[Pressure] Too High or too low?

[Kevstuf]

       
So I was diagnosed with moderate OSA and was given an APAP machine. For months I struggled to keep it on for more than a couple hours; when I went to another sleep doctor they revealed I could change the min/max pressure settings. My max was set to 15 cmH2O and I began to dial it down over time as I was still waking up at night and ripping it off. It's now set at 8 cmH2O and I'm able to wear it for ~5 hours before I begin waking up. At that point I can sometimes fall back asleep but other times I still take it off. The problem is I wake up with a really fast heartbeat and sometimes even feel worse in the morning than if I had not worn it at all. When I look at the AHI reading from the machine it's generally 2-3 which suggests I'm not having many apnea events. I'm wondering if anyone else has had a similar struggle, and whether this indicates my pressure is too high still because I'm waking up, or is it too low and I'm not getting enough oxygen? Here's a few OSCAR screenshots for a couple nights where I'm able to keep the mask on, but still feel awful in the morning:

[Sleeprider]

Oscar is not accurately showing the pressure, assuming you have a minimum pressure of 8.0 and something like exhale pressure relief of 2.0. Your respiration looks rough, and the flow limits are showing up in clusters that are very close together. I suspect this is a positional apnea, and when your airway obstructs, it causes you to awaken or arouse resulting in the sleep problems you describe. Start by reading the Positional Apnea wiki article https://www.apneaboard.com/wiki/index.ph...onal_Apnea Make any adjustment to pillows, sleep position etc you think might help. and then consider the soft cervical collar if needed. It would not hurt to increase minimum pressure a bit further and use up to 3-cm of pressure relief if it is available. I'm at a bit of a disadvantage as I'm not well acquainted with the iBreeze. Everything I see on your chart suggests pressure is too low.

Quick question, why the iBreeze instead of a Resmed?

[SarcasticDave94]

First, welcome to the Apnea Board.

Only based on the info given, your settings are likely on the lower side than what's best to treat. The indicator I'll use is FL or flow limits. This is a precursor to Hypopnea and full Apnea.

What you can do before action from me is suggested, you'll want to get the full, detailed PSG sleep study report. You'll want to post it redacted of personal info, if you so choose. We need to know the data about specifically what is being treated, and this gives the base line for comparison to know if things have improved with therapy, and by how much.

Of note, yes, you can request this full report on yourself. US HIPAA laws gives you the right to the report, and negates the doctor's possible refusal to produce it.

Side note, it's a shame you didn't get the best CPAP machine, ResMed is the CPAP gold standard. It's always your choice what you get, mask or CPAP machine needs always to be up to you.

[srwilsn3]

I want to echo Sleeprider and SarcasticDave. My DME gave me a Resvent iBreeze. The machine is incredibly inferior to the Resmed I now have (after purchasing used).

OP, can you speak to your prescribing Doctor or DME about swapping for a Resmed? I strongly encourage it. I don't think anyone should be using that machine.

In trying to address my flow limits, I tried every possible thing related to positional apnea, as board members here suggested. Many were sure it was due to position; nothing helped. However, FLs and apneas were almost completely treated without any changes by switching to my BiPAP. I'm not saying you need to do that, but I want to highlight my experience so you consider trading away from the inferior iBreeze.

[Kevstuf]

I realize my post was unclear. I had dialed down the max from 15 to 8; I think the min pressure is somewhere around 5, but I have been moving it up to 6 recently to experiment more. I have an iBreeze because that's the machine my sleep doctor gave me. I wasn't offered a choice at the time; I didn't know ResMed was considered to be a superior product. I recently downloaded an iBreeze software update that seems to have improved the breathing comfort, but I'll need to try a few more nights to see if it makes any difference.

[Kevstuf]

@sarcasticdave94

Sorry if this doesn't reply to you directly. I'm not sure how to directly reply to someone's comment; it seems to just make a new comment in the forum. I do have a copy of my sleep study, but I am doubtful about its usefulness because 1) it was conducted in 2021 and I basically gave up on making my CPAP work for the past couple years, but I'm feeling so terrible that I've been trying again. 2)I was asleep for hardly any time because I was so uncomfortable; I was maybe asleep for 2 hours 3) I am scheduled to do an at-home sleep study with a new sleep doctor next month so I'm hoping that one will give me more useful up-to-date information.

[Sleeprider]

Kevstuf, if you have apnea confirmed by one sleep study, a second one is unlikely to show anything useful. A new diagnostic test is not going to show anything other than you have obstructive sleep apnea. Even with the Resvent iBreeze your treated AHI is very good, but for comfort and effectiveness,getting a better machine would do more. The iBreeze is a relative newcomer to the CPAP market and it is a Chinese device that used to be considerably cheaper to buy. It's never a good idea to buy from the sleep doctor, due to conflicts of interest. It is better to buy from an in-network DME that is accepted by your insurance. Keep in mind, the suppliers make more profits if you accept what we consider "second-tier" Chinese machines. Especially if your insurance is not kicking in at least 80%, consider looking at the special deals from online providers like Supplier #1 that is currently offering the Resmed Airsense 10 Autoset C2C for $399. We can help you to optimize therapy, but it helps a lot to start with the best machine that gives you better data and has class-leading therapy algorithms. Meanwhile you may find the iBreeze therapy software useful from the Private Files for Members here https://www.apneaboard.com/forums/Thread...e-machines

Machines aside, have you ever tried a nasal pillows mask? They are much lighter and less intrusive unless you experience leaks of positive pressure from your mouth.

[Kevstuf]

@Sleeprider

Thanks for the reply. I'm trying a new sleep doctor as I felt my first one was inexperienced; the new doctor suggested a sleep study in case things have changed in the past 2 years. However, I am also not expecting any new major findings. Ultimately, even though my AHI seems fairly low, my sleep quality still feels very poor, just as poor as if I had not used the machine at all. Unfortunately my iBreeze is already paid off with my insurance covering some of it. I believe I paid about $315 total as it was a pay-per-month structure. I wish I had been more informed about the different machines before making a decision. Is it easy to sell my machine, or even allowed? Otherwise it would be quite a hit to buy a new machine without recouping the cost of my old one. I have not tried a nasal pillow mask, though I don't particularly find my current one uncomfortable. I am usually able to fall asleep pretty quickly (less than 20 min); it's more so staying asleep that's the issue for me. What is the iMatrix software you linked? It seems similar to OSCAR.

[SarcasticDave94]

You didn't know that it's your choice what you get equipped to treat apnea. That's part of what we do, inform people, to enable them, and encourage self advocacy. The doctor will script the level of machine but we can decide what brand. If there's no choice but one, something isn't quite kosher, because there are choices in mask, machine, heated or non-heated hoses, DME supplier, and even the very doctor that's involved.

Take it from me, a multitude of sleep studies won't necessarily give better results. Sometimes, again like my case, you might get a series of one night tests that indicate you might not have apnea worth treating, despite a prior test saying otherwise. Unless you're in need of a different level of therapy, it's possibly best to not to test much. The 2021 test didn't suddenly become useless, even if you change doctors.

Some in the supplier list buy CPAP from patients, and they also sell used that can help reduce price.