Concerned -- please help

[tom63130]

Last night was my first night on a CPAP machine (aside from a sleep study last month). My AHI was 9.3 -- thought it should be lower. From the SleepyHead software, got my graph, which is attached. (CPAP pressure is 7.)

Any assessments that anyone can share? I sure thought my numbers would look better.

Thanks in advance,
Tom

[AlanE]

Can you post a screen shot? In Sleepyhead (on a PC not sure about Mac), press F11, F12 then F11 to return to normal. If you have dual monitors, make sure Sleepyhead is on the display #1.

[AlanE]

Also after that, stand by for a bunch of questions that will help us understand your current therapy.

and

[tom63130]

Can you post a screen shot? In Sleepyhead (on a PC not sure about Mac), press F11, F12 then F11 to return to normal. If you have dual monitors, make sure Sleepyhead is on the display #1.

Sure -- see attached -- thanks!

[OpalRose]

tom63130,
Do you have your sleep study results that you can share with us; like a breakdown of your apnea events and your AHI?

Since you have a straight CPAP and not an Auto CPAP, it's just a little harder to see what your pressure needs might be. If you had an APAP, then we could suggest a pressure range and get a better idea from sleepyhead what is going on.

You've only been on CPAP one night, so it's something you should watch for a week or two. Most important is do you feel any better after one night?

[Sleeprider]

Can you post a screen shot? In Sleepyhead (on a PC not sure about Mac), press F11, F12 then F11 to return to normal. If you have dual monitors, make sure Sleepyhead is on the display #1.

Sure -- see attached -- thanks!

It's only one night, but it appears your pressure is too low and you are not getting adequate treatment of events that normally respond to pressure, particularly OA and H. The conservative approach is to give it time, but an overall AHI of about 10 is unacceptable. I think you need to increase pressure 1.0 cm at a time and see if it clears things up. If you have the Auto IQ mode on your machine, I would strongly recommend you use the machine to titrate a new pressure in auto mode.

For future graphs, put the graphs in order of Events, Flow, Pressure, Snores as described here: http://www.apneaboard.com/wiki/index.php...pnea_Board

[AndyB]

I'm sure you will get many helpful responses from experienced members of the forum, so I hesitate to chime in since I have only 7 weeks of CPAP therapy under my belt. However, I will plunge in and offer my 2 cents since I recently had a reaction like yours after my first few nights of therapy.

One night -- and especially your very first night -- is too little data to be meaningful. My first night using a CPAP I had an AHI of 15.22. I was extremely concerned by that because I had expected great results after my sleep study (severe sleep apnea, titrated to 11cmH2O, so pressure on my CPAP was set to 6-11 cmH2O). The next 2 nights were better, but hardly great: AHIs of 8.41 and 8.65. Then the next 6 nights were a roller-coaster: AHIs ranging from under 3 to over 10. Needless to say, I was not a happy guy.

Things have settled down now, 7 weeks into therapy. After two weeks I upped my pressure to 8-13 cmH2O, turned off EPR and Ramp, and most nights my AHI is under 5. Not fabulous, but technically treated. I'm still fiddling with masks (what a treat that is), and tonight I'm going to increase my pressure slightly, to 8.4-13.4 cmH2O, since I seem consistently to be at the top of my pressure range and I still have hyponeas. My CAs are also higher than I'd like, but my sleep doctor -- who is reputed to be a top sleep doc in my area -- told me not to worry about CAs that occur in the transition times of first falling asleep, waking up to use the bathroom and then falling back asleep, and then waking up in the morning.

I have climbed back off the ledge, and can now appreciated that it will take some time to adjust to CPAP therapy. I don't think you should panic this early in your new adventure.

Good luck!

[trish6hundred]

Hi tom63130,
WELCOME! to the forum.!
Try not to worry, you've only been at this new way of sleeping one night, just keep on working with it and hang in there for more responses to your post.
Much success to you on your CPAP journey.

[parkerdt]

Give it a week. My first week, I had some nights of 17+ AHI. Now, I average around 2.5 and the big numbers are outliers. Too many jump to treatment conclusions on a night's worth of data. I think that is the wrong approach. A week makes a trend, a night does not. My opinion, of course!

hang in there, and welcome!

