[CPAP] New CPAP User Looking for Some Help

[FredinNY]

Hi Everyone,
New CPAP user here and a first-time post to the forum.  Just a quick nod of appreciation to all of you who spend time here, assisting individuals like me that are looking for answers.  It’s been about 7 weeks so far, and a bit of a struggle to say the least.  I’m finally at the point where I can usually do 5+ hrs. a night with the CPAP therapy, but I’m questioning the quality of my results.
 
My sleep lab study back in September cited an AHI of 34 that was corrected with a CPAP pressure of 12 CM of water.  My machine has a setting of 12 CM, and although it has a minimum setting of 4 CM with a 30-minute ramp-up to 12 CM, I don’t use the ramp-up period, and start each night at the 12 CM.
 
The issue I’m having is that I simply do not see the AHI results I’d hoped for.  It appears that I have a fairly low percentage of mask-leak through the night, and yet I’m usually only able to achieve an AHI number of somewhere between 8-14.  I’ve only been able to get under a 5.0 AHI one time since I started using the machine.  If the sleep study was able to eliminate my apnea with a pressure setting of 12, shouldn’t I get results close to that if I’m using the machine properly at home?      
 
I do have an added incentive to get this number as low as possible.  I’m currently struggling with A-Fib, and to be honest I’m quite tired of it.  I’d like to get zapped back into sinus rhythm, but not if my sleep apnea is going to put me right back into A-Fib.  
 
I attached some recent screenshots of data from the past few days.  Any suggestions you may have would be greatly appreciated.
 
Thanks,
Fred

           
  OSCAR Stats @11-14-19.pdf (Size: 278.25 KB / Downloads: 13)

[Gideon]

Welcome to the forum.  We can definitely can and will help you.  

The first and obvious thing that needs to be fixed is that you are tucking your chin and because of that positional shift are causing a positional apnea.  See how your obstructive events are clustered, and heavily so? That is the indication.  That is common and fortunately, easily fixed.  Get a soft cervical collar, see my signature for a link.  This will quickly and efficiently lower your AHI.

Also, you have a lot of periodic breathing, It is important to see the details behind it.  Zoom in, click on the chart in an area with periodic breathing until about 3-4 minutes is showing so multiple breaths are showing.  Please do this for several different instances and screenprint them (F12) and post.  

Finally, so we know all,  You stated AFIB, thanks, any other heart, circulatory or breathing issues?  COPD, asthma, CHF, heart attacks, and Meds, especially for the above or for pain, recreational or otherwise.   This is for the elimination of other issues and is prompted because of the combination of AFIB and PB.

Thanks

[mesenteria]

I have the same experience with AFib, and that's what led to the sleep lab and the AHI of 31, also 'severe.'  I haven't struggled, though, but I clearly see that you are struggling.  We'll figure this out.

First, I see a lot of clustering.  I don't know your preferred vs now-default sleeping position, but it's quite likely that you are tilting your chin towards your chest as you relax, sag, and fall asleep.  If this happens, you'll get apneas.  If you habitually have CA events, or even just hold your breath, as you fall asleep, and if you're constantly thrashing around restlessly, or being aroused for other reasons, you'll have lots of CAs every time you go through the cycle of falling asleep anew.  It really is a vicious cycle.  Narsty, as some would say.

It would be highly advised for you to purchase, or find, a soft foam cervical collar and begin to use it.  Unfortunately, it is going to be yet another intrusion on your previously 'normal' way of sleeping, particularly if you find it 'hot' around your neck, a rather common complaint.  But it will be an oh-so-important addition, I think, that may remove a lot of the obstacles to a continued and lengthened cycle of proper sleep.

Others will offer their insights and experience.  Please be patient.

[CapeMayDan]

Sleeprider has great information on cervical collors.
Here is a link that might help you.>>>> http://www.apneaboard.com/wiki/index.php...cal_Collar

I use a cervical collar and a product called The Eliminator. It is a tremendous help to me.
The Eliminator has a tendency to tear but is easily fixed by sewing it back or you can just return it for a new one within the warranty period.
JMO, The Eliminator is really more comfortable.



Dan

[sleepyp]

The cervical collar is a very good option for clustered events, it helped me a lot.

Did you start therapy at 12cmH2O or did you build up to it? 12 is pretty high for a new user.
These graphs are very messy, like what I got when the pressure was higher than I could comfortably take at the time.
I'm getting great results at fixed CPAP 11.5 now, but it went really messy a couple of months back when the machine went over 10.
It might be worth trying a dropping the CPAP pressure down a bit, stay there for a week and then add 1cm each week until you get to 12cmH2O comfortably.

[FredinNY]

Welcome to the forum.  We can definitely can and will help you.  

The first and obvious thing that needs to be fixed is that you are tucking your chin and because of that positional shift are causing a positional apnea.  See how your obstructive events are clustered, and heavily so? That is the indication.  That is common and fortunately, easily fixed.  Get a soft cervical collar, see my signature for a link.  This will quickly and efficiently lower your AHI.

