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New CPAP user needs a bit of help - Donkey Farm - 08-06-2017
Hi everyone!
This is my first real post. So a big hello to all of you!
I have been diagnosed with OSA after a sleep study and sleep nasoendoscopy.
Sleep study shows the following:
Total sleep time: 7.1 hours
Sleep efficiency: 95.8%
Overall AHI: 14.5/hours
Mixed Apnea Index: 0.0/hours
Central Apnea Index: 0.1/hours
Mean spO2 by sleep time: 95%
Lowest spO2: 86%
Desaturation index: 14.2/hours
Snore Event Index: 138.7/hours
So, in short, mild to moderate obstructive sleep apnea with significant desaturation.
One week after, I went home with a Philips DreamStation A-Flex Auto CPAP (with humidifier and heating tube) and a Philips DreamWear pillow mask. I also downloaded SleepyHead to read my data.
The machine was set as such:
Mode: Auto
Pressure: 4-20,
EPR at 2,
Humidifier and heating at 2
I felt much more energized right after the first two nights but increased the minimum pressure to 6 as I felt a bit air starved at 4.
It’s been a week now and the machine is really doing a good job: feeling energetic again and no need for my daily nap anymore, no more snoring, etc. I am also happy that I got used to sleeping with the mask on so quickly.
On to the data now and this is where I need you help!
Average Past 8 nights data (will post pics or links after I get 4 posts in this forum):
Average Hours per Night: 07:33
AHI: 5.24
Obstructive Index: 0.25
Hypopnea Index: 2.89
Clear Airway Index: 2.11
Flow Limitation Index: 0.97
RERA Index: 0.05
Average Leak Rate: 0.15
90% Leak Rate: 0.00
% of time above Leak Rate threshold: 0.00%
Average Pressure: 6.65
Min Pressure: 4.00 (adjusted to 6 after 2 days)
Max Pressure: 9.60
90% Pressure:8.00
Average EPAP: 5.10
Min EPAP: 3.60
Max EPAP: 7.60
Results show improvement but it could be better:
The AHI shows most events are CAs and hypopneas. Would increasing the minimum pressure help to reduce the hypopnea events?
About CA events, I am not too worried about these as they seems to be clustered before I fall asleep, when I wake up or turn during the night and before getting up.
I would appreciate if you could help me interpret the data and provide advice on how to tweak the machine to improve the AHI.
Sorry for the long post and thanks a lot for your replies!
RE: New CPAP user needs a bit of help - ajack - 08-06-2017
yes, I would raise the minimum pressure till the H came good. dreamstation are a slow machine to react.
The CA should settle by themselves as you progress. Given you had little in your sleep study, it's probably the body balancing the o2 and co2.
2.1 isn't anything to be concerned about. If you want to reduce the ca, you can turn off any aflex, that often works.
you can upload your sleepyhead chart on h ttp://imgur.com/ and post it. Just put a space in the link, like I did to break it.
RE: New CPAP user needs a bit of help - Donkey Farm - 08-06-2017
Thanks for the quick reply and advice ajack!
I will increase the minimum pressure to 7 and see how it goes for a few days.
My main goal right now is to address the hypopnea events and it's probably better to change setting one at a time.
Would setting the EPR at 1 instead of 2 help as well?
Once, this is solved, I'll look at the CA events.
I am also thinking of reducing the max pressure since 20 seems useless in my case. From what I understand, it's not going to change anything but gradually I will try to pinpoint the pressure range.
So far, I find the DreamWear nasal pillow very comfortable to wear. I had to train myself not to breathe through the mouth since I was doing it all the time.
RE: New CPAP user needs a bit of help - ajack - 08-06-2017
I couldn't work a nasal mask, I mouth breathed all the time. If you are comfortable on flex 2, I'd leave it, unless you are concerned with the CA.
you can post links if you put in a space after the 'h' h ttp://imgur.com/ like this.
RE: New CPAP user needs a bit of help - Donkey Farm - 08-06-2017
Thank you!
I am leaving the A flex at 2 and the max pressure at 20 for the time being.