Dave

[tom63130]

tom63130,
Do you have your sleep study results that you can share with us; like a breakdown of your apnea events and your AHI?

Since you have a straight CPAP and not an Auto CPAP, it's just a little harder to see what your pressure needs might be. If you had an APAP, then we could suggest a pressure range and get a better idea from sleepyhead what is going on.

You've only been on CPAP one night, so it's something you should watch for a week or two. Most important is do you feel any better after one night?

OpalRose, thank you for the reply. I really didn't feel any better today, and if anything, felt a little worse than normal. I just keep having to remind myself that it's only been one night and that adjustments can be made to make things better.

It's only one night, but it appears your pressure is too low and you are not getting adequate treatment of events that normally respond to pressure, particularly OA and H. The conservative approach is to give it time, but an overall AHI of about 10 is unacceptable. I think you need to increase pressure 1.0 cm at a time and see if it clears things up. If you have the Auto IQ mode on your machine, I would strongly recommend you use the machine to titrate a new pressure in auto mode.

For future graphs, put the graphs in order of Events, Flow, Pressure, Snores as described here:

Thanks Sleeprider. I might try a pressure of 8.0 cm tonight. I don't think my machine has an Auto IQ mode, from having reviewed the manual and also played with the settings on my "Respironics PRO C-Flex+". Thanks for your tip on posting the graphs to the sleep.tnet.com site and then linking to them. Also, a question: I'm in learning mode about a number of the terms such as OA and H. Can you refer me to a good place to learn more of what they are?

I'm sure you will get many helpful responses from experienced members of the forum, so I hesitate to chime in since I have only 7 weeks of CPAP therapy under my belt. However, I will plunge in and offer my 2 cents since I recently had a reaction like yours after my first few nights of therapy.

One night -- and especially your very first night -- is too little data to be meaningful. My first night using a CPAP I had an AHI of 15.22. I was extremely concerned by that because I had expected great results after my sleep study (severe sleep apnea, titrated to 11cmH2O, so pressure on my CPAP was set to 6-11 cmH2O). The next 2 nights were better, but hardly great: AHIs of 8.41 and 8.65. Then the next 6 nights were a roller-coaster: AHIs ranging from under 3 to over 10. Needless to say, I was not a happy guy.

Things have settled down now, 7 weeks into therapy. After two weeks I upped my pressure to 8-13 cmH2O, turned off EPR and Ramp, and most nights my AHI is under 5. Not fabulous, but technically treated. I'm still fiddling with masks (what a treat that is), and tonight I'm going to increase my pressure slightly, to 8.4-13.4 cmH2O, since I seem consistently to be at the top of my pressure range and I still have hyponeas. My CAs are also higher than I'd like, but my sleep doctor -- who is reputed to be a top sleep doc in my area -- told me not to worry about CAs that occur in the transition times of first falling asleep, waking up to use the bathroom and then falling back asleep, and then waking up in the morning.

I have climbed back off the ledge, and can now appreciated that it will take some time to adjust to CPAP therapy. I don't think you should panic this early in your new adventure.

Good luck!

Thanks AndyB! Good information/insight in here, although I am overwhelmed with the terminology. Where I can learn what CAs are? (Similar to the question I asked Sleeprider above about OA and H... I'm struggling to understand and need some sort of primer.) Thanks again.

---

Hi tom63130,
WELCOME! to the forum.!
Try not to worry, you've only been at this new way of sleeping one night, just keep on working with it and hang in there for more responses to your post.
Much success to you on your CPAP journey.

Thanks trish6hundred!

Give it a week. My first week, I had some nights of 17+ AHI. Now, I average around 2.5 and the big numbers are outliers. Too many jump to treatment conclusions on a night's worth of data. I think that is the wrong approach. A week makes a trend, a night does not. My opinion, of course!

hang in there, and welcome!

Dave

Thanks Dave! I see merit in the approach of not changing anything until there is some sort of trend. Going to give this some serious consideration.