Newly diagnosed with sleep apnea - need advise

I had a sleep study done and the report shows OSA that was not well controlled using a CPAP. I reached a low of up to 82% SPO2 with close to 61 AHI. The AHI increased (129) at certain pressure levels on the CPAP. I was prescribed an APAP with the pressure setting between 10 - 20. I have been using the APAP (Resmed airsense 10) for the last 8 days. Here my questions:

1. My average AHI has been around 2.5 with around 0.3 central with the APAP. Is this a good indicator and does that mean that the APAP is doing its job
2. I don't sleep well with the APAP. I am more sleep deprived with the APAP than I am without it. I do realize that desaturation is not good but I am torn about using the APAP. I am male 45 years, 5 '8'' and 179 pounds. I am working on dropping down to 170 or less. My doctor feels that it is more how my mouth and throat are structured that is the issue than my weight. I did ask for a nose mask to try instead of the full mouth mask that I am using. I am a mouth breather and have a deviated septum since birth so not sure how much the nasal mask will help. Should I just stick on the APAP until I get used to it? I am worried that the sleep deprivation would cause other issues and will affect my ability to be productive which I did not have with uncontrolled sleep apnea. Any feedback from your own personal experiences and any professional feedback is much appreciated. Thanks, Wilson

Wilson, sounds like the APAP is pretty effective as far as getting the sleep apnea under control. 2.5 AHI ain't bad. Your issue seems to be either the machine function or mask, that is, you are complaining of sleep deprivation. Why are you sleep deprived? The APAP pressure or the mask? Once that is narrowed down, perhaps something intelligent could be suggested. And the next question would be; have you discussed this sleep deprivation issue with the sleep doc?

Wilson, I am just another user of the AirSense 10 AutoSet machine, and not a professional. So don't take this as professional advice. It is simply that of another user.

1. Yes, your APAP is doing a pretty good job in reducing an AHI of 61 down to a residual AHI of 2.5. An AHI in the 0-5 range is considered normal. That said, an APAP is normally more effective in reducing obstructive apnea than it is in reducing central apnea. What portion of that 2.5 AHI is obstructive and what part is hypopnea? In my experience I think hypopnea can be related to obstructive apnea, or central apnea. So, I always look at the hypopnea component as a bit of a question mark.

2. An APAP tries to normalize obstructive apnea and obstructive hypopnea by keeping the airway open with air pressure. That physically usually works, but it can have some side effects. Mask discomfort is usually the worst one. I have tried 5 different masks and finally settled on a nasal pillow mask. That said masks are very personal and I really can't give you any advice other than to keep trying ones to the extent you can. What I can say is that about the second worst sleep I ever got was my first night with an APAP. The worst night was when I did the at home sleep study. Both terrible sleeps. But, I have slowly gotten used to wearing a CPAP at night and the benefits are now outweighing the initial discomfort and the effect it had on my sleep quality. In short, give it some time. And if a mask is not working for you, ask your supplier to suggest another. You also mention that you have obstructive apnea that is not well controlled with pressure. That is unusual. You may want to ask your general practitioner to refer you to a specialist to see if there are other reasons for obstruction. In my understanding of risk factors, your age and BMI should not put you at high risk of OSA, so there may very well be another reason.

Some general comments. You said your AHI went up to as high as 129 at certain pressures. I would ask your sleep doctor or sleep tech what the reason for that could be. In some people central apnea goes up when pressure goes up. It would be helpful to know if that applies to you. At the same time you could ask if it is a pressure in the 10-20 range that you have been prescribed, and could be a contributor to your residual AHI if the machine runs you all the way up to 20 cm.

Many people who suffer from apnea track their results on SleepyHead. It can be very informative as to what may be affecting your sleep quality, and how well the machine is working for you. If you are interested I can post some more information on it. In my opinion as a user, the ResMed supplied MyAir applications is not very good. SleepyHead is much better.

Hope that helps some. Any questions, just ask.

Thanks for your responses. When my split study was done, I had one CSA event without the CPAP and two with the CPAP. The doctor did not think that was significant to show CSA. My sleep report shows AHI of 2.4. Total AI of 1.7 and central AI of 0.9 with a pressure of 14.5. I have not discussed my sleep deprivation with the doctor yet. I was waiting to check the nasal mask first. I do believe that the discomfort is coming from both the mask and the pressure. When I start my sleep with pressure set to 6, I feel pretty comfortable but I seem to waking up frequently when pressure is higher and I remove the mask at times.
Interestingly I gargled with warm saline water last night and I slept much better. My events per hour over an usage of 6.5 hrs. dropped to 0.5. I did use a wearable SPO2 monitor before I did the sleep study. The result was consistent with the sleep study. The report from the SPO2 monitor showed couple of lows up to 82% how ever my average SPO2 was at 94%. I am waiting for my nasal mask to arrive to see how that goes. Meanwhile I will continue using the full face mask. Is there a way for me to look at a more detailed report using sleepyhead from data that is on the Resmed APAP or do I need to use a wearable SPO2 monitor?

Thanks!

Thanks! I will download the software and take a look.