Also, you have a lot of periodic breathing, It is important to see the details behind it.  Zoom in, click on the chart in an area with periodic breathing until about 3-4 minutes is showing so multiple breaths are showing.  Please do this for several different instances and screenprint them (F12) and post.  
 
Finally, so we know all,  You stated AFIB, thanks, any other heart, circulatory or breathing issues?  COPD, asthma, CHF, heart attacks, and Meds, especially for the above or for pain, recreational or otherwise.   This is for the elimination of other issues and is prompted because of the combination of AFIB and PB.

Thanks

Appreciate the input.  I will pick up a cervical collar and I'll get those screenshots you requested.  I was never one for a sound nights sleep.  Bathroom trips alone account for at least two interruptions a night  .  My recent AFIB (and my cardiologist's comment that I'll never be free of it until I address the sleep apnea) prompted the sleep study.  No other heart ailments or medication other than the Beta blocker I'm on to deal with the AFIB (Metoprolol). 

Thanks again,
Fred

[FredinNY]

I have the same experience with AFib, and that's what led to the sleep lab and the AHI of 31, also 'severe.'  I haven't struggled, though, but I clearly see that you are struggling.  We'll figure this out.

First, I see a lot of clustering.  I don't know your preferred vs now-default sleeping position, but it's quite likely that you are tilting your chin towards your chest as you relax, sag, and fall asleep.  If this happens, you'll get apneas.  If you habitually have CA events, or even just hold your breath, as you fall asleep, and if you're constantly thrashing around restlessly, or being aroused for other reasons, you'll have lots of CAs every time you go through the cycle of falling asleep anew.  It really is a vicious cycle.  Narsty, as some would say.

It would be highly advised for you to purchase, or find, a soft foam cervical collar and begin to use it.  Unfortunately, it is going to be yet another intrusion on your previously 'normal' way of sleeping, particularly if you find it 'hot' around your neck, a rather common complaint.  But it will be an oh-so-important addition, I think, that may remove a lot of the obstacles to a continued and lengthened cycle of proper sleep.

Others will offer their insights and experience.  Please be patient.

Thanks for the response.  It may take some time, but I'm sure I'll get to a point where the "struggles" are behind me.  It's too early for me to consider living with AFib indefinitely.  I agree with the consensus here that tilting my chin is most likely contributing to my less-than-stellar numbers.  I'll be taking a look at these cervical collars to see which one sleeps the "coolest" (as I could easily be one of those people who may complain about it being too hot).  It's just one more thing to get used to I guess.  I barely got through the sleep study, as being restricted in any way brings on claustrophobic panic attacks (not certain why this is happening as I've gotten older).  I'm just grateful I didn't have easy access to Xanax 7 weeks ago when I started wearing that mask, or I would have another problem to deal with now...lol.

Appreciate your insights here.  I will be patient (not much choice).   
   
Thanks,
Fred

[FredinNY]

Sleeprider has great information on cervical collors.
Here is a link that might help you.>>>> http://www.apneaboard.com/wiki/index.php...cal_Collar

I use a cervical collar and a product called The Eliminator. It is a tremendous help to me.
The Eliminator has a tendency to tear but is easily fixed by sewing it back or you can just return it for a new one within the warranty period.
JMO, The Eliminator is really more comfortable.



Dan

Hi Dan,
Thanks for the link.  I'd like to find something that has a good balance of comfort, as well as something that sleeps cool.  I will definitely take a look at the Eliminator. 

Fred

[FredinNY]

The cervical collar is a very good option for clustered events, it helped me a lot.

Did you start therapy at 12cmH2O or did you build up to it? 12 is pretty high for a new user.
These graphs are very messy, like what I got when the pressure was higher than I could comfortably take at the time.
I'm getting great results at fixed CPAP 11.5 now, but it went really messy a couple of months back when the machine went over 10.
It might be worth trying a dropping the CPAP pressure down a bit, stay there for a week and then add 1cm each week until you get to 12cmH2O comfortably.

Hi,
My system originally came with a starting pressure of 4, ramping up to 12 within 30 minutes.  I could never use the 4cmH2O because it seemed like it just wasn't enough air, so I immediately changed it to 7cmH2O to start.  I've gotten in the habit of just starting the machine @ 12, and just leaving it there.  I believe I can get comfortable enough with the pressure and fall asleep within a reasonable amount of time. 

I can't adjust the top pressure of 12 without a script from the doctor, unless I want to hack the CPAP machine settings.  As I go through all the other adjustments I'll be making, I'll keep this in mind as an option.

Thanks,
Fred

[Dormeo]

Hello, Fred. You can adjust all your pressure settings without a scrip; click on the link at the top of the page that says "CPAP setup manuals." Some health-care professionals are quite supportive of this kind of active engagement by patients; others are not. But either way, it's your choice.

As you look for the right collar, you might consider the Dr. Dakota collar. It is pretty firm in front, with just a strap in back, so it is somewhat cooler than regular collars.