[Symptoms] Even more tired today

[Apnea Infant]

So your pressure which produced better results was with higher pressures. I reckon you need to raise your upper limit to at least 10 to help with those Obstructions, Hypopnea and RERA. I would leave it at that for at least 3-5 days to capture a trend before any further changes. Did you have EPR on as well between Jan and Mid Feb as you did not register as much Clear Airway events then. If not I would try to reduce EPR in an effort to address the clear airway events which may have been brought on by EPR.

I understand when you say you did not feel like asking for your sleep study results when you were ill for a spell. There does not seem to be transparency with sleep apnea CPAP results and treatments in most places and it is a struggle to get information to work with. I felt much the same way and when our sleep health has been compromised by Sleep Apnea it is hard to find the strength to battle through.

You have come to the right place. Many of us have been helped through our brain fog and have managed to come out 'the other side'

Stick with it. In time it will really be better.

[SarcasticDave94]

Automatic pressures from 5 to 20 in January and until mid-February. I don't have my sleep study. (I was sick for about six weeks after the study and didn't feel like asking for it.) My diagnois said "Mild Obstructive Sleep Apnea Syndrome with moderate hypoxemia." Thank you.

If memory serves well today, this 5-20 pressure range would have, or could have, served as a titration, in other words, an attempt to have the machine tell you where your best therapy pressure(s) would be. It is mainly only useful for titration only IMO, as almost everybody will need a tighter (closer Min and Max) range to be effective. This effective range will partially be determined by the brand of your machine, as Respironics machines need you to dial it in fairly close to your appropriate minimum pressure, while a ResMed is a bit more forgiving due to it's quicker response to events. Other machines not mentioned, as my experience as a patient only lies with those mentioned machines.

I suggest when you're up to it, to request the mentioned sleep study and the script. As for the reason, you want these copies in case you have to deal with another doc or DME, and also places do close up without warning. In that case, you may be stuck with no apnea documentation if the respective office cannot provide it to you any longer. BTW: You have a legal right to this under HIPAA law. They can, but most do not, charge you for printing media but for nothing else IIRC.

Hope you're doing well with treatment thus far.

[trance]

           

Yes, it was on 3 everyday since beginning PAP, except the 24th with the 6.86 AHI.

 RE: "Did you have EPR on as well between Jan and Mid Feb as you did not register as much Clear Airway events then."

Yes, the doctor called it titrating. Then he locked it in at 8. (Looking at numbers, I did best while titrating.)

RE: "If memory serves well today, this 5-20 pressure range would have, or could have, served as a titration..."

[Sleeprider]

This is kind of unusual. It appears that you do best with an EPAP pressure of 5, regardless of any other setting, and CA activity is increased when pressures get above that due to less EPR. There are essentially no obstructive events even at these low pressures. Although you had your Autoset at a 5-20 span, your pressure apparently never increased above 8.0, which with EPR at 3, gave you a range of 5/4 to 8/5.

I'd be hard-pressed not to conclude you have a tendency to complex apena with CPAP, but it is not something that becomes apparent until EPAP pressure rises above 5-cm. You could in theory get back to your old results by going to Autoset mode with pressure from 5 to 8 at EPR 3. You might also want to see what simply using lower pressure will do; for example at CPAP pressures of 6 or 7 you should be fine with EPR at 1 or 2 respectively. The main consistency appears to be a need not to exceed 5 on EPAP.

With these results, you should be doubly interested to see the details of your sleep study. You may have been diagnosed with obstructive sleep apnea, but you would not be the first person I saw with that diagnosis, and many central events in the study.

[trance]

I understand. Thank you. I 'think' I am somewhat atypical for OSA, anyway, as I am 5' 5.5" and weigh only 145 lbs.  I will try to get my study; I am accustomed to getting all paperwork for my disabled husband, yet hesitant when it comes to myself. Yeah, I know.

One thing that I need to research, here and elsewhere, is how 'foods' affect apnea. My sleep comfort is directly tied to what I consume -- so much so, that I eat a very, very mild dinner around 4 pm and have only water til bedtime. I also avoid onions and garlic at all times, because they are the worst culprits and also give me headaches.  (Don't worry -- early in the day I eats lots of fiber, protein, vegetables, etc.) Probably getting off topic... thank you all.

[paulag1955]

Apnea Infant, how does position affect CA events?

[trance]

Apnea Infant, how does position affect CA events?

EDIT: Paula, I just answered your question because I was thinking it was directed at me. Sorry....

I can't say for certain because I make it a rule to sleep on my side. I would imagine back sleeping could easily provoke apnea, though, as I sleep fitfully in that position. The 'wrong' food will pick me up in my sleep and roll me onto my back -- hate it when that happens.  

[trance]

You could in theory get back to your old results by going to Autoset mode with pressure from 5 to 8 at EPR 3.

Used Autoset from 5 to 8 at EPR 3 last night: Discounting the first 2 sessions (because I was wide awake with a headache and mask issues) I did quite well on the 3rd session with an AHI of only 1.82.  (I didn't sleep well, but I must have been breathing okay, at least.)  Thank you very much!

[SarcasticDave94]

OK well that's good-ish. AHI is very nice, as under 5.0 is considered treated successfully with CPAP therapy. But, the other half of the equation is how you're feeling from therapy, which seems to be not as well as numbers indicate. That's why I myself consider feel and numbers to be both needed to get the full story out.

If you post the chart, I'm sure someone will point out a probable cause.

[Reznik]

FYI, my doctor advised me that clear airway events are common for new CPAP users and that they often resolve on their own as time passes.  I've read studies that agree with her.  See, e.g.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3700705/

If that's true, then you probably shouldn't be making changes on a day to day basis in an attempt to get rid of them.  When they do eventually go away, you're going to assume that your changes were responsible, when in actuality they would have gone away no matter what you did.

Also, bear in mind that the methodologies used by these machines to distinguish between central and obstructive events are not perfect.  They don't actually measure respiratory effort.  It may be that they are wrong, and that you're really having obstructive events.

As far as EPR and Bi-Level, my experience has been that higher EPRs (or Pressure Support now that I'm on Bi-Level) make me feel better the next morning, even though they temporarily increase my central events.

I welcome contrary views.