Second night on CPAP

[Chief Peabrain]

Hi all,

I've had sleep difficulties for over 10 years and during that time had 3 sleep studies - the first at a sleep centre and then two at home. The first two drew blank and the third showed mild to moderate (15.6 events per hour) sleep apnea. 

From my own perspective, I'm pretty sure that the problem is my palate closing on exhalation, which is exacerbated when I'm supine. I can sleep well for hours if I'm in the right position on my side, but on my back I end up waking up. My dentist has also observed my breathing difficulties in the dentist chair.  

I do feel better after a few days on the CPAP and think it's helping in terms of my day-time fatigue. The results seem to look good too with very few events registering.

I'd really appreciate someone taking a look at my charts and giving an opinion as to what is causing the CA events, and confirming whether my assessment is correct or if something else is going on. 

Thank you!

[jdougc]

Welcome to the forum,
Post a copy of your sleep report.
Are you on any medications that affect your breathing or sleep?
Do you have any health issues that  affect your breathing or sleep?
Ramp pressure is too low at 4 cmH₂O, raise it to at least 7 cm
Increase the minimum pressure to 8cm 
The clear airway events may be treatment emergent and diminish over time.

[Chief Peabrain]

Thank you very much for the quick reply. I'll try these settings tonight and see how I get on.

[ejbpesca]

You have an extraordinarily low Mininum pressure setting and very few apnea events.  The majority of the events shown on the OSCAR chart are CAs (Clear Airway).  Those can be caused by PAP therapy.  

You can see the pressure line going down to as low as the machine will go and little or no apneas occurring.  This would make me question the validity of the third sleep study and choose the 2 out of 3 that "drew blank," as correct.

I am assuming that drawing blank means those 2 studies did not produce a diagnosis of Sleep Apnea and to me, that is what your OSCAR report is showing.

[Chief Peabrain]

Thanks for your reply. For context, I barely slept at all in the first study at the sleep centre. And the second one done at home my chest monitor fell off at some point in the night, so I don't think they're entirely reliable.

As I mentioned in my post, I can sleep on my side usually without any issues, but wake up if on my back. I am feeling more refreshed on waking up and haven't had any morning headaches since I started on the CPAP, so it does feel like it's helping.

[ejbpesca]

Does your Sleep Study Report have prescribed pressure settings?  Min 4 that you have is considered too low by many to be an adult therapy.  Min 7 is what is often given as the lowest setting for adults.

You can search for instructions/demos on how to set up a CPAP therapy machine from scratch if you do not have a pressure settings prescription.  

Let's look at what is happening with your APAP machine according to OSCAR.

You have two areas where the machine bumped up to a higher therapy pressure.  The first bump may be due to increased Flow Limitation and the second due to the events flagged over the rise in pressure.  The events are named as CAs which PAP therapy cannot treat but they could be OAs or other events mislabeled.  

My concern would be that if the PAP therapy pressure is causing CAs then the therapy is counterproductive.  If around 4 cm (Med is 4.72) does treat your OA apneas and other events then you are lucky that such a low pressure is effective.  

You can fine-tune the machine's pressure settings.  When effective therapy is being delivered some experts will suggest the Min. be set to the Statistics Med pressure figure and Max set to the 95% pressure.  A video is available on this concept by CPAP Reviews.