Hey All,
I could use some advice on tuning my CPAP machine for a complete beginner.
I did a basic in home sleep study and had a 21.1 AHI. Blood oxygen dipped to 91% but generally stayed 95-99%
On my prescription:
Diagnosis - obstructive sleep apnea Min pressure - 4 Max pressure - 20
I have completed my forth night using an Airsense 11, heated tube, and nasal pillows.
Night 1 - started a pressure 4 which was way too low to breath, I believe I upped it immediately to 6. I woke up in the middle of the night and saw AHI similar to my sleep study, so I bumped up the pressure more assuming the existing pressure was ineffective (I believe to 8). When I awoke, my AHI was down to 10.4 so I assumed the change was effective.
Night 2-4 - adjusted pressure up to 9. AHI came way down (avg 1.93). Had issues with sealing of nasal pillows. Had major stomach pains, which I believe is from swallowing air basically. I ordered a chin strap and a full face mask to see if those would help.
Night 4, I collected data for OSCAR. These were my results. Can anyone provide thoughts/feedback? I can zoom in on sections if needed. I plan to reduce pressure tonight by 1-2 and see how my AHI is impacted while I wait for the new equipment. My stomach has felt pretty terrible, and I expect that is the best approach for now.
Thanks in advance for any help you can provide!
Thank you so much for the advice! I'll definitely look into those changes - all super helpful.
I got another night of data last night with a slightly lower pressure (8-20) and had both lower CA and hypopnea events. With this adjustment in pressure, I did not seem to have the issue of air in my stomach, but I don't think I wore the equipment all night and didn't sleep for super long, so perhaps it wasn't a great test.
I did have some mask leak problems - I am not sure the nasal pillows are for me but I'm still experimenting. I will have a full face mask (f20 I believe) to try Wednesday.
If you or anyone else spots anything interesting or has more feedback, please let me know. This is all fascinating, and I'm looking forward to getting this all properly set. I have huge issues with memory and sleepiness, and I am hoping this will help improve that.
Thanks, again!
Here's my latest data after the suggested adjustments:
Well the good news is that hypopnea went down as well as flow limitations, and you only had 1 obstructive event. The obvious issue is the number of central apnea events, and more concerning is that with a few exceptions they don't seem to be happening when the pressure is higher. You have a couple of options, but I would suggest not doing them at the same time. First would be to reduce maximum pressure down to 8 cm. The other option would be to reduce the EPR from 3 cm to 2 cm. EPR seems to affect different people in different ways. One possibility is that the higher EPR has caused the central apnea events to increase. Central apnea can be caused when the CO2 and O2 oxygen control system is not stable. A higher EPR could decrease stability. I have central apnea issues and I have settled on an EPR of 2 cm, but I really did not do enough testing to determine if that is ideal or not. I do average under 1.0 now for AHI so I am not motivated to mess around with it more. How is your comfort level with the pressure? EPR should help with that.
It might be informative to see what the breathing pattern looks like when you zoom in on those CA events. Sometimes they are just caused by waking and going back to sleep. Other times they are a regular pattern that ends in a CA event. Here is an example from my records of the latter. It also may be helpful if you could scrunch down the graphs to fit Minute Ventilation in as well. I limit my leak graph to 50 to save space. If you hit 50 it is bad and you don't need to see the detail... You can also click and drag on the horizontal grey bars to get more in as well. Minute Ventilation is a good indication as to how regular your breathing is. If it cycles up and down like shown below, it is not stable. Ideally it would be a flat line.
Here is last night's data with maximum pressure reduced to 8 and no other changes. My humidifier may have ran out of water at some point in the night. Today, I definitely noticed aerophagia which became apparent kind of midday, which I did not feel the previous night. I had a few drinks with a friend before bed, so I don't know if that impacted anything.
I do notice our flow rate curves look different. Not sure what that indicates.
Chin strap and full face mask are here today. I am tempted to try the full face mask tonight to see how that is.
Thanks Sierra for all the help!
Again the good news is no OA or H events. Flow limitation is up when the pressure has been limited to 8 cm though. In your second clip I do see some indication of instability in breathing control. See the section circled with yellow highlighter. Notice how the breathing rate gets deeper and deeper and then more and more shallow until a CA event occurs.
It still would be interesting to see the Flow Rate chart next to the Minute Ventilation graph for some more of those periods of time where there are multiple CA events. Minute Ventilation is a measure of how much air is being brought in and out of the lungs. It will cycle when the breathing rate control system is not stable.
The basic problem is that an APAP can't directly do anything to stop CA events. The pressure from the machine may in fact be the cause of the CA events. So, about all you can do is reduce pressure. But, there is obviously a limit to how much you can reduce pressure. What you may have to do is stick with it for some time to see if this is treatment emergent central apnea that will go away after 6-8 weeks or so.
I can grab more data if needed, but I think last night's information is promising and worth reviewing first. I wore the chin strap that came in with the nasal pillows, and I think it made a significant difference:
If I'm interpreting this right, it looks rather encouraging. Do you agree?
Thanks!
I did sleep well - I only remember waking up once in the night instead of a bunch of times. However, in the morning, I felt more tired than I usually feel for some reason, so it was odd. Not how I was expecting to feel. I am wondering how tonight will go - I am planning to not modify anything and see how the data changes.
The RERA events do seem strange. I also had some data on Tuesday night that didn't look particularly good, but of course I don't really know what I'm talking about at this point. I didn't get a chance to highlight this the other day, so I'll include it now.
The chinstrap worn last night wasn't my favorite, but it didn't bother me all too much and seemed to make the nasal pillows fit a little better. I wasn't able to improve the seal to the same level with just the strap adjustments on the nasal pillow oddly. I'll stick it out with the stylish chin strap for now haha. My stomach also wasn't full of air when I woke up which might be reason alone to keep at it with the chinstrap. Hopefully I'm in for another night of solid, but more restful sleep!
It looks like my CA events have been somewhat on the decline, so perhaps my body is beginning to adjust to the CPAP machine. I believe I took the CPAP mask off prematurely on the night below though which would impact quantity of CA events.
Last night, I introduced a Ring02 sensor to better monitor impacts on blood oxygen (not expecting significantly accurate data). Below is the updated chart. I began wearing the 02 sensor slightly before starting the CPAP machine, so that shows in the data. I'm not sure if there is a better way to order the graphs - I can adjust if needed.
I will say that sometimes when starting my CPAP machine, I maybe wish there was a hair more pressure (I can feel ever-so-slightly out of breath, nothing terrible) but I'm a little unsure if I should be tweaking anything at this point, as results don't seem too bad. I can't say that I feel much in the way of a positive effect from the CPAP yet though.
So I have been gathering data, and here are some results from the past five nights. Mostly settings have not been adjusted other than the 28th. Blood oxygen has been somewhat low sometimes - I am having syncing issues with Oscar and the 02 ring, so for now I have included the report exports. If you or anyone has thoughts, please let me know : )
25th
26th
27th
28th
(the above day was using the full face mask due to nasal congestion)
29th
