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[Treatment] New user
New user

I am new to CPAP treatment and new to the forum.

I did a home sleep test, the result was: "Indicative of Moderate Obstructive Sleep Apnoea Hypopnoea Syndrome"
Please see attached report.
 A trial of continuous positive airway pressure (CPAP) therapy was recommended. Weight loss management was also advised in order to minimise symptoms of OSAHS.

I started the treatment this month, but can not get low AHI so far.
I did an experiment with pressure min=max=4 and got CA=2.4, OA=11.5, H=13.3 - low number of clear airway events, high number of obstructive events.
With pressure min=4,max=20 I got low number of obstructive events, but high number of CA events. Will try to attach graphs in the next post

low pressure experiment

normal settings
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RE: New user
Welcome.  You will get lots of helpful advice here. I'll hope to be among those who could be termed helpful.

You are not being treated.  Your machine should have a maximum allowable pressure near 12 and a low of about 6...just to start off with.  From there, you can tweak the settings to get the most benefit.  

You might want the 'ramp' feature for now, but we encourage people not to use it as soon as they can.  You want your therapy to be 'there' as soon as you fall asleep, which in your case might be within seconds.  The ramp takes 10 minutes or so.

You want pressure relief, probably at least 2 cm to begin with, maybe you'll add another full cm in time.

From your OSCAR read-out, you can see obvious clusters of events, even if the types of events are mixed. Those clusters tell me you are on your back, or at least have your chin tucked down toward your chest and that this pinches off the trachea. Maybe not fully, but enough to offer you considerable flow limitations. We urge people to purchase a soft foam cervical collar from most department stores and medica supplies stores, and get used to using one as soon as you can.

Please wait for others to read and to comment.
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RE: New user
I mostly just wanted to second Mesenteria's observations and advice.  If you look on p. 2 of your sleep study, you'll see you did the most snoring when you were on your back, and if you look at p. 3, you'll see you had the most events when you were on your back.  

In addition to trying a soft cervical collar, be sure you have a fairly low, firm pillow.  And how hard to you think you'd find it to train yourself to sleep on your sides?  People are sometimes able to do it, using various ways of discouraging themselves from back-sleeping.

Please post another Oscar chart after you try a range of 6 to 12 with EPR of 2.  That will help in figuring out how to help you get the best results from PAP therapy.

Do you know how to zoom in using Oscar?  I do it by selecting a period of time, then hitting the up key repeatedly until I'm zoomed in where I want to be.  Try viewing your flow rate before a CA at a one- to two-minute zoom to see what's going on.  Often what I see is that I had a bit of an arousal from sleep, which involves deeper-than-normal breathing in a less regular pattern than asleep breathing.  (Below is an example from my chart last night.) 

It's actually pretty common and normal after deeper breathing to have a pause of 10 seconds or more before you start your next inhalation.  And voila, there's your CA.  If you have a fair number of them, the problem isn't so much the CA as it is the arousal that set it off.  It's often impossible to tell why the arousal occurred, but as you settle into treatment, you may well start sleeping with fewer arousals and thus fewer CAs.

Attached Files Thumbnail(s)
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RE: New user
many thanks!

changed settings to pressure 6-12, pressure relief 2, ramp is currently off, will keep it off. 
will post OSCAR charts with new settings.

collar is purchased, will start using it.
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RE: New user

definitely will use collar, need to research how to train side sleeping.

regarding CA: 

sometimes it is after deep breathing

sometimes not:
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RE: New user
Good job on zooming in.

The first chart shows you breathing out through your mouth, then experiencing an arousal followed by a CA. The CA is followed by some deeper breathing, which in turn is followed by some dwindling breaths, though not a CA. What is happening with the deeper breaths is that they wash out more CO2 than usual. CO2 levels are what lead to the "breath now" message sent out by the brain, and sometimes it takes those levels a little time to build back up enough for the "breath now" signal to go out.

In the second chart, I agree that things aren't so clear-cut, but I'm seeing a lot of flow-limited breaths and some other anomalies that make me wonder whether you were coughing a little. A little more about flow limitations. Not all FLs are flagged by the ResMed algorithm. FLs appear as deviations from a smooth inspiration curve. The traces at the top may appear dented or flattened, or they may exhibit an odd peak. FLs are sometimes caused by limitations in the nose, but more often they're caused when tissues in the pharynx relax and sag a little. When you start using EPR, you may see fewer FLs.

In the third chart, I'm seeing an arousal after an OA, then a CA probably caused by the arousal breathing.

Over all, I continue to think that with time, you'll have fewer CAs. You may see an uptick when you introduced EPR; we'll see.
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RE: New user
I too was diagnosed with moderate apnea number 18 to be exact which is borderline Mild. 

I am a mouth breather and I use a full face mask (ffm)

After a year of fighting positional apnea I’ve started to gain more consistency with the use of a collar and 2 foam sleep wedges …

They aren’t 100 percent at keeping me off my back but I’d say they are more dependable than not dependable. When they aren’t , I’ll get AHI numbers over 3 but under 5. When they are dependable it’s less than 2. I can also tell before I even read my machine that I feel rested and the numbers will be good. Lately I’ve been off. I’ve recently changed out my mask, my headgear and my Velcro headgear attachment ..all Philips gear. My machine is ResMed10  Autoset 
Good luck !!!
CA and OA decided to call HYOP and the 3 of them crashed RERA's place, and then the 4 of them decided to call Large Leak to meet in an Unclassified location while Rice95 had the best night of his life.

Bed         best sleep I've ever had...
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RE: New user
tried new pressure settings 6-12, epr=2. 
got high leak rate and more CA events


will keep the same settings, try to adjust mask to reduce leaks and add collar from next night
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RE: New user
Leaks are quite apparently problematic.  Once you figure out how to sleep with whichever mask you have, or one that you eventually settle on (many go through half a dozen or more masks inside of the first six months or so before they find one they can live with), we can fiddle with pressures.  Right now, your machine seems to be giving you varied pulses that rise in pressure as the night goes on.

If central apneas become a persistent problem, you might need a different therapy altogether.  Like an adaptive servo-ventilator (ASV).

When centrals become the predominant form of apnea, it sometimes helps to back off on the pressure, not raise it as some might think is the intuitively correct thing to do.

I hope you get more observations and guidance from some of the other more savvy creatures that dwell here.
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RE: New user
Wish I were savvy, but I'll wade in. As Mesenteria says, you'll have to get those leaks under control. Was the change in settings the only change you made, or were you maybe sleeping in a different position or with a different pillow?

Introducing EPR may have caused an uptick in your CAs. If you like, you can stick with the EPR of 2 for a few more nights; sometimes the body simply adjusts. Or you can reduce it to 1 and consider raising it again when everything is a bit more settled. The EPR sure did thin out the FLs, though!

You had a CA index of 5 in your sleep study, so it's conceivable you have mixed apnea (central + obstructive) rather than treatment-emergent CA. But it's too early to worry about that.
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