  Ditto for any number of other body systems that can be/are impacted by Sleep Apnea.

CPAP therapy is only a treatment, not a cure.
A.Becker
PAPing in NE Ohio, with a pack of Cairn terriers
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