This my latest SleepyHead report:
h ttps://drive.google.com/file/d/0B_H3Ep-SkoQ9TnY2MmtBT2hmN00/view?usp=sharing
and the weekly report
h ttps://drive.google.com/file/d/0B_H3Ep-SkoQ9TUx3YzVIemREQVE/view?usp=sharing
RE: New CPAP user needs a bit of help - ajack - 08-06-2017
There was a bit of a cluster at the end of the night, it was probably as you were waking up or awake. The rest of the night isn't too bad.
With the chart I would also go 7, to try and stop the H before they start. You perhaps may need a bit more later, but I would keep this setting for a week. The induced CA should settle within 12 weeks. Just check they aren't going longer than 30 seconds and most will probably be under 15sec as the o2/co2 balance
The 20cm can come back to 10 for now, It doesn't seem like you will need it higher.
Others are better at this than me, but I think there is some work to do with the nasal mask, some even tape the mouth. There is a mask fit link below.
You might be mouth breathing sometimes, the tidal ventilation is low and this can be a cause. I assume you don't have copd etc, or you would have been put on a bpap.
If you have a full face mask I would use that while you set up your machine. Or I'd buy one, you need a ffm when you have a cold. The first FFM mask, I'd get a fitting from a DME or buy online with an exchange policy. I find the f20 works well, but not for everyone. Also HK has local masks for only tens of dollars
RE: New CPAP user needs a bit of help - Donkey Farm - 08-06-2017
Alright, great!
I will keep track of the CA but as I said, I am not too worry about it.
As for the mask, I went for the one that seems the least claustrophobic and it's the only one I got for now. Maybe it's not the best choice for me as I do have some significant nasal obstruction and chronic sinusitis on the left side (under treatment). That could explain the low tidal ventilation.
But the mask do feel comfortable. I train myself not to breathe through my mouth with it and if that happens it sort of wake me up immediately.
I will keep you advice in mind and will try a full face mask to see the difference.
RE: New CPAP user needs a bit of help - Sleeprider - 08-06-2017
Looks like ajack took the night shift and did a good job evaluating the charts. I completely agree a minimum pressure of 7 for the flow limits, hypopnea and obstructive events. The end of night centrals are most likely sleep disturbance and will resolve on their own. Welcome...here is an image assist until you have the requisite count.
![[Image: yubadjcwG4G919Stx6h-5y4SUXBrrS4VofgVAvHy...w1920-h906]](https://lh5.googleusercontent.com/yubadjcwG4G919Stx6h-5y4SUXBrrS4VofgVAvHyWCtMjYvMlGAd2kp7_gdFb1O4Oso0fWQnXM8JBEs=w1920-h906)
RE: New CPAP user needs a bit of help - Gideon - 08-06-2017
Welcome to the forum.
Your numbers are not bad, but need some tweaking. At this stage do slow, with small changes, you are close. The real important question is How do you feel? your comfort is real important at this stage.
Your numbers. Your sleep Study said you do not have significant Central or Complex Apnea, that is great. It means that what Central Apnea you see is most likely Pressure induced and will likely go away.
Rule Of Thumb (ROT)
ROT is to increase pressure for obstructive events, you are doing this.
ROT is to DECREASE pressure for Central/Clear Airway events.
As you see these can conflict each other. The other thing is Flex/EPR can negatively impact CA events. For that reason I suggest that you turn this feature off for a month or so, while your body adjusts to breathing nightly with CPAP therapy, then bring it back if you need it. It is considered a "Comfort" setting.
I am not concerned with your CA events, just trying to help bring them down a bit.
FYI it is the Exhale Pressure (lower here because of the Flex/EPR) that splints the airway open.
Therfore it is my suggestion that you turn off Flex/EPR for now and see how that does and leave your pressure where it is at
Fred
RE: New CPAP user needs a bit of help - Donkey Farm - 08-06-2017
Thank you all of you for the many good advices! It's really helpful.
I will let you know as I tweak things further. but I will start changing one parameter at the time. Tonight minimum pressure goes to 7 and I will leave A-flex on. I will evaluate the results at the end of the week and will consider turning A-flex off next.
The AHI is important but so far I can feel real benefits from my first week of CPAP. I had no idea I could be so energetic in the morning!