AHI and oxygen saturation worse with CPAP

[Philio]

Hello dear community,

Two months ago I did a sleep study (due to tiredness and wakups during the night with panic). The sleep study showed I have an AHI of 20. I didn't have a titration study just this one without a CPAP. You can find the study in the attachment. It is German but the most important stats are still readable on the top right.

Even before I got my CPAP machine I bought a Wellue O2 ring for tracking my staturation. I found out that I have quite a few spikes every night but they very rarerly drop below 90 (without CPAP). In most of the nights my min saturation is > 90.

It was just 8 days ago that I received my Philips DreamStation I AUTO CPAP combined with the Philips Dreamwear. I tried every night to fall asleep with it for 30 minutes. The first 5 nights I wasn't able to fall asleep, but on day 6 and now 8 (today) I was able to get 30 minutes of sleep with it. The results, which I checked in Oscar, are horrible. I had many clear airway apneas which I only had very few in my sleep study and I still had a lot of apneas even more than during the sleep study without a CPAP. Furthermore my oxygen saturation reached levels that I didn't reach when I was sleeping without the machine. 

The sleep technician that gave me the CPAP told me they don't know anything about OSCAR and I shouldn't do any manual settings with it. I also believe that they locked the pressure settings on the device.

There are however a few things on the machine I can change. Here you can see them with current values:
ramp=4
ramp duration=30 min
flex=2

Last night my oxygen saturation dropped to 85% during 30 minutes of CPAP. I'm scared to use the CPAP machine again to be honest.

What should I do?

Thank you
Philio

   
   
[attachment=56380]

[PeaceLoveAndPizza]

Start with getting the clinicians manual to see if they really did lock it down.

https://www.apneaboard.com/adjust-cpap-p...tup-manual

We can figure out where to go from there. Based on the charts posted I suggest trying a range of 7-12 with flex set to 3. That should show if a bit more pressure and flex will help with apnoeas. Assuming it is not locked down of course…

[Philio]

So I have been checking my machine and yes I'm actually able to tweak the settings. I have however read that tweaking should be done under supervision of a physician/technician so I was a bit too scared to do it on my own.

The last few days were actually horrible with the machine. I'm now able to sleep a few hours with it, however I still have a high AHI. I felt like breathing with the machine became a lot harder since last weekend. It might have to do with a congested nose. I have been using my heating stove lately and have a suspicion that this might affect humidity and my nose. On some days oxygen levels look better without the machine and some with the machine on.

I have been thinking about asking for a nose + mouth mask to try for when my nose is congested (currently wearing the Philips Dreamwear) and also asking for the humidifier part of my machine, which I don't have.

Also I apparently have periodic breathing according to OSCAR which I read can be a sign of congestive heart failure.

I put the OSCAR data of the last three nights below.

I honestly am a bit overwhelmed currently with how bad the therapy is going.

What do you think I should do?

Best regard
Philio

           

[BoxcarPete]

First of all, it's not uncommon for central apneas and periodic breathing to show up in people who are brand new to CPAP. The way you breathe with your respiratory system pressurised is different from atmospheric air, and especially with Flex or EPR (exhale pressure lower than inhale pressure) people can sometimes increase the amount of CO2 purged from their bloodstream, and the presence of CO2 in the blood is the primary driver for your nervous system to trigger respiration. If it wasn't noted on your sleep study, it's very likely due to CPAP. Don't immediately assume that you have heart failure! If you are active and able to exercise without trouble, you should not suspect heart failure.

Second, I have never run a CPAP without a humidifier and I don't know anyone else who would want to try it. Make sure you get one, especially if you're noticing upper respiratory irritation.

Finally, oxygen isn't everything. Disturbances and arousals in your sleep are bad too. Your sleep study shows over 7 hours in bed, and zero REM sleep, this is a bad thing. Some people find that it's hard to sleep in the sleep study, so take that result with a chunk of salt, but IMO the #1 goal is to get you moving through the stages of sleep without interruption. If you can do that, your oxygen levels will always be good if you are free from any major cardiopulminary conditions.

[Philio]

Thank you for the calming words, they helped me being less scared of the machine. Since the last time I have been getting the humidifer and been using it since. Futhermore I have been trying to increase compliance by just using the machine and it seems to work (I love the overview tab from Oscar showing the increase in usage).

I have uploaded the overview plus my last three days with 5, 7 and 5 hours rescectively here: https://cloud.highdynamics.org/index.php...LnmofmcBLf
Note that one night where it doesn't show flow rate I forgot putting back the SD card.

I still haven't noticed any improvement from the therapy and I'm wondering what I should do next. Should I start tweaking the settings now or should I focus on increasing the compliance even more?

Thank you everyone

[Philio]

I just added variable breathing to my charts (see link in my previous post).

I'm not sure why I turned it off in the beginning, maybe I meant to turn of VS2, but accidentally hit VB.

It seems to be that there is a lot of variable breathing happening, exactly around the events that are flagged. On this forum I read that this might be a problem. What do you think about this? Do I need a new machine?

Also is there any way to reduce the RERAs?

[Philio]

So I finally convinced myself to increase the minimum pressure from 5 to 6.

Here is before:
   

Here is after the pressure change:
       

It seems my RDI has decreased by around 40% if I compare 3 days before and after. Should I go even higher with my minimum pressure?