New CPAP User; high flow limit and event cluster

[sleepymarie]

Hello,

I'm on night 2 of using my CPAP. I did have a sleep lab titration study and they determined my machine should be set at pressure of 4.0

I've attached screenshots of data from last two nights.

Night 2 (Jan 9th) there was a long period of constant high flow limit (30 min above 0.5) followed by a period of about 30 events over the next 40 minutes.

Is this unusual or particularly concerning? My sleep doctor is on vacation for a week and half and I'm unsure if I should contact someone else.

Thank you for any insight

[SarcasticDave94]

Welcome to Apnea Board,

The cluster isn't too unusual. This is a Positional Apnea pattern, meaning something like either a thick pillow or chin tucking while side sleeping is occurring. This tuck is like kinking a garden hose, hindering flow. If you can correct the cause, this should clear up pretty quick. This is called Positional, but it isn't the same as overall body sleep position like back or side. It's just a neck kink issue.

Second, you can have better therapy with a better setup with the pressures. I would have you consider a few things, diminishing Ramp time or turning it off. You're already at minimum 4, Ramp does nothing for you.

I would change mode to AutoSet, adding 7-12 pressure range, EPR 3 full time. All those edits together, because this static 4 is not much therapy, and this is too low a pressure for most adults.

[Sleeprider]

Let's change some things, and post a new chart in the morning. Your current settings are fixed at 4.0 cm which is no therapy at all. How miserable that must have been! I'm sure that was an error in the setup by your provider, because your doctor deserves to be kicked in the butt if that's his prescription.

Go into clinical settings. https://www.apneaboard.com/resmed-airsen...setup-info
Mode: Autoset
Minimum pressure:7.0
Maximum pressure 12.0
EPR: On full-tim
EPR setting 3

The cluster of apnea is likely positional. Although higher pressure will help, please read the positional apnea article: https://www.apneaboard.com/wiki/index.ph...onal_Apnea

Welcome to Apnea Board and good luck!

[staceyburke]

You are having positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

[sleepymarie]

Thank you for the information it was very helpful, i slept on one pillow last night instead of three, I was sleeping on three because i have a problem with acid reflux.

i do have a cervical I can use if my events continue.

i have contacted my doctor regarding pressure changes.

Here is a copy of my report from last night.

Thank you again!

[Dormeo]

Even when your AHI is OK, you're having a whole lot of snoring and flow limitations, which will almost certainly improve with higher pressure and EPR, as others have recommended.

If you want to make changes even more conservatively, you could try max = min = 7 and EPR of 3. If you want to use a range, as others have suggested, you'll need to change from CPAP mode to Auto mode.

In your place, I would go ahead and change the settings myself. Most of us who post here do that. Depending on your doctor's personality, he or she may scold you or may encourage you to continue managing your treatment with evidence-based changes. As Sleeprider says, your doctor's track record so far does not really deserve your respect.

After you change the settings, try using the machine during the day or evening, outside your bedroom, to get accustomed to the somewhat different feel you'll experience. Do this while you watch TV, read, or use your devices -- anything sedentary and mildly distracting.

By the way, your leak rate is awesome! And you're doing very well to be sleeping with the machine right from the outset. Onward!