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[Treatment] First day on CPAP therapy - looking for feedback on charts - Printable Version

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First day on CPAP therapy - looking for feedback on charts - Hamguy515 - 01-10-2019

Advance apologies for the novel below!

First, a bit of background.  I am in generally good health, but have always struggled to feel rested after sleep, regardless of the duration, for as long as I can recall.  After deciding to do something about it, I had a full clinical polysomnography performed ~6 years ago under guidance of my general practitioner with "inconclusive" results for any sleep disorders, let alone OSA.  This set me back somewhere around $2k after insurance between the sleep clinic, sleep doc, etc.  They offered to do it all over again, but the cost would be nearly the same.  I declined.

Fast-forward to today, and I finally reached the point where I am tired of being tired.  Through the magic of telemedicine, I had a home sleep study performed a little over a week ago and the results were honestly frightening.  My AHI for the night clocked in at a staggering 58.4 with significant O2 desaturations (dropping as low as 69% at one point).  The doc prescribed a trial of Auto-CPAP with a range of 4-20cm, I purchased an AirSense 10 Autoset, a ResMed N20 mask, and that brings us to today.  I have combed the forums extensively to understand both OSA and the science behind the therapy and how I can take control of it.  There is a tremendous amount of research here, and I'm grateful to have it all in one place and so many helpful folks to offer insight.

Getting to the point, the bottom line is that I managed to survive my first night of therapy even though I didn't actually sleep a lot of the night. Bigwink My AHI dropped to an incredible 0.94 for the night, and woke up with more energy than I've had in who knows how long.  Needless to say, I'm darn pleased with the results so far.  I've got a ways to go to get used to having the mask on my face and still being able to fall asleep, but that will come with time.  I'm already picking up the next size larger headgear for the N20 to let me loosen the straps just a tiny bit more, and hopefully that will solve my issues with mask comfort.

At the recommendation of some past threads here, I changed the machine settings right out of the gate.  I bumped minimum pressure from 4 to 7, with EPR at 3.0.  I also started out with the ramp on, starting at 4.0 and found I was struggling to get enough air.  I eventually bumped that up to something like 6.6 and that helped.  After getting up during the night several times, I decided I didn't like how long it took to ramp up so I turned it off.  Perhaps I will use the ramp feature if I end up at a higher minimum pressure, but for now, no ramp.  

Upon waking up this morning, I had some minor aerophagia symptoms that went away after a couple of good burps.  My throat was a bit sore and felt "raw" - amazing what actually breathing while you sleep can do, I guess!  My throat has mostly improved during the day, and the discomfort is tolerable.  Nothing alarming on the pressures I have currently.

When I slept, I slept well - but there was a lot of time spent lying quietly on the machine trying to settle down.  I had to turn on my ceiling fan to generate a bit of white noise to counter the expiration port noise.  I had a good period of sleep from roughly 0:00 to 03:00, and a few other segments that I didn't keep track of.  I normally sleep "like a rock" so I anticipate that will improve as I get used to therapy.  I did end up on my back from about 05:00 to 06:00 as that was the only comfortable position I could find, and there was an expected increase in events because of that.  I need to work on getting to sleep on my side like I normally do - now with a mask strapped to my schnoz.   Too-funny

So, here is my SH data for the first night.  It's almost embarrassingly clean, but I'm still looking for any feedback on any additional adjustments I might make to improve comfort and overall therapy.  Specifically, does it appear my current minimum pressure of 7.0 a good number to stick with for now?  I'm planning to leave 20cm as the top end until I have some history behind me.  And I'll obviously continue to compile data and want to make data-driven decisions with a proven track record behind them.  (I'm an engineer by trade so a methodical approach is pretty much hard-wired - and one day does not a trend make!)  However, if I can get this all dialed in faster from the start, I think I stand a better chance of being more successful with the therapy.  

So... any thoughts and/or observations?

A thumbnail will have to do since I can't post an image yet as a new member. ;-)

RE: First day on CPAP therapy - looking for feedback on charts - jaswilliams - 01-10-2019

You still have a few snores a minimum pressure of 8 will start you out at the right pressure, keep your epr at 3

Good job once you get used to sleeping with all the stuff you won’t wake up so much. It’s a good first night

RE: First day on CPAP therapy - looking for feedback on charts - bonjour - 01-10-2019

Welcome to the forum.

Very nice numbers out of the chute.  
What really matters from this point on is your comfort. you have no need to chase numbers. Sleep on whatever side you wish or your back for that matter.  We can help you adjust for that if needed.  You may have had a bit of Positional Apnea when you were on your back.  By that I mean that you may have been tucking your chin down to your chest.  Not enough to try to correct right now.  If that brief segment is what will happen all night I'd suggest a loose fitting soft cervical collar to manage that.

