First Steps Toward Better Health: Report Eval?

[MickTravis]

Hi ApneaBoard,

What a great resource this is!

I have recently been diagnosed with SA after taking an at-home sleep test. Both my girlfriend and I noticed me waking up gasping every so often, and I've been struggling with mild hypertension and GERD for years now with no known cause. I am otherwise healthy at 6'1" tall, 170 lbs., and a regular cardio and weights workout regimen. I only wish I had gotten tested sooner. In retrospect, I'm a bit shocked none of my healthcare providers ever suggested a sleep test, but it is what it is...

The sleep test registered upper-end mild/borderline moderate apnea with an AHI just shy of 15. I feel like it might be higher than that, but the night I took the sleep test I started coming down with a GI bug, so sleep was fitful and did not come easily. 

Now, I'm using a Philips Dreamstation with the DreamWare FFM. I tried the nasal pillows but my mouth would open and I'd lose the pressure. I like the FFM, so I don't feel the need to experiment with chin straps, tape, etc.

I've only been using the machine for four nights, and I've had moderate success after the first, terrible night.    My AHI has been hovering around 5, which from what I gather, isn't exactly a stellar goal. Saturday night got me 4.9, but last night, despite hope for progress, I was back at 6.15. I have included a screenshot from OSCAR for your consideration.

Apart from trying to not sleep on my back (it's a problem for me), do you think pressure adjustments would be recommended? I see that the current min setting of 5 isn't doing too much for me. Is it time for me to try something higher? I seem to tolerate the pressure alright now.

Thanks!

   

[Crimson Nape]

Hi MickTravis -

Seeing that your starting pressure is 5cm ,as well as, seeing some hypopneas usually indicates a need to increase the starting pressure. This low pressure also makes me wonder if you don't feel starved for air.  Most users feel better at a starting pressure of around 7cm H₂O or higher.  Overall, it looks like you're off to a good start.  I feel most user's AHI will reduce as their body adapts to a new sleeping environment.  

Keep up the positive attitude!

[Dormeo]

If you like your mask, you’re way ahead of most people!  It’ll be interesting to see what happens if you raise your minimum to 7. Keep us posted, would you?

[Gideon]

Welcome to the forum.  
Here is what I see, significant Hypopnea and a minimal obstructive Apnea
enough Central that I would watch, but do nothing about at this time.
Significant Flow Limitation and RERA.  RERA is defined as a series of Flow Limitations ending in arousal, and we don't like Arousals.

Event Definition Apnea, Hypopnea, Flow Limitation

• Apnea: 80% to 100% reduction in airflow for >= 10 seconds
  
• Hypopnea: 50% to 80% reduction in airflow for >= 10 seconds
  
• Flow Limitation: <50% reduction in airflow for >= 10 seconds
  

That shows the relative severity of events.
Hypopneas, Flow Limits and RERAs by their association with Flow Limits are best treated with Pressure Support, the difference between inhale and exhale pressures, but you are near the limit for that on your machine.  So we are going to change 2 settings,  Set your Flex to 2 (looks like it is set to 1) and increase your minimum to 7.  This will slightly increase the pressure support (the difference between inhale and exhale pressure) and also increase your Exhale Pressure a little.  Note: the exhale pressure, is the pressure that treats obstructive events, including hypopnea, Flow Limitations, and RERAs, Note: on a basic CPAP exhale pressure = inhale pressure and is just called pressure.

So set Flex to 2 and Min Pressure to 7

[MickTravis]

@Crimson Nape, @bonjour, @Dormeo,

Thank you all for your kind and thoughtful replies!

I have done as suggested and raised the minimum pressure to 7. I will try that tonight and post the results.

Bonjour, the machine is currently set to FLEX 2. Would you suggest leaving it there or trying another setting?

Thank you.

[Gideon]

@Crimson Nape, @bonjour, @Dormeo,

Thank you all for your kind and thoughtful replies!

I have done as suggested and raised the minimum pressure to 7. I will try that tonight and post the results.

Bonjour, the machine is currently set to FLEX 2. Would you suggest leaving it there or trying another setting?

Thank you.

Leave it there.  As an only change you can try Flex at 3 but we do not typically see good results with Flex = 3, but you certainly you could be an exception.  Theoretically, Flex 3 should help, but we don't typically see it helping, thus the only change if you want to try it.

[MickTravis]

Thanks, Bonjour. In adherence to the scientific method, I'll modify one thing at a time and keep flex at 2. 

[matsarge]

MickTravis - welcome. Like you, I'm new to this, but I see very similar things on your report when compared to mine. I'm using the DreamStation Auto as well, and I see a bunch of events at the beginning when the machine is adjusting to the higher pressure that's needed. Based on Bonjour's feedback, I raised mine from 6 to 7 and we'll see how to goes tonight. My 95% pressure over the last 45 days is 9, with an average pressure of 7, and my AHI is around 4.5. I won't be surprised if I have to raise my min. pressure to 8 or 9 over the course of time.

[MickTravis]

Thanks, matsarge! I think some of the events at the beginning are me trying to get to sleep with the mask on. When I got the device, I tried it out for about 20 minutes while working at my computer to try to get used to it. Even though I didn't fall asleep, it registered lots of events. I'd imagine that as we get used to sleeping with our CPAPs, the events more represent actual sleep-related events and not CPAP adjustment-related events.

Let us know how you get on.

[MickTravis]

Well, I tried setting the minimum pressure to 7, but it resulted in a pretty bad night sleep-wise and the worst AHI yet. I think maybe the increase in pressure was maybe a little too much for one night. Perhaps I'll scale it back to 6 for tonight and address the mask leaking. I think the increased leaks were waking me up and making the whole thing worse.