First Night on Therapy -- CA worries

[minutia101]

So...Andy, how is the facemask working in connection with your leaks, and apnea since your using a facemask?

[tedburnsIII]

I believe that things will work out for this OP. Otherwise, he may need to go ASV, whatever. In any event, I am surprised that as a newbie he is able to sustain sleep on the machine for such relatively long periods of time.

How does OP feel the next day? Does OP feel like he has had a good night's rest?

I think it's important that he gets his AHI down to <1.0, eventually. He may also be experiencing a sleep debt.

If his optimal pressure is 11, perhaps he should increase his minimum APAP pressure to no less than 9 or 10 if he sleeps on his side.

Agree that Andy should reduce EPR to '1', or '0' if he can handle it.

[AndyB]

Here's an update, after 14 nights of therapy:

I've left pressure at 7-11 for the last 13 nights, but turned off all EPR starting 6/20.

I've tried multiple masks: the nasal masks rubbed the bridge of my nose raw, even trying to keep them relatively loose. The full face mask was cumbersome and no more effective than the nasal masks. The pillows mask is comfortable and easy to use. I am not a mouth breather, but when asleep my mouth will occasionally fall slightly open, so one night (6/18) I tried a mouthguard (ugh) and for the last 5 nights (6/21 to 6/25) I've used surgical tape to hold my lips together (not a great long-term solution).

My AHI numbers are better than my sleep study results (AHI 41, all OSAs and Hypopneas), but it's clear my body and brain are still wrestling with this new experience, as my AHI numbers are mostly over 5, and more than a few are in the 8-10 range. I now have almost no OSAs, relatively few Hyponeas, but numerous CAs.

Link to my SleepyHead stats: http://screencast.com/t/i58p99PCN

I'm pondering whether to fiddle with the pressure, perhaps increasing the range from 7-11 to 7.6-11.6 (my APAP changes pressure settings in .2cmH2) increments). The alternative is to leave pressure alone for a while longer, and give my body and brain some more time to adjust to this new adventure in sleeping.

The good news is I don't snore anymore, and I feel better when I wake up and during the day (never felt awful, but was often a little tired).

Thanks again everyone for your support and great information.

Andy

[AlanE]

Hard to see in the overview when you are getting your events. Can you post a Daily? What I can see is that you are bumping up against your max pressure setting. If it were me, I would bump the max up to 15. Since it is in APAP it will only go that high if it needs it and adjust it lower later if necessary.

[AndyB]

Here are screenshots of a couple of different time periods from last night -- the first is approximately 60-90 min into the evening, and the second is the last 30 min of sleep in the morning, when I woke on and off before turning the APAP off.

http://screencast.com/t/a8zJt6UZ0

http://screencast.com/t/0TFvC6RO

And, lastly, here's a shot of the entire night:

http://screencast.com/t/KIWsCzYxfkk

[Sleeprider]

Andy, your results suggest mild complex apnea that is most likely caused by your CPAP pressure. Increasing pressure would likely increase events, and decreasing pressure could allow more OA and H events. It is borderlike whether you might be a candidate for ASV therapy which would initiate a breath when you don't. About 15% of apnea patients develop CPAP induced complex apnea.

This is really a discussion you need to have with your doctor. Read this article for some background. http://www.hindawi.com/journals/sd/2014/798487/

I hope this helps. Lots of other resources are out there to explain this condition, but your next step needs to be a discussion with your professional.

[AndyB]

Sleeprider,

That makes sense. I think I will stick with my current settings and see what things look like in 3 more weeks, when I have a follow-up with my primary care physician. By then I should have a meaningful amount of data, which I can share with him via SleepyHead reports.

And thanks for the link to the article -- much appreciated!

Thank you

[Sleeprider]

I think the last paragraph of section 5.1 of that article may point to your best interim approach:

"When none of the previously discussed PAP therapies or respiratory assist devices are well tolerated, using lower pressures by allowing some obstruction to persist (permissive flow limitation) may be successful in some patients [11]"

Basically, reducing pressure to the threshold of OA, may reduce CA. You appear to meet the criteria for ASV treatment with an AHI over 5.0 consisting of predominately CA events. Good luck!

[AndyB]

Yes, i just read the article and noted that -- very interesting! It appears that increasing my current pressure settings could prove counter-productive.

I have much to think about, and to discuss with my doctor.

Thanks again for this very informative information.

[tedburnsIII]

Sleeprider,

That makes sense. I think I will stick with my current settings and see what things look like in 3 more weeks, when I have a follow-up with my primary care physician. By then I should have a meaningful amount of data, which I can share with him via SleepyHead reports.

And thanks for the link to the article -- much appreciated!

Thank you

Unless your PCP is board-certified in sleep medicine or has some kind of specialized knowledge, I would not place all the much credibility on what he has to say. This is not a simple case scenario- it may be beyond his level of expertise.