First night very high numbers

[Sleeprider]

Hello Apnea Board. I'm new here, just recently diagnosed. Love the board and appreciate all the info / help.
I'm 33 year old male, physically fit.

Last night was my first night on the machine and i feel horrible today, don't feel i slept well. I understand it will take some time to get used to and I'm okay with that. What I'm really concerned about is the high numbers of AHI I'm seeing in SleepyHead for my first night. My sleep study a few weeks ago put my AHI at 12. Lastnights AHI shows as 20.55. Seeing this AHI data and the other events is really scaring me thinking something else is wrong. 
I know this is only 1 day but I'm really concerned with the results.

I'm going to post several screenshots of last nights SleepyHead data. I'm just looking for some general guidance on how these numbers look? Is it possible my AHI is so high due to leaks? Any help / input would be greatly appreciated. 

I wrote this entire post and had images all lined up but I wasn't allowed to post images or links as a new member so I guess I'll need to wait until I can and then you can see all the data.

**Updated**
Added images to sleepyhead data



Note: Ignore the first afternoon session, it was just testing.

Well that is impressive!  Could you summarize what your diagnostic sleep study showed please?  Based on essentially no treatment with your current settings, and assuming this is obstructive apnea, I suggest you change your minimum pressure to 10.0 and maximum to 15.0.  I am not optimistic CPAP will work for you at all, so if you feel you are not breathing well using this pressure, please just discontinue therapy. It's possible CPAP is worse for you than no therapy at all.

Also, your statistics show a respiration rate of only 8.4 breaths per minute.  That is pretty low.  It might help if you can zoom in on a 2-3 minute segment so we can see what is happening on these events and your breathing.

I have a suspicion this is not simple obstructive sleep apnea, but would like to see results with a higher minimum pressure to confirm.  If your sleep study showed central or mixed apnea, I think you will have a pretty strong case for complex apnea and will need a different form of therapy. The fact you describe yourself as physically fit, and that the only evaluation you have had is a home sleep study makes me strongly suspect this is central in nature and that you will need ASV therapy. We can look at a few more days of data, but you need a referral for a clinical sleep study with polysomnography to evaluate for central apnea. I would encourage you to get that moving sooner than later.

[Sleeprider]

Fihappy, strike my suggestion to run pressures at 10-15. It's pretty clear that the higher the pressure, the worse your problem gets. My second though is just to set the pressure at 6.5 CPAP and see how it goes. You need enough pressure to limit obstruction, but need to avoid letting the machine run to higher pressures which brings on a lot of complex apnea issues and even more events. If you can post data from last night, that would also be helpful. My suggestion to immediately get a referral for a proper sleep study holds, and it would be ideal if it is a split study to assess a diagnostic, and a second part to see what happens with PAP pressure or to attempt titration.

[fihappy]

No, the leaks are not causing the high AHI.  There are plenty of events when the leak rate is under control.  They will cause a dry mouth if you are mouth breathing and will affect your therapy once you get things ironed out more.  

What I see is that your minimum pressure of four is far too low to allow the machine to ramp up to the pressure that you need in time. I think you will want this closer to 9.  You can try bumping it up to six or seven to start with and then gradually moving it up by 0.5 every few nights, depending on how you tolerate the increased pressure.

You can select that session where you were playing around in Sleepyhead and turn it "off" / disable it.  That will make the graphs easier to interpret.

Gotcha. Thanks for the input. I couldn't select that session, it wouldn't allow me to select it and turn it off. The others I could no problem. Updated my second nights results in the post.

[fihappy]

That is the main problem I see according to those charts you posted. 

You need a chinstrap or a full face mask to properly address the issue. Once that is fixed then the pressure settings can be fine tuned.

So this high of leaks can cause the system to report high ahi and osa events? I woke up a few times with the mask leaking out the side and shooting in my eyes. I did also open my mouth a handful of times intentionally to relieve some mouth pressure. My leak data look bad? 
If so, I may just need to tighten the mask. I'm hoping that's what caused this high ahi.

Imagine 70 lpm of air rushing out of your mouth. That's air that is not being delivered to assist in keeping your airway open. Yes high oral leaking or mask leaks can cause osa.

Your leak values are too high for a nasal mask at those pressures. Either your mask needs to be tightened or you have oral leaking. Or both. Address the leak first.

Turning flex on eliminated the leaks for the most part it looks like. Updated the results in the post.

[fihappy]

Fihappy, strike my suggestion to run pressures at 10-15.  It's pretty clear that the higher the pressure, the worse your problem gets.  My second though is just to set the pressure at 6.5 CPAP and see how it goes.  You need enough pressure to limit obstruction, but need to avoid letting the machine run to higher pressures which brings on a lot of complex apnea issues and even more events.  If you can post data from last night, that would also be helpful.  My suggestion to immediately get a referral for a proper sleep study holds, and it would be ideal if it is a split study to assess a diagnostic, and a second part to see what happens with PAP pressure or to attempt titration.

