Runaway Pressures, CAs, Horrible Sleep

[wantingsoundsleep]

Hi,

I am new to the forum and APAPs. I was diagnosed with mild sleep apnea (AHI = 8.5 with an at-home test) but pretty bad symptoms (depression, anxiety, fatigue, sleepiness, brain fog, abnormal blood lab results). I started using a Resmed Autoset 10 with a pressure range of 5-20 on Friday and the experience has been horrible. My sleep is heavily fragmented, I wake up constantly with air blowing out my mouth, I feel terrible. My AHI was reading between 10 and 15 for Friday and Saturday night (I, unfortunately, do not have OSCAR data for these nights)

I found this board and have done two things since those nights: 1) I taped my mouth in case that was the culprit of leaks and pressure issues, and 2) downloaded OSCAR and started looking at the data from Sunday night. 

Sunday night was pretty bad, I woke up today very tired and mentally fatigued. Also, I had a lot of gas (bloating, burping, etc).

In my very limited experience with interpreting OSCAR data, I noted that my AHI was low until the last few hours of sleep, where pressure ramped up and a correlated increase in Clear Airway events were noted. It appeared that my OSA and partially obstructed events were managed with lower pressure. Desperate to get some semblance of rest, I dropped the pressure range to 5-10 and took an hour nap, where I had zero AHI and wakings (yay).


Am I just having issues with runaway pressures and tightening the range should solve that issue? Should I continue to refine the range by reducing pressure until I start to see OSA/hypopneas pop up? Thank you very much for reading my story and for any advice you can provide. I am happy to find a community dedicated to properly managing these issues.

Thank you

[Gideon]

I would like you to I Clyde the standard charts, especially the flow limit chart as that is likely what is driving pressure.

Set min pressure =7 and EPR=2 fulltime.

[wantingsoundsleep]

I'm sorry, I see in your signature the standard charts to include. I have attached both records with those charts.
On another note, EPR has been set to zero since I received my machine. Thank you for your help.

[staceyburke]

Welcome to the board. I will give you 2 suggested changes with a brief explanation. 

First 5 is to low of a pressure for most people. I would try 7, the increase should help you breathe. 

Second the first night charts show a large amount of positional apnea. That is when you sleep in a position that cuts off your own airway. You CAN NOT fix that with pressure changes - you have to stop sleeping in that position. It my be sleeping on your back or to high a pillow. 


The good night you did not have any positional apnea. Find out what you did differently. You really don’t have a lot of other problems. Which is great news.

[wantingsoundsleep]

Thank you very much for your reply.
Your response that I don't really have a lot of other problems is very encouraging, as I have been having a real tough time with this.
Are you picking up on the positional challenges by looking at peaks in flow rate corresponding with hypopneas? At least, that's what I am gathering from the wiki.

I'll bump up the min pressure to 7 tonight. Any reason not to keep the max at 10 as that seemed to help my very limited one-hour nap today.

[wantingsoundsleep]

Just wanted to add some data to this thread.

My at-home study showed:

24.5 BMI
509 minutes
Respiratory Event Index: 8
47 Obstructive Apneas
11 Central Apneas
5 Hypopneas

[SarcasticDave94]

OK I was just going to ask about the diagnosic study data. There's a tendency for some centrals and Obstructive. Note that this a one night snapshot and CA are consistently inconsistent, meaning variable per night.

A one night snapshot, you nor the doc have any idea what the CA will be like one night to the next. Even so, your best bet with the AutoSet is to avoid CA via settings as best as possible, hence little to no Ramp or EPR.

Suggestion: begin a sleep diary where you note various settings you're using, and how you felt, each night is best case, but however you see fit. You need to track how CA makes you feel. A setup for evidence in case you can't avoid CA enough and need to progress to ASV. Not saying you need ASV, but preparing for it in case you do, then your homework is already done.

[wantingsoundsleep]

Thank you for your response, Dave.
I will start a log tracking settings and how I feel each day.
For now, I'll set to 7-10 pressure, zero EPR, zero ramp and see how I do tonight.
I really appreciate everyone's help and I am hoping that soon I can look at the machine fondly rather than how I currently look at it 

[Gideon]

Your flow limits are high, I'll look in after you start using EPR. It WILL make a difference. The only question is how much, if any, impact will it have on your centrals?

[SarcasticDave94]

Was current EPR settings mentioned? Changing that level of 1-3 could be telling on the Central levels.

An example I'm referring to would be to suppose you're on full time EPR 3, changing it down to EPR 2 would either change CA or not. Either is an effect to be noted. I think a corresponding min pressure appropriate to the current EPR level may also need to be introduced for EPR to be fully effective. But I'd also want to keep edits to a minimum so we know the effect the specific setting change made.

This would also tell us how effective an AutoSet is for treating your events and symptoms.