What's next to fix/change?

[jgoole]

Hi,

I have been using my APAP for about a month now, with little improvement. My AHIs tend to be in the 11-18 range, and I'm not sure what to do to get it lower. At first I was having a lot of large leaks, but I switched masks and those have mostly been eliminated, but I still have the high AHI. Here is last night's data, which is pretty typical since I switched masks.

Since I am using an APAP, it is my understanding that changing pressure won't help. Is that correct? If so, what else should I change?

Thanks in advance,
Greg

[eseedhouse]

Since I am using an APAP, it is my understanding that changing pressure won't help. Is that correct?

No, that's wrong. These machines need help, usually by narrowing down their range and usually doing that by bringing the lower pressure up. I'd move up to at least 7 on the low end, probably higher, but don't do it all at once. A half centimetre a week will give you time to adapt but you may find you can go faster. Typically a DME will set these things up wide open and that's usually a definite mistake.

There are other things you can change to improve your experience and help you sleep better.

Download SleepyHead and learn to use it, and to post your graphs on the forum. There is power in knowledge and knowledge requires data.

[DeepBreathing]

G'day jgoole. The SleepyHead chart you linked to shows you have a complex mix of obstructive and central apneas and a lot of hypopneas. This needs some careful consideration, and is not just a matter of raising the minimum pressure.

First thing is to have a look at your sleep test report and find out what your central apnea / obstructive apnea and hypopnea indices were in the untreated condition. If you already had a high proportion of central apneas then an ordinary CPAP isn't going to fix them. If, on the other hand, you had few or no centrals, then it's likely they have been caused by the machine and are pressure-induced central apneas. Often these will go away of their own accord but sometimes need more active treatment.

[kwhenrykerr]

I raised my pressure settings faster than some have suggested. But I also take more chances than many people do. It has worked out for me with cpap so far.

Others on this forum are much more informed than I. I would suggest that you listen to the many good suggestions and chose your path. I will suggest that you give each change you make time to show its effect before making another change.

[jgoole]

First thing is to have a look at your sleep test report and find out what your central apnea / obstructive apnea and hypopnea indices were in the untreated condition. If you already had a high proportion of central apneas then an ordinary CPAP isn't going to fix them. If, on the other hand, you had few or no centrals, then it's likely they have been caused by the machine and are pressure-induced central apneas. Often these will go away of their own accord but sometimes need more active treatment.

Thanks, DeepBreathing. My sleep test results were (from a 5 hr. 50 min. sleep session):
Total Respiratory Disturbance Index: 24.7
Total Apneas: 50
Total Obstructive Apneas: 11
Total Hypopneas: 49
Total Central Apneas: 37

Apnea Index: 12
Unclassified Apnea Index: 0
Obstructed Apnea Index: 3.00
Central Apnea Index: 9.00
Mixed Apnea Index: 0

Of course, most of these numbers mean nothing to me.

The diagnosis was, "Findings are consistent with Moderate Obstructive Sleep Apnea," with a recommendation for an Auto PAP machine.

Is 37 a high number of Central Apneas?

So far, I have not seen a DME or sleep therapist. I bought my stuff online and have been using Apnea Board to learn what I need to know. Maybe it's time to consult a sleep therapist? My only option was Apria and I didn't want to deal with them since they were charging outrageous amounts for equipment, and I don't have insurance coverage.

Thanks,
Jgoole

[cate1898]

Welcome to the forum jgoole!

Sounds like your SA may be better treated with a different kind of machine, but I am far from an expert. You need the knowledgeable people on here to comment on this. My knowledge is extremely limited. Whatever the fix, you need to get your AHI lower.

[PoolQ]

You have the machine now and your centrals are not "off the chart" so I would suggest trying to get the hypopneas under control and see if it can be done without increasing your centrals. Sometimes centrals can be caused by pressure changes.

As far as increasing the low end pressure, from a pure therapy reason the rate you increase is not the main issue, it's you tolerating it that is mostly the problem. Your body will react to it right away as long as it does not disrupt you sleep. I would bump it up by 0.5 and watch your data: look for your HA going down and your CA not going up- a few is fine.

It might be nice to see a close up of the CSR area.

[kwhenrykerr]

Greg might ask what position you sleep in ? On your back ? on your side ? Flat or raised head ? Do you tuck your head when sleeping ?

I do very bad on my back. I try to sleep on my left side. It gives me my best sleep. I have started to use a soft neck brace to keep me from tucking my head, it has worked. Like the rest of the gear I had a hard time getting over using it. It is now just part of the trip to la la land. I am up to about 4 hours of sleep on a good night.

I just keep reading and trying stuff.