First month with CPAP

[age237]

Hi,

Today is a month since the beginning of my CPAP therapy.
 
I have been 3 weeks with a CPAP APEX Fit and this last week I have already been given a CPAP with full registration capability, a Resmed Airsense 10 Elite, with humidifier.
 
I thought that the only important thing to get adapted to the therapy was the mask and that the CPAP devices were basically all the same, just an air pump, but from the first night with my new CPAP I realized that this is not my case. The feeling I have now with my new Resmed CPAP is a much easier breathing, both in an inspiration that seems to be assisted automatically giving me a very natural feeling of the air entrance as in a more fluid exhalation. What a difference! Evidently, the humidifier made my nose and throat not so dry in the morning.
 
Now I do not have headaches but I still wake up with yawning, I still feel tired during the day and I still need to take a little 40 minutes’ nap after eating. Maybe, one month is too soon in my case to get adapted.
 
Prior to the start of the CPAP therapy, my Apnea and Hypoapnea index in the first full night sleep study was 55.4 and in the REM phase of 56.9, with an oxygen desaturation index below 90 of 2.9.
 
It is important to highlight that the two fully night sleep studys toke place after having changed my habits of life in the last months (less food and physical gym exercise), lowering 7kg (15.4 pounds) and going from a Body Mass Index of overweight to normal weight. Before, this, the rates of my sleep would be even worse.
 
I do not understand very well the sleep reports obtained with SleepyHead of these 7 days since I have data. The results of each day are very different from the previous one, and I know that the first thing you are going to tell me is that my fixed pressure is too low, but before I start playing with the pressures I would like to learn to interpret them and understand what it is happening.
 
Should I be concerned about my AHI?

Should I be concerned about the level of central apneas?
 
Should I be concerned about Cheynes-Stokes breathing intervals?
 
I had the CPAP for my 40-minute naps (is this a mistake?).
 
These are the images of these first days, I would appreciate an advice / interpretation by someone of you more experienced in SH.
 
Thanks in advance.















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[ajack]

I'm new too, but you are going to have to upload the images again, so it's clear image and set out the page as they want it. This member has the links to the how to, at the bottom of the post.
http://www.apneaboard.com/forums/Thread-...#pid198373

[Melman]

ajack is correct,

The images are to small and unclear to read. If done properly they will link to the image in IMGUR and we will be able to expand them for easier reading.

From IMGUR.com Just left click on the image, then click on "large thumbnail", and finally "Copy" for the Link for BBCode. Paste that into your post and they will be easier for us to read.

[age237]

I am sorry. It was my first post with pictures.

I think is easy if I let you a link to google.photos:
https://goo.gl/photos/y8cSRA7yx4Jx8eENA

Thank you

[Hydrangea]

Welcome! Bienvenidos. I notice you're from Spain. Your English is fantastic.

I can't comment on charts, as I'm too new to know what I'm looking at to be useful.

But I wanted to say yes, DO use the machine for your naps!

You're doing great!

[Sleeprider]

Age237 you have predominately CA events with events ranging from 8 to 11 per hour. With a fixed pressure of 6.0 and EPR off, this is a pretty high event rate. We can't help you to resolve this through changes to the machine settings as they are already ideal for complex apnea. When you had your sleep study, did it include central apnea events? Did you have a titration study where technicians calibrated a CPAP to find your therapy pressure? What were the results?

You have moderate complex apnea with CPAP pressure. Improvement may come with time and adapting to the machine pressure. The best results for this kind of apnea is to use ASV (adaptive servo ventilator) therapy. That requires a considerably more expensive machine.

[age237]

Age237 you have predominately CA events with events ranging from 8 to 11 per hour.  With a fixed pressure of 6.0 and EPR off, this is a pretty high event rate.  We can't help you to resolve this through changes to the machine settings as they are already ideal for complex apnea.  When you had  your sleep study, did it include central apnea events?  Did you have a titration study where technicians calibrated a CPAP to find your therapy pressure? What were the results?

You have moderate complex apnea with CPAP pressure.  Improvement may come with time and adapting to the machine pressure. The best results for this kind of apnea is to use ASV (adaptive servo ventilator) therapy.  That requires a considerably more expensive machine.

Thanks Hydrangea, my English is not so good, I need to help me for some expressions with the google translate tool.

Thank you so much for your explanation, Sleeprider.

I did 2 full night sleep studies. The first was for confirming the disease and the second for calibrate the CPAP therapy pressure.

The results in the first study ( TST = 313,0 minutes) were as follows:

                          Apnea Events             Hipoapnea Events
Obstructive        167  88min 38sec        120 76min 50sec
CA                         2   00min 40sec           0  00min 0sec
Mixed                    0    00min 0 sec           0   00min 0sec

The report of the second study (CPAP calibration) is very brief and gives few index, only gives some graphs of desaturations, heart pulses and pressures, but does not detail the events by type.

If I understand, my deep pathology could be related to complex (central) apneas but before starting the CPAP therapy it was hidden beneath the obstructive apneas. As soon as the obstructive ones disappeared thanks to the CPAP therapy, the central ones appeared, which I suppose are quite difficult to treat.

Is the ASV the same as an Auto CPAP?

[Sleeprider]

Age237, it's not so sinister as a lurking central problem.  About 15% of people with obstructive apnea, develop central events when put on CPAP therapy.  Read this (moderately technical): https://www.hindawi.com/journals/sd/2014/798487/

Abstract

Complex sleep apnea is the term used to describe a form of sleep disordered breathing in which repeated central apneas (>5/hour) persist or emerge when obstructive events are extinguished with positive airway pressure (PAP) and for which there is not a clear cause for the central apneas such as narcotics or systolic heart failure. The driving forces in the pathophysiology are felt to be ventilator instability associated oscillation in PaCO2 arterial partial pressure of Carbon Dioxide, continuous positive airway pressure (CPAP) related increased CO2 carbon dioxide elimination, and activation of airway and pulmonary stretch receptors triggering these central apneas. The prevalence ranges from 0.56% to 18% with no clear predictive characteristics as compared to simple obstructive sleep apnea. Prognosis is similar to obstructive sleep apnea. The central apnea component in most patients on followup using CPAP therapy, has resolved. For those with continued central apneas on simple CPAP therapy, other treatment options include bilevel PAP, adaptive servoventilation, permissive flow limitation and/or drugs.

Adaptive servo ventilation (ASV) is a bilevel positive pressure machine that provides a higher inhalation pressure (IPAP) and lower exhalation pressure (EPAP), and has the ability to increase the IPAP with pressure support on a breath by breath basis.  So when you breath on your own (spontaneously), no pressure is applied, but if you fail to take a breath or the breath is too shallow, the machine can provide enough pressure to cause a breath to occur without any effort on your part.  It is non-invasive and we have many members here that use it.  Your complex apnea problem is only borderline for insurance to cover this therapy for you, and as I said it may improve spontaneously.  We just won't know for a while.

[ajack]

Also given you are from Spain, it is all subject to your health system and their rules, I would contact your Dr about the centrals, so he is in the loop. It may not be too late to return the machine and hire/borrow till you know, as sleeprider said, that the centrals may settle, or if you need an ASV.

[age237]

Thank you so much Sleeprider, your explanation about Complex Sleep Apneas and ASV is as clear as my humidifier's water.

Thanks ajack. Of course, I will contact the pneumologist before doing anything. If I am right, changing devices is not a big problem here once an specific disease has been identified and confirmed.

In a few days I have also an appointment with the cardiologist and I will comment these results with him.

I will comment here the evolution of this issue.