APAP seems to ramp up to max within 15 mins for no reason

[JonathanBravo]

Good evening everyone.

I was diagnosed with sleep apnea by a home test about 6 months ago with an AHI of 17. I started using the Resmed Airsense 10 with an F40 mask, and using the auto setting. I tried a nasal pillow but i'm a partial mouth breather and the F20 over-nose doesn't work well with me. My score kept in the 6-11 AHI range even after treatment so my sleep doctor tried a CPAP titration study, and they determined a pressure setting of 11 was enough to stop all events. I tried this for a few weeks but it didn't really improve, so they decided "maybe more pressure is worse for you, lets try auto pressure 5-11 range". It's been about a month and this has also failed to bring my events down and i'm not really feeling any benefit from PAP therapy at all after 6 months. I'm stuck getting AHI of 6-10 every night and no amount of tweaking changes anything.

A major thing i'm noticing, is that the APAP seems to ramp up to max pressure after about 15 mins without any real change in my breathing. It stays high up all night and sometimes wakes me up from the pressure. My doctor wanted to bring the pressure down a little to help with comfort and CA events, and then use the auto setting to attack the obstructive events, but the pressure is just staying up. Has anyone else experienced this? I've attached screenshots from the last 2 nights.

Settings are currently 5-9 pressure, auto setting, EPR off. I don't mind the EPR being off at all and apparently it helps with the CAs.

Thank you!

[Deborah K.]

Your pressure rises so quickly because you need more pressure.  You should raise your pressure range to 8.6 to 12 as your median pressure is just below nine, and your body needs higher pressure.  

Your flow limits are high, so you need to turn EPR on full time, set at 3.  This will make your breathing easier and will lower your flow limits, which we need to get as low as possible.  It's possible that your CAs may go up, but don't worry about those for now, as you need the EPR to help with your breathing.

Did you have a lot of CAs in your sleep study?  If you don't know, can you post a copy of your sleep study?  If you don't have it, ask your doctor for it.  By US law, they have to provide it if you ask.

[AshSF]

Since you are using the APAP mode to titrate your pressure need, I would suggest you raise the range. 8-12 would be my recommendation for the next 1 week. And then evaluate the charts again.

[JonathanBravo]

Thank you Deborah K. and AshSF. I've been using the new settings of 8.6-12 for the last two weeks now. I've attached three OSCAR screenshots from the last 3 days, and these are pretty representative of how things have been. My API scores are consistently in the range of 5.5-12, and average about 6.5. When I wake up i'm out of breath and it takes me 1-2 hours to wake up, and then i'm exhausted by 6pm. 

Does anyone have any ideas or suggestions? I'm thinking of maybe dialing down the EPR a notch or few. Thank you

[SarcasticDave94]

Did you get your PSG sleep study detailed report yet? You need to know the back story on these Central Apnea/CA. They're consistently too high. After 6 months on the AutoSet, these CA if treatment emergent should have diminished by this time.

Call the doctor's office and request the "detailed sleep study report". Do not accept No when you request this. HIPAA law gives you the right to request and receive it.

Once you do get it, you'll need to post a redacted of your personal info version. Specifically that table with events count and type, plus the doctor's diagnosis and recommendations.

[JonathanBravo]

Did you get your PSG sleep study detailed report yet? You need to know the back story on these Central Apnea/CA. They're consistently too high. After 6 months on the AutoSet, these CA if treatment emergent should have diminished by this time.

Call the doctor's office and request the "detailed sleep study report". Do not accept No when you request this. HIPAA law gives you the right to request and receive it.

Once you do get it, you'll need to post a redacted of your personal info version. Specifically that table with events count and type, plus the doctor's diagnosis and recommendations.

Thank you for your reply. I've posted the results from a take home sleep study that a doctor prescribed just over a year ago. I had an in lab study with a different doctor a couple months ago, but it was a 'titration study', so I was on CPAP and they just slowly increased the pressure until events stopped. I can try to get that full study too, but because i'm on CPAP with that I don't know if it's as useful. Thank you.

[SarcasticDave94]

OK, there are a few CA under pAHIc at a count of 7. You don't happen to live at higher elevation, do you? That too can cause CA in some.

Maybe you'll want to voice a complaint with your doctor. You might get to switch to a bilevel ResMed VAuto, running high or very high trigger.

[JonathanBravo]

OK, there are a few CA under pAHIc at a count of 7. You don't happen to live at higher elevation, do you? That too can cause CA in some.

Maybe you'll want to voice a complaint with your doctor. You might get to switch to a bilevel ResMed VAuto, running high or very high trigger.

Hi SarcasticDave94, thank you for replying.

For the last few weeks i've been on APAP 8.6-12 and then last night I put it up to 8.6-14. Every morning I still have a belly full of swallowed gas, and I feel like i've been punched in the head all night. I'm utterly exhausted all day. My AHI is holding fast in the 5-10 range and it's 50-95% CA events. I don't live at a higher elevation. I will try speaking to my sleep doctor, but they've dropped such statements as "Huh, turning up pressure doesn't work so lets try turning it down" and "You have some program that lets you see your breaths? We don't have that. It must be fake. I can only see what your events were for the night". They have awards covering their reception area and their own clinic. So I don't hold much hope ..

Anyway ... I've posted last nights result. What I notice when I zoom in, is that many of the OA and CA events look identical. Could OSCAR be identifying them incorrectly? I've attached screenshots below. Also, is it normal that sometimes i'm not breathing and my CPAP takes a good 20-30 seconds to respond and turn up the pressure?

Thank you!

[SarcasticDave94]

When there is a Central Apnea, the CPAP basically doing nothing is the correct programmed response, because your AutoSet isn't capable of a correct response to treat any Central Apnea.

On the doctor's office not really knowing how to help, unfortunately that's typical. Many of these sleep specialists moonlight for extra pay, but that doesn't require skill in treating Apnea. You might get better medical support with your primary care.

I think by now you'll probably be better off with the VAuto. I'm sure there's enough failure with your therapy thus far to attempt the request to go to the bilevel due to not tolerating CPAP.