What to expect - should OSA's be right down ?

[CurryKitten]

Hello again,

You may remember be from a post a few weeks ago wondering if OSA was the right diagnosis. Since that time I've been using the CPAP machine pretty much most nights, and I can tell you I'm feeling much better in terms of my daytime sleepyness. My wife is also a fan as I may well still be snoring, but the noise is being blown away by the air squirting in there.

I had my follow up appointment with the sleep specialist nurses which I'm afraid I didn't find to be particularly useful. I pretty much filled out the sleepyness scale and they said "great, you aren't sleep any more, we'll see you in a year". I've still been have a really dry mouth and told them it was disturbing me, but I was just told to take the mask off some some period of the night... "it's what most people do"

I was really interested to know if this was actually sorting my OSA's, or what. I noticed in the manual of my RemStar Pro machine it mentions the amount of large leaks and AHI's, but these hadn't been enabled. This seemed a bit daft, so I found out how to enable them on the net, and did so. This showed a rather scary 30% large leak rate, and an AHI in the 30's

I then found some open source software called SleepyHead, and with that I could read my SD card and get a really good breakdown of my sleep and the amount of Hypopnea, OSA, Clear Airway Apnea, and overall AHI.

So last night was one of the best nights I had (although only 4hr 50m on the mask) It scored me with an AHI of 22.33, Hypopnea of 15.68, OSA of 6.62 and Clear Airway apnea of 1.03.

I'd kind of expected the use of CPAP to bring this down to nothing... or something approaching that. In my sleep study, the amount of OSA's was counted at about 10 per hour which was seen as not particularly high. It doesn't look all that different.. should it ?

I find it a bit weird that the consultant doesn't want to follow up after two weeks on the machine by looking at the actual data. The nurses are happ that daytime sleepyness is better... and so am I. But it seems with the AHI I'm having, it could be even better.

[Kipper]

The hospitals usually prefer you to use the machine for a few (6) months, to allow everything to settle down. It takes time for the body to adjust to an alien (and I don't mean Darth Vader type alien!) addition to the body. I can mostly strap on the mask, adjust ramp setting, lay down and wake up 7 hours later (dog permitting), but I have been using CPAP for 5 years. If you leave the settings and readings alone, and just concentrate on sleeping, all will come right. Recheck the readings in a month, and see what difference there is then.

[symmit]

Hello and welcome.

If the sleepyness is gone and the clinic is happy then I think you can be happy it's effective enough.

Or you can (like myself and some others) become an obsessive stats chaser and start altering the pressure settings on your machine until you get the AHI down below 5 (or chase lower if you like).

I am not a professional but if you're still snoring then that's normally a sign that the therapy could be better -start by trying to address the leak (if you're using a nasal mask that could be caused by mouth breathing)

Do you know what your pressures are set at? Tweaking them upwards by the minimum amount (0.5 at a time) every few days may help. Do some reading on this forum and others!

[CurryKitten]

What can I say, I like to look at stats and try and measure progress. I'm using a ResMed Mirage Liberty mask, so technically full face,albeit with nasal pillows - although I am most definately a mouth breather.

I've really been chasing after leaks, and I can usually feel a little air gush on my face is there's one coming out of the mask. Sleepyhead breaks this down into Leaks and Total Leaks - where apparantly total leaks is the amount of air leaking including the stuff that should be venting anyway. Mine looks like this -

Screen shot 2012-02-08 at 15.05.29.jpg

What I don't get here is that at 10cm H2O the Mirage Liberty tells me it vents about 37L per minute, but my total leaks over the first hour or two are at around the 50l mark, but my leaks column appears to read 0. Leaving me confused about around 10l per minute possibly going somewhere it shouldn't or possibly venting on purpose.

[Tigers Fan]

Liberty masks are nor the easiest to get on with - mainly due to prong leaks and/or sore nostrils. I'd try to obtain a standard full face mask through your clinic and failing that, you have to consider buying privately. Many of us do that.

Seems you have been sent away with the standard 10cm setting, sleeping better, not snoring as much, come back in a year. This is bog standard in Southampton.

Some treatment will improve matters but nowhere near what is possible if you get the pressure settings just right for you - and that varies up and down a little according to , well, all sorts of things.

Sounds like you need to give attention to two major areas - leakage and pressure settings.

TF

[CurryKitten]

Thanks for that advice. I did start with a Phillips comfortgel full, but after only 1 night I ended up with a nasty sire on the bridge of my nose which then turned into a leaky puss-filled yukky thing.

