[CPAP] Still have a high AHI, don't know what is happening

[gwc2795]

Thanks!  I’m already seeing how helpful it will be!

great, please post results tomorrow.

[Hojo]

I'm a strong advocate for a cervical collar, not one that is so tall that you can hardly move, just enough to keep from tilting your chin down.  A cervical pillow has an opening in it and you may be able to slip your chin down between the opening so I would caution against using that style.

If the collar helps and your OA events go down, then you could lower your pressure and this may help in lowering any CA events.

[tedvpap]

It looks like you were never titrated.  Instead you doctor guessed at an auto range.  When you complained that your treatment was poor, the doctor switched you to CPAP at 9 (in the middle of your auto range).  It is too bad that the doctor did not look at your data because it is clear that your pressure is too low to address your obstructive sleep apnea.  If you are not going to get titrated, encourage your doctor to go back to auto mode and increase the maximum pressure limit so you can let the machine help you since your doctor's guidance is not useful.
And don't let the doctor prescribe the lower pressure of 4. That is way too low. As a starting point, set the minimum to 9 since that is closer to where your needs are.
If you do not understand what I am saying or why, let me know and I will elaborate.

[allanri]

I think the purpose of my sleep study in two days is to do the titration. The doctor wanted me to have a machine for a couple of weeks before the sleep study so that I could get used to sleeping with a mask. Sleep studies are uncomfortable enough; wrestling with something that looks like a facehugger from the movie Alien for the first time would probably make for a pretty useless assessment. 

I’ve only had the machine for 11 days ... so  maybe I’m expecting too much too soon.

[tedvpap]

It looks like you were never titrated.  Instead you doctor guessed at an auto range.  When you complained that your treatment was poor, the doctor switched you to CPAP at 9 (in the middle of your auto range).  It is too bad that the doctor did not look at your data because it is clear that your pressure is too low to address your obstructive sleep apnea.  If you are not going to get titrated, encourage your doctor to go back to auto mode and increase the maximum pressure limit so you can let the machine help you since your doctor's guidance is not useful.
And don't let the doctor prescribe the lower pressure of 4.  That is way too low.  As a starting point, set the minimum to 9 since that is closer to where your needs are.  
If you do not understand what I am saying or why, let me know and I will elaborate.

I figured that your titration was next. 
Titrations are good but understand it reflects only one night; where most of the time was spent at the wrong pressure.  So when the doctor prescribes the machine settings: encourage auto, at a high enough upper pressure limit so that the machine can help you when needed, with a high enough lower limit to keep the pressure close to where it is needed.

[Sleeprider]

Ted makes a good point, and your upcoming titration analysis will help a lot. I agree, that you will ultimately end up at a higher pressure, and/or using a positional apnea aid. I also agree that a single fixed pressure is not always the best approach, but a titration at least gives you a better idea than using the default minimum of 4-cm with a best-guess maximum pressure. Titration is nothing more than a trial and error approach to finding a pressure that works withing acceptable limits, often with 20 to 90 minutes of trial at that pressure. Setting auto pressure around that number usually results in better AHI than fixed pressure. Given the clusters of OA you have on the one graph posted, I think a lot of your problem is positional, and you will ultimately end up at lower pressure once you deal with that.

In any event, the next sleep study/titration will give you a lot of information to work with, including whether CA is an issue for you.

[allanri]

Thanks for your thoughts, everyone. I’m hoping the titration reveals something that will be useful.

Now, one other thing I should mention: I’ve had several nights where - during the ramp phase - I feel like breathing is something I have to think about doing. That is, I feel like I’m having to make myself inhale and exhale. It’s a very strange, uncomfortable sensation. You feel like you might not breathe unless you force yourself to. One night, i couldn’t handle it, and i removed my mask for the rest of the night.

In addition, I often find that when I am exhaling, the back of my throat constricts, and it feels like I’m trying to force the breath out through a very tight opening, sort of like blowing through a straw (not sure if that makes sense?).  I know one of the things PAP users need to get used to is exhaling against pressure, but this particular sensation of my airway closing off as I exhale seems weird, and strangely tiring. It’s like just breathing is a workout.  

Is any of this typical?

I mentioned both of these to my doctor ... not sure if this influenced his change to my pressure settings?

[tedvpap]

Thanks for your thoughts, everyone. I’m hoping the titration reveals something that will be useful.

Now, one other thing I should mention: I’ve had several nights where - during the ramp phase - I feel like breathing is something I have to think about doing. That is, I feel like I’m having to make myself inhale and exhale. It’s a very strange, uncomfortable sensation. You feel like you might not breathe unless you force yourself to. One night, i couldn’t handle it, and i removed my mask for the rest of the night.

In addition, I often find that when I am exhaling, the back of my throat constricts, and it feels like I’m trying to force the breath out through a very tight opening, sort of like blowing through a straw (not sure if that makes sense?).  I know one of the things PAP users need to get used to is exhaling against pressure, but this particular sensation of my airway closing off as I exhale seems weird, and strangely tiring. It’s like just breathing is a workout.  

Is any of this typical?

I mentioned both of these to my doctor ... not sure if this influenced his change to my pressure settings?

It is best not to use ramp.  

The feeling you have could be due to:
1) he newness of treatment - give it time for you to get comfortable
2) difficulty exhaling against pressure - this will also improve with time
3) obstructions - higher pressure is obviously needed based on the data you posted. 

[allanri]

Well, last night was a yard sale, as we used to say in my skiing days.  I was quite tired but it took my a long time to drift off. Then I woke up, and was hungry, because we'd a had late lunch/early dinner. So the machine was off for about 40 minutes.  Also, I was trying out a couple of loaner masks from my local CPAP store. I wanted to see how I'd do with nasal pillows.  The answer: not very well. I couldn't get over the sensation of having something stuck up each of my nostrils. Half way through the night I switched from the F&P Brevida to the ResMed AirFit P10.  Didn't care for either, so eventually, I went back to my F20.  In the meantime, I realized I'd forgotten to switch the mask type in the settings of my machine ... so, another period of non-sleep.  Eventually, exhausted, I took the mask off at around 5:30 ... but then, feeling guilty, put the Brevida back on at 6:30; I switched back to the pillows because I find the F20's headgear rubs the skin on my ears raw.   So, here it is, FWIW ... 

[attachment=6057]

[allanri]

So last night was good ... slept like a baby ...still a lot of OAs though. Looking forward to my sleep study tonight and having them make some significant changes to my pressure!

[attachment=6068]