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05-13-2024, 03:41 PM (This post was last modified: 05-13-2024, 03:53 PM by yb202.)
Newbie help
Hello everyone,
I am new both to this forum and using Oscar. I am having difficulty getting my AHI below 5 and would appreciate your advice on understanding what is happening with my readings, and any suggestions to improve my situation. For a bit of context, I use nasal pillows and do have regular issues with congested sinuses (had numerous procedures done to try and alleviate that). I tried a full face mask but didn't have much success with it as I am a slide sleeper and had a lot of leaking. I decided to get an SD card a while back and try to better understand what is happening.
I have attached my readings. It looks like My clear airway and hypopnea readings are higher than my Obstructive apneas. My sleep doctor ran a sleep study on me, but the results stated I do not have Central Sleep apnea. Any help or advice would be welcome.
05-13-2024, 04:23 PM (This post was last modified: 05-13-2024, 04:25 PM by PeaceLoveAndPizza.)
RE: Newbie help
You do not have proper settings for you. Not enough pressure nor pressure support with the current configuration.
Try the following:
Mode APAP
Min pressure 10
Max pressure 15
EPR 2 full-time
The extra pressure will help with the OA and H events, and the pressure support will reduce flow limitations and help with comfort. Your EPAP will be the same as your fixed pressure, at least to start. As the pressure increases to handle the events, EPR will make it more comfortable and help manage the pressure swings. We will have to see how your CA’s respond to the EPR.
Note we will likely have to tweak things a bit further, but let’s wait a few days. Post a new chart then and we can adjust from there.
Many times people who have just started get some centrals because your body is not use to the therapy and will adjust in a few weeks. So it is a wait and see if you continue to have that problem.
You are on a constant pressure of 8. Have you tried a range of pressure to see how that effects you?
You have 2 main problems:
First you have positional apnea. You can see positional apnea where either H or Oa events are clustered together. Getting rid of as many as you can will lower your AHI. Positional apnea can NOT be controlled by pressure changes. You have to find out what position you are getting into and cutting off your own airway. Have you changed your sleep position? Sleeping on your back? Using more (or new) pillows? These things can cause positional apnea by chin dropping to your sternum and cutting your airway. Think of it of a kinked hose – nothing can get through – you have to unkink the hose…
IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar. I have a link to collars in my signature at the bottom of the page. It shows people who are not wearing a collar and the SAME person wearing a collar. There is a huge difference between the two.
The second is high flow limits. Flow limits are apnea also just like H and Oa events. They cause 2 problems, they drive up pressure (your do not because you are on a fixed number 8) and they stop you from getting into deeper sleep or can wake you up. We use EPR (exhale Pressure Relief) to help with flow limits but in some people they cause centrals until the user is use to them. You already have so centrals so I'm not suggesting we do that right now.
So the main thing you can do is stop the positional apnea with a collar or sleep position changes.
Thank you for getting back to me. My CPAP machine is set by a CPAP store who I was assigned to by the sleep clinic. My doctor probably won't like it if I make changes without discussing with him first. The current settings are based on a titration study I had at the sleep clinic. I should have mentioned this earlier, my AHI without CPAP is over 40. You mentioned I need extra pressure for my OA, apologies if this is an ignorant question, I thought MY OA was low?
Thank you for that information. I am a side sleeper but it is very possible I turn in my sleep. Will check the collars as you suggested.
I have been using the CPAP machine for around 4 years now. My compliance wasn't too great initially but have started to take it seriously since a year ago. Is there an average time when centrals should be decreasing for new users? I attached my historical data in case it provides more insight. Thanks again for taking the time to help.
Well..... I have an excellent DME, but they set my unit incorrectly, with a fixed setting, and I had 150+ central apneas each of the first few nights. So, yep, prolly saved my life that I changed the settings, even though I assume I'm not "supposed" to.
So, yep, taking control of your therapy will likely mean handling your settings. That's the nature of the beast, whether docs and DME's like it or not.
However, DME's are most interested in having you meet the insurance thresholds. They call this "compliance", aka "successful". And, they have to get you below 5 in AHI. This is evidently how they make their bucks. Their bottom line depends on compliant customers. So, I don't think they're gonna care what you do with the settings if they can notch you up as compliant. Same with the doc: it's all about numbers. If your chart looks good, how are they gonna argue? The current settings clearly don't work.
To start let us define a cental. It is holding your breath, no obstruction is found and lasting 10 seconds or more. All of us do this sometime at night - while turning over in bed, pulling up covers or adjusting a pillow. And if it is at the beginning of the night or right before we wake up we don't really worry about those.
You do not have many and I would not worry much about them unless they are clustered together for a period of time. The other thing to know is the machine is not 100% on if it is a real central. If you were in a sleep lab with wires connected and a belt around your chest to measure your attempt to breath or not, then we would know for sure.
Again, you don't have enough to worry about. Your positional apnea is what you should focus on. I agree that EPR should be looked at to make your therapy better but again I would wait until we get the PA taken care of.
I ordered the Caldera Releaf Neck Rest, it arrived last week. Have been using it but unfortunately haven't seen much improvement. I have an appointment booked in with the sleep clinic later this month where I will bring up the pressure. If you have any other suggestions, it would be very welcome. I have attached two days of readings using the neck brace.