Thanks SleepRider, appreciate all the info. I updated my post to include my adjustments made and my second night of data. It is significantly different. Looks like I did get some relief and I do feel a little better today. Take a look and let me know your thoughts.

[Sleeprider]

Welcome.  You need four posts before you can use link.  We can figure out links with spaces in them.

First, don't worry.  Take a deep breath.  Relax.  You are going to be fine.

The higher AHI was likely due to the fact that you were awake much of the night.  The machine does not know if you are awake or soundly asleep and your breathing while awake can look like breathing events.  This is very, very common.  In the sleep lab, the monitor your brain waves and can tell if you are awake and discard data when you are not sleeping.

It could also be that your Flex settings are causing central apnea events, reducing Flex usually fixes this (assuming you don't actually have central apnea!).

Updated my post to include the links in text format.

I re-posted the image on the current page.  Much better results.  Once again, it kind of confirms what I said in the previous post.  Your best results are with the lowest pressure.  I don't think Flex is what affected your leak rate, and that is very acceptable.  I still think your best result may be at 6.5-7.0 fixed pressure with no flex.  It's going to take a couple weeks to have this settle out, but your problem still appears to be complex apnea rather than simple OSA.  I guess if the AHI settles to an acceptable rate, that's okay.  At least the event rate is less than half of the previous session...wow.

[fihappy]

Welcome.  You need four posts before you can use link.  We can figure out links with spaces in them.

First, don't worry.  Take a deep breath.  Relax.  You are going to be fine.

The higher AHI was likely due to the fact that you were awake much of the night.  The machine does not know if you are awake or soundly asleep and your breathing while awake can look like breathing events.  This is very, very common.  In the sleep lab, the monitor your brain waves and can tell if you are awake and discard data when you are not sleeping.

It could also be that your Flex settings are causing central apnea events, reducing Flex usually fixes this (assuming you don't actually have central apnea!).

Updated my post to include the links in text format.

I re-posted the image on the current page.  Much better results.  Once again, it kind of confirms what I said in the previous post.  Your best results are with the lowest pressure.  I don't think Flex is what affected your leak rate, and that is very acceptable.  I still think your best result may be at 6.5-7.0 fixed pressure with no flex.  It's going to take a couple weeks to have this settle out, but your problem still appears to be complex apnea rather than simple OSA.  I guess if the AHI settles to an acceptable rate, that's okay.  At least the event rate is less than half of the previous session...wow.

Yes it is very interesting. I also noticed these results have mainly Clear airway events vs OA. The flex definitely made a difference in the amount of air blowing all over my face and eyes that is for sure. I think you are on to something about the lower pressure. Here is the details from my sleep study.

Sleep study info:
Cnt. Index: 0
ApI: 9
AHI: 12
RDI: 37

O2 Saturation:
 Mean: 96.5%    Min: 89.8%
% <90%: 0
% <85%: 0

Time Recorded (hr): 7
Sleep: 6.1

% EFF: 86.4
% REM: 9

[richb]

SR is suggesting a lower fixed pressure to help reduce the Central type events that you are experiencing. The hope is to find a pressure low enough to eliminate or greatly reduce the Central events while providing sufficient pressure to keep your airway open preventing Obstructive events. You do seem quite sensitive to the higher pressures and to the Flex setting. The good result that you had with your pressure change suggests that the lower fixed pressure might be quite beneficial. It would be helpful if you posted a 3 minute (Sleepyhead) clip of some of your events. We could confirm the types of Central Apnea and Hypopnea that you are experiencing.

Rich

[fihappy]

SR is suggesting a lower fixed pressure to help reduce the Central type events that you are experiencing.  The hope is to find a pressure low enough to eliminate or greatly reduce the Central events while providing sufficient pressure to keep your airway open preventing Obstructive events.  You do seem quite sensitive to the higher pressures and to the Flex setting.  The good result that you had with your pressure change suggests that the lower fixed pressure might be quite beneficial.  It would be helpful if you posted a 3 minute (Sleepyhead) clip  of some of your events.  We could confirm the types of Central Apnea and Hypopnea that you are experiencing.  

Rich

Thanks to both SR and Rich. The change I did was to raise the min pressure from 4 to 7 and the flex turned ON with setting 3. 
For this evening I was thinking about changing it to around 6.5 fixed and flex at 2. Thoughts? 
I think I'll have to set it as a range though min6.5-max6.5 because when i change the machine to cpap mode it doesn't give me the relief during exhale.

Here is some more detailed results and closeups.






Another window







And another window

[richb]

Thank you for posting the clips. Your graphs are showing the rising and falling patterns typical of Central Apnea even during periods that are not scored. I would try the 6.5 with no flex. The idea is to eliminate the pressure differential from inhale to exhale. Your machine can just about eliminate Obstructive events but can cause Central events due to the washing out of normal blood CO2 levels. This dual type of Apnea is often referred to as Mixed Apnea. The first goal is to work with the settings to try and eliminate the Central events with lower fixed pressures while still keeping the Obstructive events at bay. 6.5 is a low pressure but is considered in the therapeutic range for Obstructive Apnea. Try tweeking your present machine before looking at other options.

Rich