NOOB Data - Looking for Guidance

[FOMO]

Hello Everyone!  I am new to CPAP and this Forum (I joined last week).   I have been using my Dream Station for the last 11 nights.  I did a sleep study (I don't have a copy) and was told I had moderate to severe sleep apnea - the AHI was 33 when sleeping.  Even though my current AHI numbers are pretty high they are significantly reduced from the sleep study.  I posted two data screenshots below.  The first is the 'best' night I have had and the second is more typical of the results I am seeing.

What I have learned from review of the event graph and flow graph is that the large clusters of events occur during periods of wakefulness.  Typically at both ends of the chart and times when I get up and then try to fall back to sleep.  The periods in between the clusters when I am sleeping seem to be pretty good so the therapy is definitely working when asleep.

My unit is set to Auto (APAP) and the pressure range is 4cmH20 - 20cmH20.

[attachment=13977][attachment=13978]

The large gap in the first graph was caused by not reconnecting the mask after getting up.  I laid down, decided to let my body level out for a minute or two before reconnecting and fell asleep.

Any guidance on how to lower the AHI (particularly the CA events) would be greatly appreciated.

[Gideon]

It is important to see if you have central apnea prior to treatment.  It is possible that your Central Apnea is treatment-emergent if so it should take 2-3 months to dissipate.  

Flex can have a negative impact on Central Apneas so first I'm going to suggest that you turn flex off.
To reduce a bit of your obstructive event I suggest raising your min pressure to 6.

It is possible that raising the min pressure will also increase your central apnea.  If so we will re-evaluate and see where we go from there.

It is also important for you to relay how you feel, how you think the changes are impacting you.

[ajack]

I would ignore the CA events for now. There are a couple of clusters, but overall they are low. As bonjour said, they resolve for most people as you progress. For the obstructive OA/H, I would raise the min pressure to 6 and see what it cleans up. Your apnea is being treated in the low end of the pressure range, which makes it easier for you. You may finish up on min 7 or 8

[FOMO]

Thank you for these suggestions. I really appreciate your help.  

I did make a change prior to receiving your comments based on my understanding from reading other threads.  Assuming the CA's were mostly therapy induced (caused by the pressure) I reviewed my pressure readings and lowered the maximum pressure to 7.5 producing a range of 4-7.5.  This did significantly lower the number of CA's in the "falling asleep" cluster but the OA's increased.  I had much fewer OA's while sleeping though.  

After receiving your post last night I tried turning off the flex which made it very uncomfortable for me so I ended up dropping it from a setting of 2 to 1 instead.  I will leave the settings alone for a few nights to let things settle down before introducing the additional change and will post updated charts for review at that time.

[FOMO]

Hi - attached below is my chart from last night.  As described above my APAP settings were set at 4cm - 7.5cm with the flex setting moved from 2 to 1.
I was awake, trying to fall asleep, during the cluster at the far left.  I was also awakened by sounds I got up to investigate just prior to the cluster in the middle of the chart - there is a small break just before the pressure began to ramp up after turning the machine back on.  Overall the CA counts have decreased since dropping the max pressure and dropping the flex to 1.

I feel like I slept better last night and feel more rested today.

Additional Info:  The problem that caused me to have a sleep study in the first place was not being able to fall asleep in a reasonable amount of time and at a reasonable hour.  My entire sleep cycle seemed out of whack.  The sleep study determined that even when I did get sleep it was not quality sleep. From the report "The patient's Apnea Hypopnea Index (pAHI) was 21.9 events per hour of sleep.  The patient's Respiratory Disturbance Index was 30.1 events per hour, increasing up to 44.5 per hour in REM sleep".  
Two weeks ago I began forcing myself to adhere to a reasonably normal schedule.  In bed by midnight and up around eight regardless of the quality / quantity of my sleep.  I also committed to wearing the mask all night - even if I did not sleep (I had major claustrophobic issues with the full mask, tried nasal pillows and the under nose nasal type as well without success).  So far I have been successful keeping the mask on all night - a few gasps here and there but making good progress.

Do you still recommend bumping the minimum up to 6cm?  if so, should I leave the max at 7.5cm or raise that back up to 20cm?

Let me know your thoughts  ...…..

[attachment=14077]

[Gideon]

Set Max = 7 (to limit pressure excursions)
set Min = 6 (6 is typically a comfortable pressure and should help with obstructive events.)
set Flex = Off

as I said before, Flex can have a negative impact on Central Apneas so first I'm going to suggest that you turn flex off.

I'm going to ignore everything before about 00:05 (5 min after midnight) assuming you are tossing and turning and causing false centrals, this is not uncommon.

Your obstructive are showing some clustering which indicates that you are tucking your chin down and thus increasing your airway resistance.  I call this positional apnea.  This can be corrected with a loose fitting  soft cervical collar.

You have enough obstructive apnea, hypopnea, and flow limits to indicate that you would benefit from an increase in pressure.  We should hold off on that until we see that the above changes bring.

[FOMO]

Thank you for reviewing so promptly.

I modified the settings as suggested and added a ramp-up of 15 minutes. I am hopeful the ramp-up will help me comfortably adjust to the 'no flex' setting. When I tried turning the flex off the other night I was not able to tolerate it very well so ended up just lowering it from 2 to 1. Let me know if there are any concerns with adding this ramp-up.

I will leave settings as-is for the next couple of nights and post further results for review.

[FOMO]

Good Morning.  I am feeling better in spite of my high AHI counts.  I am encouraged by the improvements but know there is a long way to go and a lot more benefit to be had from this therapy.

Bonjour, thanks for your advice - it is making a difference!  I made the changes suggested (max 7 , min 6, flex=off, cervical collar) four nights ago and posted a couple of nights results below (the best night and last night) for your review.  I have found that ramp-up does help so would prefer to keep it if that is not causing issues.

About last night:  There are three significant clusters during periods when I was awake and trying to fall asleep - at the beginning, at the end, and around 2am after reurning from the bathroom.  There is another large cluster when I was tossing and turning around 5am and woke up.  I included a zoomed-in screenshot of this time period below. 

The number of events during my actual 'sleep time' seems to be decreasing which is a very good thing and those numbers are extremely favorable compared to the 21.9 AHI (OA and HA only) noted during my sleep study.

I feel like these current settings have settled in and am ready for the next 'tweak'.

Suggestions?

[attachment=14245][attachment=14244][attachment=14246]

[Gideon]

We will try Max=7, min =7  Basically a straight pressure.  If this doesn't work we will try max = 6, Min = 6.
That will eliminate all pressure variation.
Then we will see if we need to consider an ASV.  

the steps will be to (sorry) ignore the central apnea and properly treat all your obstructive apnea and demonstrate that your Central apnea is bad.
then get your doctor on board.  Not there yet, I'm thinking ahead.

[FOMO]

Thank you.  This approach seems logical and I incorporated changes as suggested (7 min, 7 max). I will provide updated charts in 3 - 4 days after changes settle down.