New CPAP User

[heyitsme]

New CPAP user, used the machine about 7 times so far. I went down the route of getting a CPAP from feeling very tired in the morning, having headaches that felt like I was holding my breath too long, and generally being tired all day. Bought an o2 finger meter from EMAY and saw enough drops under 94 and 90 to look in the CPAP direction further.

I haven't gone to the doctor as it's USA and I'm not exactly sure why I pay for insurance do to the prices that we pay. I found a new Resmed 10 APAP and bought the heated tube to go with the already in unit heated humidifier.  Coupled that with the Dreamwear Nasal mask, a chin strap because I had mouth leaking issues. I should also note I'm a very heavy grinder of my teeth at night and always wear a mouth guard; I've continued to wear and with the chin strap my mouth seems to remain closed at night without tape. I'm about $440 in or so, the Resmed was $325. Cheaper than the doctor route.

Only issues remaining are..
- Do I need a CPAP?
- What does the SleepyHead screenshot tell me?
- Two times using the chinstrap method has resulted in me sleeping for about 6 hours with no leaks, rainouts, or other problems I've had. I have woke up two times after 6 hours for no reason that I can find, normally I would sleep from midnight to 7:30-8AM. Guessing this is due to getting used to the CPAP.

Attached is a screenshot of SleepyHead (I believe I formatted it correctly) and also the o2 finger meter reads from a different time before CPAP was used and after CPAP was used. Based on the o2 readouts (they've correlated to using vs. not using the CPAP positively) it seems to be helping. 

I know this isn't medical advice and I'm not taking it that way. I appreciate any help on insights however. Thank you!

Thank you

[heyitsme]

Should have added in, my significant other noted I've snored loudly, tend to talk in my sleep, and it overall sounds like I'm dying (out of breath). I've also have issues with congestion at night which I've used Afrin for a few times though I don't think you're supposed to use it repeatedly.

Here's the snore data which sounds like it may be needed.

[Gideon]

Welcome to the forum.
Not bad for a start.

Did you have a sleep test? I strongly suspect the answer is no. I was looking for confirmation of the presence or a sense of Central apnea without CPAP.

Do you need CPAP? Based on your SO's observation, yes.

Your pressure is responding to flow limitations, per medical guidelines your obstructive apnea is well treated.

Events represent a continuum from bad to good. Starting with Apnea, then to hypopneas, to flow limits, and finally to normal. Flow limits are largely ignored by the medical community because there is not set value for them to call normal.

I'd like to reduce your flow limits so that they don't cause a significant pressure increase.

The issue is that by doing so it is likely I'll increase your Central apnea numbers.

To understand your Central Apneas i need more info.

During the dense cluster toward the start of the night were you awake? If so we ignore those but I still want to look at them.

I would like you to provide a two minute view of that dense cluster at the start of the night and a couple of the other Central events. That is click on the events untill the chart shows 2 minutes across the screen. That will tell us more of what is happening.

[heyitsme]

No on the sleep test. It would be nice to see the results without the machine though I can't see going through all the troubles of doing so. 

Thank you for your response. I was awake at the time though from the flow rate I think that's right before I went to bed, before is erratic. 1st shot is the full series at start and the second is the 2 minute requested.

Got through about 7 hours yesterday and I definitely feel a difference, I think I woke up midway though was able to go back to sleep. The first day I used it I woke up more awake than I ever have.

Looking forward to your thoughts and thank you again. I can upload more data if needed from this morning if it helps. I did end up changing the minimum pressure to 6 before reading your post to see if there we less events. Haven't looked at it yet.

[Gideon]

A 2. Minute view of the central at 225 please

[heyitsme]

2 minute is attached, thank you.

[heyitsme]

From last night, doesn't look good. The large leaks (grey) towards the end were me waking up. Pressure was on 6-15 instead of 5-15. Second attachment are the events starting at 4:05, I'm pretty certain I was asleep then.

[Gideon]

See how the flow rate slowly decreases up to the central, and then slowly increases after the event. This is an indication that the CPAP has increased the efficiency of your breathing and as such is washing out too much CO2 from your blood to below your apneic threshold resulting in a central apnea. In your case a treatment-emergent central apnea. Note that having a "low" CO2 concentration is the primary signal that you (incorrectly) have no need to breathe. Typically these disappear on their own in 2-3 months as your body adjusts.

I do want to add EPR in slowly (you will likely need EPR=3) to manage your flow limits. Your min pressure should = 4+ EPR.

I would also like you to try Min = max = 4 with EPR off for at least part of the night (1-2 hours). This is the min capability of the machine and I would like to see if any obstructive events become evident. This is to see if obstructive events become apparent. If no, do we can say that you are 'well treated" at the machines min. If they do show in any kind of number we can say that you do have OSA.

So
Min = Max = 4 EPR =0 or off for 1-2 hrs.

Then

Min = 5, Max=15, EPR=1 Small bump in EPR to mitigate the potential increase in Centrals

[heyitsme]

Great info, will give it a shot tonight. Side note I feel like I've had two coffee drinks already this morning even though I haven't, no brain fog or anything like that, wide awake. Thank you

[DaveL]

See how the flow rate slowly decreases up to the central, and then slowly increases after the event.  This is an indication that the CPAP has increased the efficiency of your breathing and as such is washing out too much CO2 from your blood to below your apneic threshold resulting in a central apnea.  In your case a treatment-emergent central apnea.  Note that having a "low" CO2 concentration is the primary signal that you (incorrectly) have no need to breathe.  Typically these disappear on their own in 2-3 months as your body adjusts.  

I do want to add EPR in slowly (you will likely need EPR=3) to manage your flow limits.  Your min pressure should = 4+ EPR.

I would also like you to try Min = max = 4 with EPR off for at least part of the night (1-2 hours).  This is the min capability of the machine and I would like to see if any obstructive events become evident.  This is to see if obstructive events become apparent.  If no, do we can say that you are 'well treated" at the machines min.  If they do show in any kind of number we can say that you do have OSA.

So
Min = Max = 4 EPR =0 or off for 1-2 hrs.

Then

Min = 5, Max=15, EPR=1  Small bump in EPR to mitigate the potential increase in Centrals

I am so impressed. That's an incredible observation. (What a difference from my care.  My old sleep doc from heck used to look at my cpap to be sure I had it turned on; then he would write me a slightly higher prescription and I would book another appointment in 18 months...)