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Completely New APAP/CPAP User Advice
#1
Question 
Completely New APAP/CPAP User Advice
Hi all,

New here, and new to the CPAP/APAP scene.  Just recently got my APAP (Philips Respironics DreamStation Auto) on Wednesday of last week.  For small background, the doctor said my AHI was pretty mild (~6 - 6.5) the night of my in-home sleep study, and my pressure range is set to 4.0 - 8.0.  Now obviously, I've only had this a week, and I've yet to have a followup with the doctor, but I was wondering if there's any advice you kind and knowledgeable folks might have for me going into said followup as well as things to try/do on my own time.

In the time I've been using it, I've unfortunately been going through a small phase recently of too little sleep, objectively, so I realize that may interfere with the whole situation.  I'm using the Philips Respironics DreamWear full face mask (small), though I just got a Philips Respironics DreamWear nasal mask to try at some point.  My humidity setting is usually on 3 or 4, I haven't messed with it much really, and I don't have heated tubing.

In the almost-week that I've used the APAP, I do feel better, but not anything drastic, which could be due to the too little sleep issue, as I'm sure it isn't helping (hoping to readjust tonight but the daylight savings time always screws me up).  I realize it's not always immediate or anything like that, but what bothers me more is how much my AHI recording is fluctuating per night, and the fact that last night, it got up to 8.47.

WED: 6.04
THU: 5.17
FRI: 5.24

   

SAT: 4.69

   

SUN: 8.47

   


I don't think I did anything drastically different Sunday than I have any of the other nights, but clearly something was different, and I'm wondering if you guys can clue me in on anything you may see here, as OSCAR is pretty new to me so I'm learning how to interpret the data still.

Thanks in advance for any and all help and advice, this looks like a fantastic community here.  And on the bright side, I do feel at least a little better (hopefully not placebo), plus the girlfriend has mentioned I quit snoring for the most part (still do a little on my back according to her).

OriginSaint,

EDIT: I should probably note that Friday and Saturday have gaps in the usage of the machine. I want to say Friday I woke up and was thirsty and guzzled water and then fell back asleep before putting the mask on, and Saturday I think I used the restroom and forgot to put it back on. Both times I eventually woke up and put the mask back on, but I didn't want to leave those random gaps unexplained!
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#2
RE: Completely New APAP/CPAP User Advice
Welcome to the forum.

You have a lot of flow limitations, RERAs, and hypopneas that your machine does a poor job of treating.  Treatment of these is best treated with pressure support, the difference between inhale and exhale pressure.  A better machine is a BiLevel which can achieve fairly high-pressure differences.

To better reflect what is going on focus on RDI as being the target numbers,  RDI = AHI + RERAs which are about 1,  The presence of RERAs is an indication that your Flow Limits are too high.  RERAs by definition are a series of flow limits that end in arousal.  Needless to say, arousals are disrupting.  These are typically under-reported.

Your Obstructive events tend to be clustered together, this typically indicates that you are tucking your chin to the point that obstructions occur and your AHI increases.  A soft cervical collar typically prevents the chin from tucking, thus decreasing your obstructive events.  See the link in my signature for a more through description.  No amount of pressure will eliminate these obstructions.

I would also set your min pressure to 6 and see where that gets you.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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#3
RE: Completely New APAP/CPAP User Advice
Hi OriginSaint. Welcome to Apnea Board.

Bonjour has given a pretty good summary of what's happening here. In addition to what he covered, your machine is frequently bumping up above the maximum pressure. Some of this is caused by the positional apnea - tucking your chin down to your chest and compromising the airway. No amount of pressure will overcome that so you need to consider a collar or orthopaedic pillow which supports your neck and lets your head fall back just a bit.

At other times, though, the machine is trying to go higher but is limited by the setting. I'd push the maximum up to around 15 - the machine will only go as high as it needs to, and 15 should give it enough working headroom. Increase the minimum to 6 or even a bit higher, and set the flex to 3 (maximum).

If you do make these changes, you'll need to square them away with your doc at the next consultation, so go prepared with the relevant arguments.

A final consideration is that increasing pressure and flex can bring on central apneas, which are difficult to manage. So keep an eye out for those - it can become a balancing act.
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