New CPAP User Seeking Advice on What to Ask Doc

[BobbyMcGee]

Hello, I’m a CPAP ‘newbie-for-about-a-month-now’. Hoping to get some advice on some questions to ask and how to speak to my sleep doctor next week during my initial follow-up appointment after using my machine for the past month. 

Sorry this is a bit of a long post, but I feel my life could definitely get better with this therapy if it's the right path to keep taking, so I want to provide more information rather than too little in the hopes I could get some great advice here.

I’m using a ResMed AirSense 11 with AirFit P10 nasal pillows. I've hit compliance by sticking it out and suffering through this tough learning curve. I kind of felt a little refreshed after the first 4 or 5 days but now I’m feeling a little worse—waking up 4 to 5 times a night, and upon waking up in the morning, I’m back to the pre-CPAP tiredness, fatigue, headaches, depression, brain fog. 

I like to sleep on my side and stomach and bought a pillow with the “dug-outs” on each side. Pillow is helping a bit but I'm constantly fidgeting around to get comfortable without the nasal pillows moving out of place to fall asleep. I do open my mouth during the night so I also wear a cervical collar to try and keep that from happening. Don’t think it’s helping but maybe the data can confirm or refute that. Willing to try a full mask or tape or chin strap, but really would like to make these nasal pillows work.

My main concern is I fear that my doctor is going to say things like: “Everything looks great. All your numbers are down so I’ll see you in six months. Bye for now.” Believe me, I'm glad to be getting these lower numbers than my sleep study results, but something is telling me by the way I feel that I could do better with some adjustments and knowledge of what to talk about with my doc.

After researching a bit on this group and elsewhere, if I understand correctly, the Central Sleep Apneas (Clear Airway events in OSCAR) can still really be the main/major issue preventing progress (and can't be treated by CPAP? Is that true?) but the severity of them can only truly be detected during an in-lab sleep study—so when looking at a new CPAP user’s data, most medical professionals may ignore CA’s since numbers look good. (Only speculating here from various things I've read.)

I notice that my CA events are usually far above in number than my OSA events. Is that normal? I understand there's a thing called "treatment emergent" CA that can occur but I don't want my doc to say that's what this is and write them off, telling me they'll go away on their own when I'd rather have it addressed in some way now. Any advice on how to address that if it comes up?

Again, I’m new so forgive me for all the questions and if I sound ignorant when trying to explain all of this. If anyone could be so kind as to review my data and provide some questions I can ask my doc, or things my doc may say that I can address, (or adjustments I should make in your opinion), I’d truly appreciate it.

Thank you.

At-Home Sleep Study results summary:
AHI: 20.4
ODI: 10.6
Snore %: 16.8

RESPIRATORY PARAMETERS 
Night 1 (2025-03-13): Hypopneas in this study were calculated using the 3% desaturation rule. 
The overall AHI (REI) was 20.4 per hour, with a central apnea index of 3.1 per hour. 
The patient was supine for 58.7% of total recording time. 
The supine AHI was 30.3 per hour. The non-supine AHI was 6.2 per hour. 
The average oxygen saturation was 95.0%, and the nadir was 89.0%. 
The average desaturation drop was 3.6%. The patient spent 0 minutes below 88%. 
The ODI was 10.6. Cheyne Stokes respirations were not observed. 
Snoring was noted for 86.6 minutes. 

CARDIAC DATA 
The heart rate ranged from 50.0 to 182.0 bpm. Mean heart rate was 57.6 bpm. 

IMPRESSIONS 
Moderate Obstructive Sleep apnea (OSA) 

DIAGNOSIS 
Obstructive Sleep Apnea (G47.33)

   

[ejbpesca]

Hello and welcome to the forum.

Here are some things I noticed on your OSCAR report that your doctor should not see as "doing fine."

1. The Median pressure is 8.  That may be a good setting for your Minium pressure.

2. Your maximum pressure is 12.  The APAP is trying to go beyond 12 as shown by the red line.  Raising the Maximum pressure will allow it to do so.  Putting it to 20 (the highest) will show just how high it will go then it can be reduced later.

3. Just before time 3:00 a cluster of OAs occurred.  That is many times due to a sleeping position.  It happens to me when I roll to my back and tissues collapse.  It could be due to chin tucking that cannot be resolved by PAP.  Some resolve it by using a thin pillow to keep the head from lowering.  Some use a cervical collar to prevent chin tucking. Your sleep study shows most apnea occurring during supine sleeping position. There is much discussion here about chin tucking and supine position sleeping position. You can do searches to bring up threads on the topic.

Raising my minimum pressure resolved many of my events that produced an unacceptable over 5.00 AHI.  8 may be a better minimum pressure for you may produce a more effective therapy. The way some address CAs is using EPR set to 3. If they are persistent and were a major factor on your sleep study a bi-level machine may be prescribed that has more options for pressure settings. CAs can occur as one adapts to PAP therapy. I don't think your sleep study included sensors for brain activity that would detect "central apneas." OSCAR shows them as "clear airway," apneas which could be brain based, not from obstruction. It may take an in lab sleep study to determine if central apneas are a major problem needing addressing by a different type of PAP machine, but your CAs may reduce with time as you adapt to therapy.

[BobbyMcGee]

Thank you so much for this valuable information and assessment of my data.

As you can tell, I'm extremely new to CPAP and this whole process of trying to treat my sleep apnea. Very happy I found this board with friendly and knowledgeable people like you to help newbie's like me.

[ejbpesca]

On supine and non supine sleeping.  I sometimes think I would not need PAP therapy if it were not for sleeping on my back when my AHI can go to AHI 70.00! for an hour.  Your non supine AHI is nearly normal.

It was suggested I get a cervical collar to resolve my back sleeping issue.  A tried 3 collars that did not work for me, but I understand they do for some to prevent chin tucking.  I also found it was not chin tucking that was the problem it was tissue collapse and/or palatal prolapse causing my high AHI during clusters of OAs.  Therefore, ERP may not be the best setting for me.