Tweaking,  Set your Min 8, because it set the starting pressure to manage the events closer to the pressure needed to control the events thus shortening the response time.  Not needed but totally safe.  Similarly, max pressure may be lowered to 15 (or left at 20) the purpose is to prevent "runaway" high pressures but I don't think you will need to worry about that.  Mine is set at 25 (different machine) which is the machine max like 20 is for you and I have never gone near that value unintentionally.
As you have already done, turn off the ramp.  You are close to your ramp pressure.  If you need the Ramp try it for 5 minutes, keep it short because all it does is delay the CPAP from becoming therapeutic.

The major motivator for you should be How do you feel?  

You mentioned aerophagia.  If that bothers you we would suggest lowering your max pressure until it does not cause an issue, slowly and not more than 1cmw per night, usually closer to .5 (you have to do .4 or .6), even if it means an increase in your AHI. Your max pressure was 14 so initially between 13 and 13.6.  

You mentioned a sore throat along with the aerophagia, Ask your Dr if this can be GERD.  Don't know but it is certainly possible.


RE: First day on CPAP therapy - looking for feedback on charts - bonjour - 01-10-2019

On your charts squeeze the Flow Limit and Snore charts vertically, Grab an edge and decrease the vertical dimension.  We do want to see the Flow Limit chart because it is one on the things that your machine reacts to.

RE: First day on CPAP therapy - looking for feedback on charts - Walla Walla - 01-10-2019

I actually would go with 9cm as your minimum pressure. Your medium pressure is already a little over that So the increase will just help prevent events sooner. Other than that great numbers.

RE: First day on CPAP therapy - looking for feedback on charts - Hamguy515 - 01-10-2019

Thanks for the very quick feedback and the warm welcome!  I had previously read a lot here about the benefits of using a loose-fitting cervical collar, so had already ordered one online to test out due to the low cost and high up side.  Unfortunately, all of the collars I could find locally were far too small to be anywhere near comfortable overnight, even though they would do a fine job for their normal purpose.  I expect to have that in-hand tomorrow.  I typically sleep on my side, but finding that sweet spot where the mask didn't impact the pillow was challenging last night.  I anticipate all of this getting better as I get used to using the equipment.

The feedback about focusing on how I FEEL rather than chasing numbers is a very good point.  I suppose I am honestly so anxious to get sleeping better that I don't want to take longer than it has to in order to make the fine-adjustments.  The numbers just tell a part of the story and help us make a decision.

I'll bump the start pressure up to 8cmw for tonight's session.  I was thinking that was a logical step given the amount of time I was spending above that level, and the explanation about reducing the amount of time the machine takes to get itself into that therapeutic range makes perfect sense.

As for the aerophagia, it wasn't problematic this morning - more something of note in case it was relevant to any suggestions.  I'll monitor over the next several sessions and keep in mind that dialing back on the upper limit may be in order.  The sore throat was not too bad, but also noticeable.  I've not suffered from GERD in the past, but I'll keep that in mind as a potential cause if it becomes troublesome.

In case it's meaningful for this discussion, here's another screenshot from SH with the requested edits.  The numbers in those areas looked pretty minimal, but I'll keep in mind that they are useful and ensure they're included going forward.


(01-10-2019, 04:24 PM)Walla Walla Wrote: I actually would go with 9cm as your minimum pressure. Your medium pressure is already a little over that So the increase will just help prevent events sooner. Other than that great numbers.

This makes a lot of sense logically... I may consider making a jump to 9cm tonight.  Thanks!

RE: First day on CPAP therapy - looking for feedback on charts - Hamguy515 - 01-12-2019

Quick update after two more nights of therapy and 100% compliance for both.

Settled on 8cmw pressure for first adjustment and had a pretty good night (Night #2):


Slightly higher AHI but I'm not chasing the numbers.  Looking at pressures for the entire night though, I decided to follow the advice from Walla Walla and bumped the minimum pressure to 9cmw for the next night.  Couple of central events, but I don't see any reason for concern with any of it.  Still having trouble getting comfortable when going to sleep or getting back to sleep, but that will come with time.

Last night (Night #3):


I was traveling on business, so a strange bedroom is an uncontrolled variable here.  Finally got my soft cervical collar so slept with it all night.  Not sure whether to credit pressure, collar, or combination of both, but the results were very positive.  I'm going to leave the start pressure at 9cmw and review after collecting another several days of data.  I was a bit surprised to see my pressures increase to nearly the machine's maximum a couple of times during the night (first period of high pressure woke me up from a pretty deep sleep) but during both periods the machine appears to have done what it needed and prevented the OAs well.  Because of this, I'm leaving the maximum pressure at 20cmw for now.  

Anything else I should be keeping an eye on over the next several days as I aggregate data?