Sleep is worse with CPAP - any hope?

[njtech]

Greetings all! My father was diagnosed with Sleep Apnea (15-24 AHI) and was prescribed a CPAP. It's been over two months now and he still is not able to adjust to the machine since his quality of sleep with it is worse overall. His nightly AHI fluctuates and can be 4 , then 20 the other night.(I have no idea why) He does 1-3 hours each night with a machine. He absolutely refuses to see his sleep doctor or try alternative treatment methods. I am attaching his Sleepyhead chart. Is there anything that can be done here to manage his sleep apnea? Would someone be able to provide some hints/guidance? Thank you!

[Walla Walla]

You can bump up the minimum pressure to 6cm. That should help him breath better. But he really needs to start using the machine all night so it will benefit him. Also it would allow for more data to look at. It's pretty hard to get a reading on someone's treatment if they're not using the machine.

[ShaunBlake]

Hi, njtech, and welcome to the forum/fun/family!  Sadly I'm not one of the gurus, and likely never will be.  Hopefully some will be by soon and begin offering wise counsel for your dad.  God bless you for caring for him!

It's great that you've jumped in with a couple of charts; that will really help.  Please give us a bit more information about your father's refusal to see his sleep doctor, and what alternatives have been suggested to him?  Also explain how the sleep doctor Dx'd him and determined the machine settings – was it done through a sleep study (if so, home or lab?) and did it include titration?  Were you given a copy of the results?  If so, it would help our gurus to see that (but please "redact" any personal information before posting!)

Not only am I not a guru, I'm also not familiar with the Dreamstation.  However, the settings seem to be pretty common and I would have expected fewer obstructive events than your father is having.

I regret not being able to help though I'm sure someone will soon.

Edit: See?  Walla Walla came in helped while I was hunting and pecking!  

[DeepBreathing]

G'day njtech. Welcome to Apnea Board.

May I ask how old your father is? The approach may be different depending on whether he's a fit sixty-something or a frail 90 year old.

In any case, WallaWalla is correct that we need to work on increasing his average hours. The machine can't treat apnea while it's not being used, and the short periods of use can skew the data. For instance on the Saturday he had a large number of clear airway events, but these were all in the first 20 minutes or so, when he was probably in the sleep transition stage. It makes his nightly AHI look bad, but in fact they can likely be disregarded.

Another thing that got my attention is that on one night the trace starts at 7:00 pm but on the other it starts at 4:00 am. Erratic and disrupted sleeping patterns are not good for us, whether we have apnea or not. But when we're trying to adjust to the machine it probably makes it so much harder.

Finally, is he able to articulate what it is that's disturbing his sleep? For some of us it's an inability to breathe at low pressures while others are bothered by higher pressures (not likely in his case as his maximum doesn't go beyond 10). And many people find the mask uncomfortable, in which case mask liners may help, or else a different type of mask is required.

I know I've bombarded you with more questions, but we need to get a fuller picture of what's happening before we can dispense much in the way of constructive advice.

[Sleep2Snore]

It might help him if you turned on the Pressure relief when he breathes out it will drop the pressure of the machine to make it easier for him to breath out.  If he finds the mask odd he can sit at might with the mask only on (no hose or machine) and then use the machine after he gets used to the mask, still sitting watching TV at night until his brain accepts the mask and machine.  A lot of people find it hard to adapt and if he has a rather blunt sleep doctor he will be reluctant to go near him/her.  You need to try to get him to work on using it for a bit longer every night, even half and hour longer every night will help.
Philips Resperonics call the Pressure Relief "Flex", this will help him breath out easier. 1 will be lowest and 3 will be highest pressure relief so it will be easier to breathe out.

[tedvpap]

Increase the minimum pressure. Work your way up to 8.
Commit to using it. Quitting is easy and wrong. Habits take time.
Sleep hygiene is very important. Go to bed ready for sleep.

[DaveY]

It takes time. It took me about 3 months of daily CPAP use (5+ hrs) before my sleep quality improved to a reasonable level. 5 months in now. A good mask is also key IMO.

Dave

[MyronH]

One thing no one mentioned yet, is that he may want to ask his doctor about trying a BIPAP machine. Even though he is at lower pressures of 5-10, it could help him. I kept having issues too with lots of events, then when I went to get a second opinion from another sleep doctor, he let me try BIPAP. The extra push of air helped to push past more of the blockages I have. The only thing it won't help with any more then CPAP, is with positional problems, like if you tuck your chin at night closing off your airway. I think I still have that problem.

[CB91710]

The main issue that I have with sleep disturbance is the noise from the air moving in the hose.
The A10 is a quiet machine, and the P10 is a quiet mask, but on a very quiet night it can be annoying and if I do wake up, it can be hard to get back to sleep.
On all but the coolest of nights, I'll keep a fan running in the bedroom to provide a little white noise to mask it.