[Pressure] New to CPAP - trying to titrate

[grubsztyl]

Hey there,

I was recently diagnosed with mild sleep apnea of AHI 6.8. Despite my apnea being mild, I can't recall a single night in past 20 years waking up refreshed or rested. I experienced brain fog, morning headaches, difficulty concentrating, memory issues, struggling to keep awake while driving. I'm in my 30s, not obese and fairly fit. 

I did at-home simple PG study. I think my AHI might be actually higher because they combined two nights into one, and the first night I barely slept. Also the oximeter malfunctioned one night, I was told it must had fallen off for at least three hours but that's untrue, it was literally taped to my finger and I woke up wearing it.

Nevertheless, I decided to buy an AirSense 10 AutoSet and tested it for one night. Even though I had difficulty falling asleep and woke up around 3 am and had troubles falling back asleep, I was surprised to wake up feeling very alert. It felt like the brain fog was literally lifted, even though I felt I barely slept. No morning headache. Amazing. Still, I feel something's off because I woke up in the middle of the night. I can see pressure in OSCAR steadily dropping before I woke up.

OSCAR shows that I still had AHI of 3 and flow limitation of 0.21. I'm not sure where to begin to fix this. I read that minimum pressure is to be 2 cm lower than Med - so it was. I read that the way to reduce flow limitation is to increase EPR to 3 - it was already set to that. Ramp is off. How to proceed from here?

I'm attaching OSCAR screenshot.

[Sleeprider]

Your obstructive apnea all occur in clusters, which is likely positional. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

Regarding settings, you are using 6.0 minimum, 20.0 maximum and EPR 3. You need to increase your minimum pressure to 7.0 in order to make the EPR consistent. With a minimum pressure of 6.0, you only get 2-cm of EPR and exhale pressure (EPAP) remains at 4.0 until pressure rises above 7.0. I think if you resolve the positional apnea with some adjustments to pillows or a soft cervical collar, you can easily reduce the maximum pressure to 12.0. Try to get a bit more sleep. Most of us need 7 to 8 hours to feel rested.

[grubsztyl]

Thank you very much Sleeprider, I will make necessary adjustments and report with the results.

[grubsztyl]

I slept on a very flat pillow last night and it seems the apneas are no longer cluttered together but rather spread throughout the night... I slept worse today than last night too. I know I should sleep longer but it is what it is - I work long hours this week and can't help it. I also experienced some major leak in the early morning and woke up because of it. I've received today foam cushion for my F20, perhaps it will be more comfortable and leakproof because I have a short beard.

Per Sleeprider's helpful suggestions, I will be limiting max. pressure tonight to 12. I'm still worried about the flow limitation, though. We'll see what tonight brings. I'm attaching new Oscar screenshot.

[Sleeprider]

Here's what you did. The 95% flow limits reduced from 0.04 to zero, which is actually better than you think. Tidal volume and minute vent came up. The CA events went away but you have more OA, so very simply, you need to raise minimum pressure to resolve that. If you feel sporty, raise minimum pressure to 9.0 and that should take care of most events. If you're reluctant to go with that, at least move to 8.0 and let's see how much work remains.

[grubsztyl]

Day before tomorrow should be scratched off... I switched the silicon mask to foam and it leaked all over the place, I couldn't get proper seal. My AHI was over 8 which is actually more than I scored on my sleep test. What's more, I came done with a cold. I use nasal decongestant before sleeping but my nose is stuffed in the morning anyway.

Attached screenshot is last night after I switched back to the silicon mask. The screenshot shows min. pressure 8 but it was actually 9, I switched it to 8 for 15 minutes after waking up to see what it feels like. Min. pressure 9 was very uncomfortable for me - I felt like I wasn't getting enough oxygen while breathing. I was surprised to see that my mask was also leaking this night as well, however, I didn't notice it at all... Min. pressure 8 feels a bit better but I do notice it's a bit less comfortable than min. pressure 7. Is this something I will get used to?

My poor AHI from last night is probably a result of both leaking and my cold. I feel it's not very 'diagnostic' and I should probably wait till my cold passes before making any major adjustments. Maybe max. pressure needs to be higher during a respiratory illness?

[grubsztyl]

*day before yesterday <- that's what I meant in the previous post, lol.

Seems like I'm struggling even worse than before. I'm trying to pinpoint the problem and wonder whether the flow rate pattern is consistent with positional apnea. I've tried comparing my charts with the wiki but mine looks a bit different. I haven't woken up today with congested nose - I'm using nasal decongestants and steroids. Honestly, past two nights felt like I wasn't using CPAP at all.

I'm attaching a screenshot with a close-up of the flow rate pattern in one of the clusters... in the first sleep apnea shown I'm not breathing for over 40 seconds... yikes.

[grubsztyl]

I tried setting max. pressure to 16, thinking that maybe for some reason I need more pressure now. No luck, it still doesn't clear the OAs I'm getting. I'm lost. I don't understand why two nights I had decent AHI and now from all of sudden I'm back to square one.

[grubsztyl]

I've taken a few steps back to rethink all that I'd done up to this point. I did following mistakes:

• I assumed that a flat pillow would fix positional apnea. It appeared to do so at first but in fact it was just luck that I slept in the right position.
  
• I developed some irritation on the bridge of my nose. I put a bandaid on it. That was a huge mistake. It created leaks that weren't registered as Large Leaks. I was totally unaware of it and didn't feel a thing. 
  
• I started playing around with the settings with no idea what I was trying to achieve...
  

Last night I slept with a soft cervical collar and reset my pressures to start over. It was extremely uncomfortable but I managed to fall asleep and I slept for three hours... almost uninterrupted. According to the charts, I had a small clutter of three OAs just after I fell asleep but other than that it was pretty okay. Perhaps my collar wasn't tight enough and my chin slipped under it. I woke up in the middle of the night and struggled to fall asleep again but I read that's pretty common when you're starting out. 

I feel pretty okay today. Tired but nowhere as bad as previous nights. I can feel my brain fog lifting. It's amazing what just three hours of almost uninterrupted sleep can do...

My plans:

• I ordered a few collars to find the one that's going to be more comfortable.
  
• I ordered padacheek liners - it might take up to 4 weeks to ship to Poland. At first Poland wasn't listed as possible destination but after writing an e-mail to Padacheek they added it to the list for which I'm grateful. In the meanwhile I'll be trying to use silicone patches on my nose to protect it.
  
• I might be switching to F30i. I don't like how F20 is constricting and it's hard to move around in the bed with the hose in the way. I also can't wear my eye sleep mask with it... I will order it and test it.
  

Tonight I'm upping the min. pressure to 8 to see if I can get rid of the odd apneas here and there. I got used to 7 pretty easily but 9 seems too much for me at this point.

[grubsztyl]

It's been a few days. I've found out that my sleep apnea is worst while I'm sleeping on my back. Unfortunately, SCC doesn't fix it. I've been experimenting with forcing myself to sleep on my side but during the night I do roll over onto my back and there's nothing I can do to prevent it. I'd prefer to avoid sewing a tennis ball into my shirt... so far I've been trying to position my pillows so that I'm always on some kind of incline. 

It seems like my positional sleep apnea can't be completely fixed. I don't necessarily feel bad with AHI of 2-3 but I still get morning headaches and feel a little drowsy. AHI of 6-8 makes me feel dreadful. It looks like my sleep is extremely sensitive to even slightest disruptions.

I might be considering getting drug-induced sleep endoscopy to find out the exact culprit. I know that surgeries are a hit-and-miss thing but looks like neither CPAP or SCC is able to completely eliminate my OAs.