Doubts about my diagnosis? (Test results + First night with CPAP)

[IAXEM]

I took a test about two weeks ago with Lofta, which said I had mild sleep apnea and a AHI of 9.0. I had a followup call with them where I raised my concerns.. but that didn't really yield any satisfying answers, and the person I was on the phone with didn't like that I had purchased a Card 2 Cloud Airsense 10 for $300. Alas, the phone call felt like a waste of time. 

Anyhow. 

           

Most of the apnea events took place in the later hours of my sleep. I remember waking up a lot feeling anxious, maybe a little restless - and a lot of those times I did wake myself up from snoring/snorting. 

But this doesn't happen very often? I don't know if it was anxiety from the test or something, but I was having a rough time which I normally don't. 

Is there a chance this skewed my results? I feel like most nights look like the left side of the Respiratory events on the graph. But then, this is the first time I've been tested. Still, I can't help but wonder if my score would be a lot lower if it weren't for that chunk. Or is the fact that it even happened enough to merit the final diagnosis?

Also, my heart rate shot up to 180 for a split second. I wonder if that's a misreading. I recorded myself overnight and I DID shift around at that time. Maybe I pressed the probe onto my finger or something which caused a double reading.

So while my symptoms align with sleep apnea, I'm just having doubts as to how severe it is.

[IAXEM]

(Continuing here as I could only post 3 images)

Last night was my first night of therapy. Its far too early to derive much from it, but I couldn't help feeling a little eager to see the data and/or any early results. 

   

It feels very... inconsequential. Of course, I don't really know what I'm looking at - I have limited knowledge from the countless CPAP related videos I've been watching the past few days from numerous channels. At a glance, this doesn't look bad compared to other charts. 

AHI of less than 3... Few leaks, and consistent breathing throughout the night. Only a couple of Hypopnea events, but multiple Clear Airway events (only now heard of those, am a little worried). Did... it do its job, over this one singular night? Or am I doing 'too well' because I was already, in fact, doing well without? 

I feel fine. Felt like my sleep was a lot longer than it really was, but Im not terribly tired either. Too soon to say, obviously, but I don't feel that much different at the time of writing. But I also just got home from work. 

I just want some reassurance and/or opinions as I wade into all of this.

[Old Steve]

Welcome to the forum.

I think you are off to a good start. The CA's will most likely get better with time, the CPAP treatment can actually cause them.  I would suggest setting you minimum pressure to 6cm, your maximum pressure to 12cm and the EPR to 2.  Then in two or three days post some new charts.

[IAXEM]

Welcome to the forum.

I think you are off to a good start. The CA's will most likely get better with time, the CPAP treatment can actually cause them.  I would suggest setting you minimum pressure to 6cm, your maximum pressure to 12cm and the EPR to 2.  Then in two or three days post some new charts.

Thanks. 

Mind elaborating on why those settings in particular?

[Old Steve]

I am sorry I forgot to give you much info. 

The main reason is comfort, a good percentage of CPAP users that have a very low minimum pressure of 4 or 5 cmH2o can have a feeling of air starvation.  

The second reason is to fine tune.  If you look at your OSCAR chart you will see that about half the time your CPAP is already averaging 6.36 cmH2o of pressure anyway.  

Changing your EPR to 2 from 1 keeps your minimum cmH2o setting ratio the same as it was before the change to 6cmH2o and may also help your flow limits.  Higher flow limits usually means more arousals. 

Also, after some time and feel more comfortable with the CPAP try turning off the ramp.  You are getting no real treatment when it is turned on.

Oh I forgot, looking at your charts the 20cmH20 maximum pressure, you simply do not need it.


These are just suggestions, as I said an AHI of 2.81 cmH2o is a good start, but it can be better.  Post some more charts in a day or two so we can see how you are doing...

[Sleeprider]

Your median pressure is 6.36 and 95% is 8.36, so it's pretty easy to conclude your minimum pressure of 5.0 with EPR 1 is too low. I'm going to suggest minimum pressure at 7.0 and EPR 2. This should knock down the flow limits. Your therapy is pretty good, and the presence of some CA events is common in new users. If you can provide a 2-3 minute zoom of the chart at 01:10, I'd like to get a closer look at what's going on with all those spikes and the events. They are also present at 01:30-01:40 and have a very periodic look. Your sleep test did not include monitoring of periodic limb movements. Are you aware of anything like that?

