New Machine Higher AHI

[Hauty]

Hello!

I'm new here but have been diagnosed with sleep apnea for 10 years.  I have been using the same system one cpap machine up until about a month ago when Philips sent me a dreamstation 2 due to the system one recall.  I took the dream station into my cpap shop and they setup with pressure to match my prescription's pressure.  The first night of use I noticed that my AHI episodes were a bit higher with the new machine but chalked it up to me getting used to a different machine.  As days went on my AHI episodes kept climbing to the point of hitting over 20 AHI average.  Over the 10 years that I used my system one I only saw my average AHI episodes hit over 20 less than 5 times.  I have now had multiple nights of over 20 AHI average in the past couple weeks.  My wife has told me that she has woken up from air rushing out of my mouth.  This has only happened 2 times, in 10 years, with my old machine.  I haven't had a good night of sleep since using the new machine. I have adjusted my low end pressure, the AFlex settings, turned on ramp, turned off ramp, tried new nasal pillows, tried new actual pillow and cannot get my AHI episodes under control.  I downloaded oscar to get more information on what is going on and could really use some help.  I am exhausted and in desperate for a good night of sleep!  I attached a screenshot of last night's sleep, which was so bad I had to sleep for an hour without the cpap.  I don't know how to read this information and was wondering if someone can help me out!

Thanks!!

[SarcasticDave94]

Welcome to Apnea Board,

You're getting a lot of Central Apnea on the chart. Was this normal before the machine change?

Also, what was the specific System One called? Something like Auto SV? Any idea what your diagnosis was? Were CA present fairly frequently before?

My reason for asking these questions, Central Apnea may have been what your previous machine was designed for, and in that case this is the wrong machine. We're only at the maybe stage at this time however.

I would suggest flex 2 at the most, avoid Ramp if possible.

[Hauty]

SarcasticDave94,

Thank you for the speedy response!  To be honest with you I haven't really dug into this kind of information with my nights sleep until I got the new machine.  My old machine was a philips respironics REMstar Auto A-flex.  When I was looking for the manual to find the model number, since I sent it to philips already for the recall, I found a report my sleep doctor printed out in 2014. I did have some central apnea episodes but nothing higher than 5 for the handful of days the printout covered.  That was the last time I have every looked deep into how my night of sleep has been.  I've always averaged below 10 ahi per night and never really needed to dig into what was going on.

Currently I have the ramp off.  I didn't have that feature on my last machine and didn't find it necessary to have on.

Something maybe weird, maybe not weird, about my sleep apnea is that the harder I sleep (like having very vivid dreams) the worse I feel when waking up and the higher my AHI episodes are.  On the opposite end of it I've noticed that if I have any amount of alcohol before bed, my AHI episodes are super low.  I had brought this up to my doctor years ago and there was zero answer as to why.  Now that you brought up central sleep apnea its getting me thinking that my AHI episodes are higher the deeper the sleep, its possible my central sleep apnea happens more and since alcohol doesn't let me enter that deep sleep, that is why my episodes are lower.  Not sure if this is all related but its something that popped into my head.

[Phaleronic]

As Dave noticed there are lots of CA events in that daily chart. Did you have a-flex enabled on the old machine? I believe the DS2 can do either c-flex or a-flex and it may be set to c-flex...

[Hauty]

Phaleronic,

I'm fairly confident that A-flex was enabled on my last machine.  I didn't have to mess with it alot since it was setup originally.

I couldn't find any other settings besides 1,2,3 for the flex settings in the DS2.  Not sure if its doing A-flex or C-flex, and honestly I've never heard of C-flex.

[Abrecaminos]

What was your average of central apnea events with the other machine and before you started using the CPAP machine (in the first sleep studio)?

Your obstructive apnea is controlled, but it is possible that the CPAP machine itself contributes in part to your central apnea episodes.

I have only been using CPAP for 5 years, and rather than giving you an advice, I think you should find the cause(s) of your central apnea on your own and with the help of your doctor (if they are not just idiopathic). Also, your doctor or someone with more experience could tell you if an ASV (Adaptive servo-ventilation) machine might be good for you.

[Hauty]

Honestly I don't really know what my CSA events were before the new machine.  I never had to dig into my nightly episodes as things were working just fine.  I am starting to wonder if the new machine is causing more CSA events than my old one.  The A-Flex on my last machine seemed to breath with me vs the new machine seems to just lower the pressure when I exhale.  The old machine seemed to lower the pressure when I exhaled and then increased the pressure when I inhaled where I can't feel the inhale pressure push with the new machine.  I was hoping there was a setting I was missing that would fix this but it sounds like a Dr. visit might be in order.