Coincidentally I tried it back on earlier today convinced that on the first day I'd just had it too tight. But it leaked like nobodies business until I tightened it quite a bit, so I could just see myself getting another sore off it.

I was wondering it the dryness or lack of moisture of the skin would hinder a decent seal. Since day one the machine has dried my mouth so much that I can barely unstick my tongue from the roof of my mouth, but Southampton just don't want to give me a humidifier. So I might be buying my own quite soon... I'm sure it'll help with the dryness - but is this a red herring as far as leaks are concerned ?

[CurryKitten]

Well, since that last post more progress.

First thing I tried doing was shaving. I've used a beard trimmer to 0.5mm for the last few years for that "rugged" look. Having a proper wet shave revealed that my face does in fact look like a potato - however, aside from some spikes in leaks where I must have been moving my head around, the total leak score was around the 30l Mark, which is inline with the vent rate in the masks manual.

I also went back up to the hospital yesterday after phoning and basically saying that I'd be unlikely to continue with CPAP without a humidifier. A lo and behold they got one for me. Wow, the difference is amazing, it like just breathing normal air. I had to check a few times to make sure it was on.

Last 3 nights AHI scores have been much better, if slightly inconsistent with 7.5, 10.5, and 13 respectively. Which while curving upwards slightly is way better than the high 20's of last week. And that's before messing with pressure settings.

[symmit]

That's great. My humidifier broke at Christmas and I couldn't believe how much different is is without (had one from the beginning!)

Is your machine an auto? If so will it report your max and 90% pressures?

[CurryKitten]

No, my machine isn't an auto... though reading about APAP, I wonder about why all machines aren't - they sound like they work much better by only producing the pressure when it's required. Is there any downside.

So I stayed on my setting of 10cm setting (with a 20 min ramp up from 4cm). I was hoping to look at what my average AHI over 7 days was, and then potentially upping the pressure and seeing what difference it made.

However, AHI's have been skyrocketting in the last few days, and I just can't work out why. After I previously reported 7.5, 10.5, and 13. They then went 26.69, 34.97, 36.30 and last night 32.96. Really finding this weird. The leak issue is definately looking good now, with sleepyhead reporting around 30l per minute which is well within it's prescribed vent rate at 10cm. The machine itself reports large leaks for last 7 days are at 11% (down from 30%)

Yesterday in particular I suffered from some real daytime sleepiness that I haven't experienced in a few weeks. It felt awful, and my wife remarked on how grumpy I was, then my daughter told me off for snoring on the sofa. I don't want to go back to being that person again.

Does anyone else see these wild changes in AHI ? It's weird because I don't feel I'm doing anything different in my bedtime routine.

[Barely Awake]

Is the figure you are reading as AHI an average of 7 or 30 days, or is it the previous night's reading?

[CurryKitten]

Is the figure you are reading as AHI an average of 7 or 30 days, or is it the previous night's reading?

My machine only gives me the 7/30 day average, the figures I'm quoting are from my daily downloads into Sleepyhead.

[symmit]

Is there any way you can post your actual readouts from your software- is it possible you're misinterpreting it?

With the steady increase, is it counting the number of events since you started recording and not the average per night?

[CurryKitten]

Ok, well I hope this helps, as another 30+ night last night, and I've just been snoring on the sofa. First image is my daily summary score.

Screen shot 2012-02-16 at 19.06.25.png

This next image is my detailed graphs, you can see the OSA quite clearly as the software lets me zoom in, and you can see the breaths getting shallower and then stopping. I think leaks look pretty good, I think a few times perhaps of moving about and dislodging my mask

Screen shot 2012-02-16 at 19.06.52.jpg

This last one shows my progress over a number of days (where if it's not clear from the chart, dark blue is an HA, light blue an OSA and magenta a CA

Screen shot 2012-02-16 at 19.08.01.jpg

The only thing I've done differently was to cure the leak rate, by shaving. First night of this was on the 10th, prior to that my total leak rate was in the 50l+

Help

[symmit]

Well, I'm not a doctor but that doesn't look right to me. I know that if I drop my pressure too low (below 8) then my flow limitation events go right up like your osa events, but of course my machine being an auto will compensate for that.

If I were you, but obviously I'm not! I'd start upping my pressure by 0.5 or 1 every few nights and seeing if the OSA events drop, but as others have said you may want to speak with your clinic first.