[IAXEM]

I am sorry I forgot to give you much info. 

The main reason is comfort, a good percentage of CPAP users that have a very low minimum pressure of 4 or 5 cmH2o can have a feeling of air starvation.  

The second reason is to fine tune.  If you look at your OSCAR chart you will see that about half the time your CPAP is already averaging 6.36 cmH2o of pressure anyway.  

Changing your EPR to 2 from 1 keeps your minimum cmH2o setting ratio the same as it was before the change to 6cmH2o and may also help your flow limits.  Higher flow limits usually means more arousals. 

Also, after some time and feel more comfortable with the CPAP try turning off the ramp.  You are getting no real treatment when it is turned on.

Oh I forgot, looking at your charts the 20cmH20 maximum pressure, you simply do not need it.


These are just suggestions, as I said an AHI of 2.81 cmH2o is a good start, but it can be better.  Post some more charts in a day or two so we can see how you are doing...

No worries! 

Yeah I'd heard about that going into this. My prescribed range was originally 4-20, but I did feel like 4 was a little low, but didn't want to deviate too far right off the bat so I upped it to 5. It's nice to be closing in on a more precise range already, thanks. 

I set your suggested settings last night and did pretty well I think (that I can tell with my uneducated glance ?

   

I also took a long nap this afternoon which was... sort of the opposite in comparison. I woke up to water/condensation in the tube. I did receive a protective sleeve/insulator for it today (mainly to deter cats, but hopefully it solves the condensation too).

   

It's worth mentioning that, as far as I can tell, the leaks are mainly a result of me reaching up to adjust the mask - whether because it feels off, or I'm subconsciously worried its already leaking. I hope that in time I can learn to mess with it less.

Thoughts on Sleeprider's suggestion to up the minimum even further to 7.0?

Sleeprider

---

our median pressure is 6.36 and 95% is 8.36, so it's pretty easy to conclude your minimum pressure of 5.0 with EPR 1 is too low. I'm going to suggest minimum pressure at 7.0 and EPR 2. This should knock down the flow limits. Your therapy is pretty good, and the presence of some CA events is common in new users. If you can provide a 2-3 minute zoom of the chart at 01:10, I'd like to get a closer look at what's going on with all those spikes and the events. They are also present at 01:30-01:40 and have a very periodic look. Your sleep test did not include monitoring of periodic limb movements. Are you aware of anything like that?

Sure, here you go:

   

I do tend to move a lot while I'm asleep, not just switching positions. The past couple of nights (ever since my sleep test, really) I've setup an indoor security camera to record my sleep. Looking back at the footage around the time of the above screenshot, I move my right arm a couple of times, roll over to my right, adjust my mask and...

Oh, haha. My girlfriend checks up on me and thinks my mask is leaking through the vent holes, so she wakes me up to alert me about it. I recall that. 

I turn my head over at 1:30, and roll over to my left at 1:40. 

I may sleep tonight with a 6-12 pressure range again and maybe up that to 7 tomorrow. 

I really appreciate your guys' responses.

[SarcasticDave94]

I'm intrigued by the fact that your doctor's office didn't like that you went rouge and bought the CPAP before they could sell you one. They're probably very worried about the lost revenue.

[Old Steve]

It appears that you are making progress.

As to Sleeprider's suggestion...Sleeprider has more Sleep Apnea knowledge in his little fingers than I have in my whole body.  

[Sleeprider]

I thought I'd comment on what I see in this graph where we were looking at the flow spikes.  At the very beginning of this snip, there are high flow limitations which results in reduced respiratory flow and rapidly rising pressure. This culminates in about 3-breaths of recovery breathing and triggers a periodic respiratory spike at 40-second intervals. The really large arousal at 1:08:40 fully satisfies respiratory needs and causes a pause in breathing at 1:09:10 that resolves.  The Hypopnea flag simply notes the 30-50% flow reduction for that period, but is probably a false flag without desaturation.  I can't explain the periodic spikes, but it looks like movement from the bleachers here.

This really brings me back to the previous recommendation I made to increase minimum pressure and EPR to avoid those flow limits that arise near your current minimum pressure.