[CPAP] Questions from New CPAP User

[Steptoe]

I am relatively new to CPAP therapy. I had a home sleep study and my doctor's office said I had "severe" sleep apnea with an AHI of 32, and a very low oxygen level. I was not provided with a copy of my sleep study results. I started using a DreamStation Auto CPAP on April 7, 2021 and have used it every night since then. I can't say that I sleep or feel any better, and I certainly don't wake up more refreshed or with more energy than I did before. I am not a mouth breather, but I have always done a lot of tossing and turning.

I have received very little information or support from my doctor's office. They did adjust my pressure settings on May 2 to 8.0 minumum and 12.0 maximum from 5.0 minimum and 15.0 maximum. This did improve my AHI readings. I only saw the doctor once, when he ordered the sleep study, and my second appointment is June 29. All other communications were by email with the doctor's staff. The office that provided the equipment has been more helpful than the doctor's office, but if it weren't for watching Lefty27 YouTube videos, I would be totally in the dark.

My concern is that after almost 60 days of CPAP use, my AHI averages around 6.7. I have tried several different masking including the DreamWear Full-Face Cushion, the DreamWear Nasal Cushion, the ResMed P30i Nasal Pillow, and currently the ResMed N30i Nasal Cushion. My AHI score hasn't varied much between these masks, but I find the nasal cushion mask much more comfortable and easier to sleep with.

I see AHI results on this and other forums[attachment=32468] far lower than what I am getting. I have several questions: (1) Is an average AHI of 6.7 bad; (2) What can I do to improve my AHI; (3) I know that some of the hypopnea and obstructed apnea events shown on Oscar occur at times that I am awake. How can this be? (4) I note that my AHI numbers are higher during nights that I sleep primarily on my back, rather than my side? Does that make sense? (5) I downloaded Oscar, but I have difficulty reading and interpreting the results. It seems to me, however, that I may have problems with leaks. The summary usually shows no large leaks. Are leaks an issue in my therapy.

I have attached my latest Oscar readout, together with the statistics page. Thanks for the help. I hope my questions aren't too dumb.

Steptoe

[Ratchick]

Hi and welcome.

I can try and offer you some advice, but you're in the best place for more knowledgeable people to help you out.

1) 6.7 is higher than we'd like but it's not devastatingly bad. It can definitely be improved though. Ideally, you want below 5.

2) That depends. There are lots of things, from tweaking your settings, using a soft collar if you have positional apnea, changing your pillows, etc. That's why the charts are useful so people can see what's going on.

3) Apneas happen while you are awake and falling asleep normally. You might take a deep breath and then not need to breathe for a little longer, which the machine mistakenly marks as an apnea - all an apnea is is a period of at least ten seconds where you don't take a breath. You can be holding it. You can be moving around, you can be relaxing. There's a lot of things that can cause that during the time you are awake and falling asleep, to the extent that it's termed "sleep-wake junk". So don't worry about the things happening while you're awake for now.

4) This suggests you may have positional apnea,or chin tucking, which is not uncommon, but when others have looked at your chart more, they can probably say yey or ney. But yes, it's normal to have position affect your obstructive apnea because certain positions can kink your throat, making it easier for an obstructive apnea to occur.

5) It can take a while to figure out how to read the charts, but that's what the board is for, and there are lots of people here who can give you had to figure out where to go.

Edit to add: No, your questions are absolutely not silly, so don't worry about that. We all have to start somewhere. Also, I had a quick look at your chart. Not an expert, but it looks like you could have some positional clusters, as you suggest from your questions. Your leak level isn't perfect, but I'm not sure how much of an issue it is causing - the mask is always designed to leak a certain amount of air normally. It's the leaks over and above that that is the problem. I'm sure someone can help with that if necessary because while zero leaks aren't the target, controlled leaks make for better therapy. It's possible that the leaks aren't from the mask fit but from a mouth leak, but again, I'm no good at spotting that on charts, to be honest. But I'm sure the more knowledgeable crew will be on at some point and offer suggestions and ask for any other charts they need.

[clownbell]

Hello Steptoe --

I am not a long-time or highly sophisticated user. Until one of those fine folks replies to your queries, I will give you such limited info as I can.

(1) Is an average AHI of 6.7 bad
Not a huge problem. Less than 5 is considered normal, so 6.7 is mild. It can be, and should be, improved, but 6.7 is so much better than your AHI of 80prior to PAP treatment

(2) What can I do to improve my AHI
The experts will be along soon to look at your OSCAR data and make recommendations.

(3) I know that some of the hypopnea and obstructed apnea events shown on Oscar occur at times that I am awake. How can this be?
OSCAR can't tell whether you are asleep or awake.  

(4) I note that my AHI numbers are higher during nights that I sleep primarily on my back, rather than my side? Does that make sense?
My understanding is that the best sleep positions are right side, left side, and on your back -- IN THAT ORDER. It makes sense that AHI is higher when you are on your back. If you can sew a tennis ball into the back of your pajamas, that will prompt you not to sleep on your back.

(5) I downloaded Oscar, but I have difficulty reading and interpreting the results. It seems to me, however, that I may have problems with leaks. The summary usually shows no large leaks. Are leaks an issue in my therapy
The experts will come along and provide a better answer, but my understanding is that significant leaks mean your therapy is not as effective. The definition of "excessive" leak depends on which machine you have, and the experts will opine on this as well.

Best of luck to you.