[CPAP] Newbie to CPAP Therapy

[SleepyPrince]

Hello,

I'm 34 and have been a loud snorer for the past 15 years . I was recently diagnosed with severe sleep apnea with an AHI around 67. 
I dont have any complications health wise (so far) except I have bad mood changes and very quick tempered.


I stated my therapy a week back .I have trouble adjusting to it , but over the days I'm getting better at it.
I still see that my AHI are 5-6 every night. 
After one week of therapy I'm not sure what to expect after looking at the results. One is that my events are 5-6 which is way low from 67, but another question is do I have to bring it close to 0-1? Do I have to check with my sleep doctor about these events?

I'm fairly new to this and read that many people instructed to install OSCAR to understand the data in detail. I will be doing that .

I have a ResMed airsense 10 & a AirFit 20 full mask and so far its all right. My main concern is I have a deviated septum and one of my nostril is blocked around 75%. I read that fixing it might not cure sleep apnea but is it worth the shot.

Thanks in advance, I will keep you posted after I install the OSCAR.

-Vivek

[SleepyPrince]

I have attached my OSCAR reports from last night. Not sure if this is normal since I'm using it only for 1 week, or do I have to take measure to minimize the events much more. Any help is greatly appreciated.

Cheers

[Crimson Nape]

Since you are using an AirSense Autoset, you will be better served to set your graph display to, "Standard" instead of, "Advanced". (View ⇾ Reset Graphs ⇾ Standard)

Based on your Flow Limitation value, even with the EPR set to 2, your CPAP will use the maximum set pressure.  Don't expect any pressure increase to help.   You might try using a setting of 3, to help reduce your flow limitations, but don't expect any miracles.  If you are a back sleeper, the worst position for OAs, you need to try sleeping on your side.  The left side is preferable, but anything other than your back will work.

[staceyburke]

To build on what Wes posted- you look to have positional apnea. Positional apnea is when you cut off your own airway by the position that you sleep in. Sleeping on your back many times causes chin tuck. Chin tucking is when your chin drops down to your Sternum cutting off your airway. Think of it as a kinked garden hose- nothing will go through until you unlikely the hose

Take a look at my signature on collars. It will show you people without collars and the same people with collars. It is a huge difference.

Last thing I would suggest is to raise your min from 5 to at least 7 or 8. 5 for most adults is just not enough oxygen (air) coming through the mask. If you have your mask adjusted correctly that is ALL the air you would be inhaling. I take at least 9 or I’m pulling off my mask to get enough air.

[SleepyPrince]

Thank you for the suggestion. I usually sleep on to my side, but didn't know about the neck tuck that causes positional sleep apnea.

I did not use an collar yet, but tried to sleep on my side using an elevated pillow.

I have attached my stats. I'm little more concerned about my hypopnea and RERA. Any my pressure is still at 5-15.

Its been almost 10 days of using CPAP and every day my events vary between say 4-8. 

In addition to sleeping on the side, Do i need to change anything else ? Thanks in advance.

[staceyburke]

You have high flow limits and that is what drives up pressure on a ResMed.

EPR(exhale pressure relief) is what we use to help with flow limits. The min must be raised so the EPR can be used

I would change to:
Min8
EPR3

That will make your exhale 5 and help with the raising pressures AND reduce flow limits

[SleepyPrince]

Thanks for the suggestion.   

I managed to set my EPR level to 3 but last night I started seeing clusters of events and as you guys suggested I thought its due to positional sleep apnea . I have ordered an collar and yet to try it out.

But what bothers me most was the CSR events (Cheyne Stokes) last night for 19 mins. I woke up after the ends of the events . Mostly I guess due to lack of breath.

Below was my Oximetry sleep study results.
Average SpO2 : 94.00%
MinSpO2 : 74%
Percent sleep time 90-100% : 93.95% (206.5 min)
Percent sleep time 80-89% : 5.23% (11.5 min)
Percent sleep time <89% : 4.6%% (10.10 min)

I have also attached my Oscar reports from last night, where I noticed the CSR events first time . I'm not really sure why suddenly i got these events and if this is related to central sleep apnea? 

Do I have to use an oximeter just in case to understand my spO2 level during the sleep. I would appreciate any insights about this .Thanks in advance.

[staceyburke]

I will let others that know more about the csr to comment on that.

I use oxygen 24/7.  You need your O2 levels above 88%.  It can drop for a very short time without problem but if you are experiencing levels below 88 for an extended period of time you are in need of supplemental Oxygen.  If you are not sure you should get a night time monitor to record your levels.  I use the least expensive model CMS 50S.  It can be purchased on Amazon and probably walmart.  between 100 and 150.   If you have questions I can answer about supplemental Oxygen let me know.

You said in your post you set the EPR to 3.  But you left your min at 5, so your EPR did not do anything.  Your flow limits are still very high and that is driving up your pressures - in fact they are topping out and not doing any good.  You need to raise the min to at least 7 to get any benefit from your EPR.

EPR is exhale pressure relief. It helps with the exhale and helps with the flow limits.

To explain - the min is the inhale and exhale pressure
The max is the highest the machine will go to stop apnea
The EPR subtract from the min to give a lower exhale pressure.

Example Min =7  EPR =3 so Inhale is 7 exhale is min 7 - 3 EPR =4

I again suggest you move the min to 7 (you can do 8 or 9) but raise it
EPR 3

This will really help you, IMO.

[SleepyPrince]

Thank you the valuable suggestion.

Last night I had set my min to 8 and max to 15 and slept for 3 hours. Then I woke up and changed min to 10 and max to 20.

In the first part of my sleep, I had 24 OSA events with CSR event too. This is my second night continuously getting CSR events.

Total Events
   

Part1
   

CSR
   

I'm sort of paranoid seeing the CSR events in my OSCAR reports. 
I have ordered the OXIMETER to track the O2 levels and will keep you posted after using it. Any insights will be highly appreciated.

[SleepyPrince]

Attaching zoomed out portion of the CSR events.