New APAP user requesting evaluation

[JimIve]

I’m a new APAP user (1 week) and looking for some feedback on my charts, things to try next, concerns etc.

A bit of background… Diagnosed with severe obstructive sleep apnea (AHI=50/hr) after taking a ResMed Sleep monitor home for the night just over a month ago.  Haven’t had an overnight in lab sleep tritiation (been
told by the DME at my location that they Tritrate pressures instead by using an APAP for a few weeks).  DME has difficulties communicating, so I’ve decided I’m better figuring this out for myself and then
finding another sleep specialist to check on things when I have everything stable.
...
(I'll dribble this in over a few posts to this thread so I can add my SleepyHead Images at the end, as New Users require 4 posts to post images)

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I’ve purchased an AirSense 10 AutoSet, Heated Hose, AirFit P10.  I reached 100% compliance from the start, been using it every night , and haven’t experienced notable air leaks.  Sleep has
been similar to normal (8 hrs), although some nights more than usual and some have been an hour less due to being hooked up to equipment (i.e. uncomfortable), range 7.1 - 9.5 Hrs.

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Had issues with sores on the outside of the nostrils initially, but resolved that with less tension on the nasal pillows and Lanisinoh to heal it and to stop the pillows moving around at night (thanks to the great advice found on this forum).

[JimIve]

 Also tried a Dreamwear Gel Mask for 6 hours one night, but felt I couldn’t get enough air through it due to sleeping on my side restricting one of the pipes, so returned to the P10 mask.  If they could make a P10 with the Gel Pillows like the Dreamwear,
I’d be golden :-) .  I’m not mouth breathing and am using the tongue against the roof of the mouth technique recommended on this forum.  I have a Pulse Oximeter in transit.

[JimIve]

myAir reports an AHI range of 1-3.1 and a score of 95-100.  I live at 3000ft.

I’ve been at the default pressure, 4-20 from the start until 2 days ago, when I changed from 6-20.

Other Settings are:

• Ramp Time:Auto
  
• Start Pressure:6
  
• EPR: On
  
• EPR Type: FullTime
  
• EPR Level:3
  
• Climate Control:Auto
  
• Tube Temp:Auto
  
• SmartStart:On
  

[Sleeprider]

If you have some images on Imgur, you can post the link with a space before you have the 4 posts and member status...
for example h ttp://URL

[JimIve]

One item of particular concern to me is that the overall AHI is okay (<5), but the individual hourly AHI in SleepyHead has been as high as 7, 10 and 12 and other days around 3-4.

[JimIve]

Here’s my sleep study results:




Here’s the last 2 nights at Min Pressure 6 (one good one poor):






Here's a poor night at Min Pressure 4:

[Sleeprider]

One item of particular concern to me is that the overall AHI is okay (<5), but the individual hourly AHI in SleepyHead has been as high as 7, 10 and 12 and other days around 3-4.

You are using pressure 7-20 with EPR 3 and the pressure really doesn't go over 16 cm.  I think your pressure is fine, and you tolerate the EPR well.  With your pressure in that range with EPR your exhale (EPAP) pressure starts at 4.0 and gets to about 12-13, so your pressure range should be fairly comfortable.  I think the clustering of obstructive events is not a serious concern, and would respond better to positional therapy or a soft cervical collar than doing anything with pressure. 

The sleep study is interesting, and I rarely see anyone with significant time in the prone position.  Your CPAP therapy is treating you well, and nothing is critical here. If you're tolerate of pressure, you might go to 8.0 cm minimum, keep EPR where it is.  Maximum CPAP pressure does not really enter into anything, and your machine is reacting to OA events appropriately.  A higher minimum pressure might avoid some of the OA events which don't have much preceding snore or flow limit to raise pressure ahead of them.  Avoid letting your chin tuck to your chest by pulling your pillow onto your shoulder when you sleep on your side, or using the soft collar, and the AHI spikes should disappear.

[JimIve]

Sleeprider: Thanks for your time/help, I'll try that advice out piece by piece and report back with results.  Didn't realize that EPR was reducing the the pressure by 3 cm, might explain why I felt short of breath with the Dreamwear sleeping on side @ 4cm.

Regarding the prone position during the study, that was an anomaly, for some reason for part of it I slept "nearly" flat with head twisted sideways, waist band gadget would have read flat instead of sideways, also was accompanied with frequent wakeups gasping for air, when I was finally lucid enough to figure it out, I changed position.  Because of that I got the charts from the DME because I wanted to make sure it wasn't that, that caused the Severe Apnea conclusion.  It was the worst period of desaturation (80%), but I also was down to about 84% when on the left, so conclusion that I needed a CPAP was convincing.

[trish6hundred]

Hi JimIve,
WELCOME! to the forum.!
Good luck with CPAP therapy.

[ajack]

The machine adjusts pressure after the obstructive event. So that is why having the minimum pressure set is important. Sleeprider's suggestion of 8 should take care of most of them.