Help Lowering a Varying AHI for a Newbie

[rtkierke]

Hello all! I recently started cpap therapy on Monday, and after getting over a rough first few nights, I have started to get used to the feeling of suffocating and not being able to exhale while falling asleep. This was causing a very rough adjustment, several panic attacks, and CA events the first three nights (including inability to fall asleep due to max pressure ramp up). Now (after switching from cradle to pillows and getting adjusted), I am getting varying AHI when I sleep. Night before last I had 1.0, but last night, I had 2.4 and feel noticeably less rested. I have read through much of the Oscar wiki but am struggling to understand what I should change or what is occurring. I was hoping you fine folks could help. What can I do to improve my therapy results? (One thing I've noticed is the extreme inhalatory saw wave shape versus a sinusoidal shape. Example in last image.)

Info:
Resmed Autoset 10
p30i
(history of arm movement in sleep; chronic pain/atypical trigeminal neuralgia; severe TMJD)

Overview: 
[attachment=61342]

10min Representative OA Small Cluster:
[attachment=61343]


Random High Zoom:
[attachment=61343]

[PeaceLoveAndPizza]

My opinion is you would benefit by doing a few things. 

First, turn off ramp unless it is absolutely necessary. You are not getting therapy during that time and the pressure increase may be disruptive to deeper sleep states.

Second, I think you would be better served setting your minimum pressure to 8. Your median is just about 8 as determined by the machine and it should be used as the starting pressure. If it feels like too much you could use 7, then increase a wee bit over a few nights.

Min pressure 8
Max pressure 15
EPR 3 full-time
Ramp off

That should help with the pressure swing related arousals. Your flow limitations are acceptable, but we need to keep an eye on that as well in case there is a change with the new settings.

[rtkierke]

Thanks for your response! I thought the level was auto set. I haven't seen any options to change minimum pressure. Am I overlooking it due to a name or placement? I'll try it without the ramp tonight.

[rtkierke]

Nevermind! I found out how by using this crazy site called Google   I'll try for a couple nights and report back. Appreciate you and any other readers for the advice.

[HalfAsleep]

I recognize this problem. I recently had a titration sleep study and the tech just about killed me by setting the CPAP minimum to 4. I felt as though there was no air to exhale. I've never experienced anything like this. My ribs cramped, I tried squeeeezing with my lungs, my arms got pins and needles: no air. I verified there was in fact air of some sort coming out of my mouth, because I tried mouth breathing for a few breaths. The tech made a few adjustments, and finally he settled on giving me way more pressure. Voilà, I fell asleep immediately. I never want to go through that again.

Moral of my story: many folks feel like they can't exhale at 4. It's not just you.

[rtkierke]

After a rough hour adjusting, it was good for the first night, but it went back up to 2.5 last night and I feel noticeably well rested. 

Not so good last night:
[attachment=61490]

Better night before last:
[attachment=61491]

Random zoom of not so good last night:
[attachment=61492]

Any and all advice is welcome and much appreciated. The numbers belie the difference in feeling.

---

Other zooms:
[attachment=61493]

[attachment=61494]

[rtkierke]

And it is continuing and...possibly worsening? Earlier I meant to say noticeably less well rested. Last night it was 2.75 and now with more CAs than ever before...by a large margin. All I did was change the minimum from 8 to 8.6. Am I seeing my periodic arm movements here? I was definitely waking up with a couple minor leaks. The AHI may seem low, but the feeling between 1 and 2.7 is night and day for me. I feel pretty crappy today. 

Last night: 
[attachment=61530]

[PeaceLoveAndPizza]

The CA’s at the end look to possibly be SWJ (sleep wake junk), meaning you are waking up or already awake. The machine is not meant to deal with awake breathing, so seeing CA’s are not unusual in that scenario. 

I suggest increasing your min pressure to 10 and reducing the max pressure to 12 to constrain the pressure swings. We may need to increase the max a bit, but lets focus on the OA’s for now. A bit more pressure may be enough to deal with those.

Regarding the CA’s, once the OA’s are managed you can try decreasing EPR from 3 to 2 and see if that impacts them. It is not unusual to have CA’s when starting CPAP, so rather than focusing on them right now, for the moment I want to see the OA’s response to a bit more pressure.

For now try these settings…

Min pressure 10
Max pressure 12
EPR 3 full-time
No ramp

Then, depending on how things go in a week or so if the CA’s remain you try…

Min pressure 10
Max pressure 12
EPR 2 full-time
No ramp

[rtkierke]

Your advice is most welcome, once again. I'll give it a try for the next few nights and report back.

[rtkierke]

Update time! I'm interested in what you make of this. I feel I may need to up my max pressure. I also switched from the p30i to the N20 AirTouch (memory foam) and get a much more secure feeling fit across positions (though I am getting moisture build up in the mask). 

Most recent night: 
[attachment=61699] (w N20)

Previous two nights:
[attachment=61700] (w N20)

[attachment=61701] (w p30i)