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New CPAP User - AHI Unchanged from Prior to Treatment
#1
New CPAP User - AHI Unchanged from Prior to Treatment
Hello all,

I began CPAP treatment for sleep apnea earlier this year, instigated by some TMJ issues that at least partially stem from nighttime bruxism. I took a sleep study in 2016 or so and was diagnosed with sleep apnea (AHI in the low 30s) but did not start treatment at the time. As a result of my TMJ flare-up I took another sleep study earlier this year and was again diagnosed with minor apnea (AHI around 6) - in the intervening period I had lost about 20 lbs. Even though my apnea was more minor the doctor recommended CPAP treatment and I was on board in the hopes that this would help address the bruxism along with some minor lingering daytime tiredness and lack of focus at work. 

I was nervous about using the machine (my dad really struggles with his) but found that the first full-face mask seemed to fit well. I struggled to keep the mask on all night for the first week or so but generally took to it pretty quickly. I've been using the CPAP consistently since early May and have no trouble falling asleep or keeping it on, aside from a rare uncomfortable night. I typically get 7-8.5 hrs of sleep on it per night.

However, I haven't really noticed any improvement in my condition since the beginning of treatment. I know improvement can be delayed but I figured I would start to see some changes after 3 months. It's possible the bruxism is subsiding a little bit overall, though it's hard to tell (and those habits may take a while to break). However, I am more concerned that I haven't noticed any change in my average AHI in comparison to my pre-treatment numbers. I've posted a few charts from OSCAR below that I hope are illustrative (please let me know if some other information would help!). These represent a few typical nights plus one towards each extreme.

My average nights are in the AHI 4-6 range, although I do regularly have nights in the 8-10 range (maybe once or twice a week). Occasionally I will have a night in the 2-3 range, but that's as low as I've seen and fairly uncommon. This does not strike me as a big improvement over my pre-treatment study results, but I am also no expert at reading this data. I only started recording OSCAR data in the last couple weeks and had previously relied on the myAir app to track progress. Since my PCP recommended trying the CPAP I haven't met with an expert to discuss these results (and going through the system is a huge hassle anyway) so I thought I'd turn to this board for your thoughts!

I'd be interested in your analysis of my charts here - I don't quite know what to make of my CA events which tend to outnumber OA. Is it possible these will go down over time? I'm also curious if you have any recommendations for setting adjustments I should be looking at to achieve better results. I haven't attempted to play with the machine much (aside from minor humidity and ramp adjustments) under the assumption that the APAP would mostly figure out what pressure was best for me.

Thanks in advance for your help!

Apparently I cannot share images without meeting the post quota.
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#2
RE: New CPAP User - AHI Unchanged from Prior to Treatment
Okay, I went and made some posts in the off-topic forum to try to meet the 4 post quota for new members to share images. I've done that but still cannot share my OSCAR data. What am I doing wrong here?
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#3
RE: New CPAP User - AHI Unchanged from Prior to Treatment
Welcome to the forum,  we can and will help you

Looking forward to seeing your charts.  You cannot share images but you can attach them.  see my signature for how.

The most telling portion of your OP is this


Quote:I'd be interested in your analysis of my charts here - I don't quite know what to make of my CA events which tend to outnumber OA. Is it possible these will go down over time? I'm also curious if you have any recommendations for setting adjustments I should be looking at to achieve better results. I haven't attempted to play with the machine much (aside from minor humidity and ramp adjustments) under the assumption that the APAP would mostly figure out what pressure was best for me.
To understand that better post a full (redacted) copy of your diagnostic sleep study.  The details will talk about Centra/Mixed and maybe a couple of other names for it apnea.  Often not mentioned in the summary.  This will tell us if you had it pre-CPAP.

There is Treatment-emergent central apnea that is not uncommon that typically goes away in 2 to 3 months.

A characteristic of central apnea is that is consistently . . . . . inconsistent.  In other words it can vary all over the place.  Your machine cannot treat central apnea, so instead we try to avoid it.  Increasing pressure and pressure variance, including EPR does a fine job of treating obstructive events, but can also increase central apnea, yes polar opposites, so it becomes a balancing act.  

We will know more once we see your charts.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
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Dealing with a DME
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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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#4
RE: New CPAP User - AHI Unchanged from Prior to Treatment
your machine is on default settings. most feel air starved at min 4 cmw. one thing to try until you can post oscar charts is to push min up 1 cmw at a time to see if that feels better.

a surprising number of new cpap users get pressure induced / treatment emergent ca. did you have ca in your sleep test(s)? your machine is not designed to address ca so the trick is to find the sweet spot between raising pressure for oa and reducing pressure for ca. pressure induced ca usually dissipates in 30 to 90 days.

ca is often inconsistent and therefore so is your ahi. in my experience having mixed apnea (ca not pressure induced), it can be hard to get ahi down under 5 with apap.
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#5
RE: New CPAP User - AHI Unchanged from Prior to Treatment
Thank you for your help! Let's see if I can get some images attached. I will dig up my sleep study information and follow up in another post.
   
   
   
   
   
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#6
RE: New CPAP User - AHI Unchanged from Prior to Treatment
I'd like to attack your Central Apnea mostly.  As I said yours is consistently inconsistent.  What we are going to do is avoid it.  I'll give you a choice, EPR = 0 or 1.  A good chance I'll ask for EPR= 0 in the future.  This should have a good impact on your Central Apnea but because of its inconsistency, it will take a week to see if it worked.  You may get a good idea quicker but it will take a week.  

An additional change is also intended to help the centrals but also maintain treatment on your obstructive events.  That is to set min pressure to 7.

So Min Pressure = 7 and EPR = 0 (best for centrals) or 1
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#7
RE: New CPAP User - AHI Unchanged from Prior to Treatment
Thank you bonjour! I will give this a shot and see what shakes out. I've also attached the results from my home sleep study. As far as I can tell I had very few CA events before CPAP treatment, so I'm hoping I can knock those numbers down quite a bit.

   
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#8
RE: New CPAP User - AHI Unchanged from Prior to Treatment
Hi meemer2590,

Welcome to Apnea Board. I was wondering if there was anything more on that sleep study you posted. Are there more pages? I'd suggest posting the whole thing but react (AKA black out) personal info.

Here's to near future success...
Coffee
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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#9
RE: New CPAP User - AHI Unchanged from Prior to Treatment
Hi Dave,

This is the rest of the info from the sleep study - just a summary as far as I can tell. 

   

I've adjusted my machine and have spent two nights with the new settings. One went well and the other did not, so I'll give it some more time! I'm a little surprised how different it feels with the bumped-up minimum pressure and EPR turned off (it only gave me the option of ON or OFF, so I went with the latter). Anyway, I'll check back in next weekend once I've spent some more time with the new settings.

Thanks for your help, everyone!
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#10
RE: New CPAP User - AHI Unchanged from Prior to Treatment
There are more options. You can set EPR for 1,2, or 3. Under EPR on you will see EPR type and under that EPR level as you scroll down. You may need to select EPR on in order to scroll to type and level.
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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