[CPAP] 1 week into CPAP still high AHI

[Oreoguy29]

Hi everyone,

I’ve been using CPAP therapy for about a week now, but my AHI remains high (8.02), and I’m noticing a significant presence of central apneas alongside obstructive events. I’m a bit concerned about how to fix these. I’ll attach below a few days of data. Any ideas?

[Expat31]

Several initial things to do. Firstly need just these 5 graphs

1.Events
2.Flow rate
3.Pressure
4.Leak rate
5.Flow limitations (You are missing this one, to make space, go to Preferences, Appearance, and reduce graph height to say 100, see attached screen shot.)

We need a full night's data, no zoom at the moment.

You have clusters of positional apnea. Please read through this link. In summary, this problem can be solved by avoiding sleeping on your back, using a soft cervical collar, or using a thinner pillow. The link is pretty self explanatory.

Regardin settings, it may be a good idea to switch off ramp, as you get no therapy during ramp periods, if you can tolerate it. 

Your minimum pressure of 5 seems a bit low, I would suggest you initially increase a tad higher to 7.

I see a couple of other things, you are not using the comfort setting of EPR. Good to read through the link to get  an idea what it is all about. 

However you have plenty of central apneas. Did you have central apneas in your sleep study?

If you can repost your graphs in the standard format, as above, and depending on your replies to our questions, we can move forward


Thanks.

[SeePak]

Hi oreo

You really need to get your leaks straightened out!

The therapy is suffering due to that, and a lot could change with pressures etc. if you had NO LEAKS!

expat is making some good points.

The leak repair will make things a lot clearer.

And in my experience, when sleeping on my back, i can have LOTS of CA events. Rapid fire type thing, clusters.

That could clear up in your charts as well when you get Positional straightened out as expat points out.

Good Luck

[alemon]

You're having positional apnea. Please do a quick search of the wiki on ways to prevent this - you can tell because your events are clustered. No amount of pressure will ever fix those. Don't worry about CA's for now, that's not your problem yet, that's a last-step of therapy-improvement fix.

Your baseline is far, far too low for you. Set your minimum to 10 - I think it should be at least 11 tbqh, but we'll start conservatively. Your flow limitations are also quite high - this means that your machine is detecting partial obstructions. Try a few days with a minimum pressure of 10 keeping the max the same and post charts again. It may be worthwhile adding a cm of EPR, but it's always best to try to change one thing at a time.

[SeePak]

Alemon

Yes positional
And yes pressure can't fix that

So

I question that you're trying to get the pressures to be raised without fixing the positional first!?

For sure there appears to be a low min. pressure however I think it would be prudent first to get a hold of the positional to see where he ends up.

Know what I mean?