I could use some help

[tiredaf]

Hello all,

 This is my first post but I've already learned a lot by reading others so, thank you for this resource. Original AHI of 21.3 as per home study.

 I really need to get my AHI down below 5 consistently. When my cpap machine showed up (AirSense 11) it was preset at a range of 5-15. I struggled for about a month just wearing the mask but finally got comfortable with a P30i. My AHI stayed slightly below 5 for the first 3-4 nights then it started going all over the place from 4 up to 15.

 After an overnight sleep study, they found my optimal pressure to be 10 so they set the machine at a constant 10. I felt like a puffer fish that night, cheeks puffing out, air leaking out my mouth, with an AHI of 12.6

Last night I set it back to 5-15 and made a concerted effort to sleep on my side and ended up with a 4.8 which isn't great but it was an improvement. 

I'm starting to lose faith in my sleep doctor and would like to get this machine dialed in. If someone could help me decipher what is going on and offer some advice how to improve my sleep, I would be grateful.

Thanks in advance. 

Edit: Sorry, I'm having trouble importing an image of my data, stand by

[tiredaf]

Please see attached thumbnail

[Gideon]

Welcome to the forum.

First your min pressure of 5 conflicts with your EPR of 3. Your min should not be less than 7.

Because your Rx was 10 fixed, and you had trouble with it let's set your min at 8.

So.

Min=8
Max=15
EPR=3, Fulltime.
Ramp=Off, if you need it we will turn it back on.

Because you are experiencing some centrals we would like to know if you had them pre-Cpap. Could you post a copy of your sleep Studies these should include charts and tables in addition to the narrative. Please redact your personal info as no one here needs your name, address, phone number, mother's maiden name etc

[tiredaf]

Thank you!

 Below is the data from the pre-cpap home sleep study. Hopefully Copy and Paste is acceptable..

Study Overview
The study began (Lights Out) at 8:53:14 PM. Baseline SPO2 was
91%. Nadir SPO2 was 81%. Snoring was present. Sleep disordered
breathing events were documented. The study ended (Lights On) at
2:54:56 AM. The patient was monitored for a total of 361.7
minutes.

Respiratory Data
A total of 38 apnea events occurred for an apnea index of
6.5/hour. 87 hypopnea events occurred for a hypopnea index of
14.8/hour. 125 apnea and hypopnea events were observed during the
analysis period as follows, 36 obstructive apneas, 2 central
apneas, 0 mixed apneas, and 87 hypopneas for an apnea/hypopnea
index of 21.3/hour.

There were 115 oxygen desaturations that occurred during the
study. Desaturations were based on 3% or greater drop from
baseline. The lowest SpO2 was 81% with an average of 91%. Last,
the minimum SpO2 value associated with a respiratory event was
81%.

Cardiac Data
The average heart rate during sleep was 58.8 bpm. The highest
heart rate during recording was 91 bpm. The lowest heart rate was
48.

Diagnosis:
Overall AHI of 21.3/hour.

[Gideon]

Great. Your Centrals are most likely Treatment Emergent Central Apnea and will likely go away on their own over the next 2-3 months but we will keep an eye on them. Do note that these centrals are commonly sensitive to the EPR setting.

These centrals are occuring because your CPAP is flushing more CO2 from your system to below your apneic threshold. You should know that our drive to breathe is, simply put, driven by the need to eliminate CO2 and its byproducts, not from our need for oxygen.

[tiredaf]

Well, I've already learned more from you than my clinician.  I've made the recommended changes to my machine, we'll see how it goes. Thank you

[tiredaf]

[attachment=47271][attachment=47272][attachment=47271]Here are the results from the last 2 nights using the new settings. AHI went back up but I'm guessing it's because of the higher pressure setting? In OSCAR, where can I find the numbers that differentiate the Obstructive and Central apneas? Is Central apnea the same as Clear Airway? Thank you

[Crimson Nape]

For our purpose, the terms "Central" and "Clear" are interchangeable. Meaning, the apnea was not caused by an obstruction. The technical terminology seems to be different, but requires an EKG for determination. Using an EPR can exacerbate CAs. Your OAs seem to be positional. Hove you considered reducing the EPR value to see what happens?

- Red

[tiredaf]

I haven't tried reducing the EPR. I'm still very new to this so I'm not versed enough to troubleshoot my issues. Gideon seemed to think the Centrals would probably clear up in time, I hope that's the case. Right now I'm taking a throw-everything-at-the-wall-and-see-what-sticks approach. Should I be giving all these machine setting changes a few nights to work, or is it possible to see immediate results?

[Crimson Nape]

Yes! You should always allow time for changes to work. A lot of time, a change will appear immediately, others will require a few days. The longer time is because your body may need to learn to adjust to its new environment. Another thing is to limit the changes you make. Try sticking to one or two at a time.

Patience is the key. . . I know, you want patience, and you want it NOW!

- Red