New CPAP user seeking advice on treatment (sleepyhead data attached)

Hi all! I'm two weeks into auto CPAP treatment for mild sleep apnea and have seen only a small reduction in daytime fatigue. My AHI has been around 7 every night, and I'm waking up a lot and feeling tired the next day.

I was on 4-20 pressure range, but my doctor increased my pressure to 8 this week. But, my AHI is still over 7 and I'm still tired and waking up a lot -- see attached SleepyHead data which is pretty representative of the average night since I started treatment. I'm using a full face mask (mouth breather) with a DreamStation machine. Any advice would be much appreciated!

With all the wake ups it's hard to hazard a guess if those flagged events are real or sleep/wake/junk false positive flags.
Meaning if you were awake when they were flagged they don't count.
Or if they were real they could be a factor in causing the wake ups.
Makes it hard to evaluate with any certainty as to what the problem is.
Also makes it hard for the machine to have time to do what it might want to do depending on what it senses.
It can go higher but doesn't seem to want to for some reason or other and that makes me scratch my head a bit as to why it isn't being more aggressive. Unless the flagged events aren't real and are SWJ and you aren't haven't the other stuff that the auto adjusting algorithm needs to get the machine to increase the pressure.

Do you take any medications of any kind? If so, what?
Do you have any other physical or mental health issues that could be a factor in the wake ups?
Do you spend much time with the mask on and you are awake?

Answer these questions please and it will help me figure out maybe something else to try.

thanks!

1) only medication is Symbicort for Asthma
2) no other issue that could explain wake ups
3) the first session and the beginning of the second were before i fell asleep. other than that, i tend to fall back asleep quite quickly after i wake up.

what's a SWJ? i also am attaching a night where I woke up less (when the machine was set to 4 - 20).

SWJ.....sleep/wake/junk....false positive flagged events

These machines only measure air flow and respond and record accordingly.
Our asleep breathing is nice and regular and fairly easy to see but our awake/semi awake breathing is often very irregular and the irregularities can be something that causes the machine to flag some sort of apnea event. Awake/semi awake flagged events aren't real in the sense of needing or warranting to have anything be done about them because we aren't asleep.

I once helped a guy whose AHI was near 20 and was really ugly but he had a lot of wake ups showing and with some discussion we found out that he was having some trouble staying asleep and the bulk of his AHI was SWJ. Once we got him to not lay awake for hours tossing and turning and got him to sleeping better than his AHI immediately went down to less than 2 and with no pressure changes.

Your machine isn't trying to increase the pressure much despite all the obstructive flags (we ignore the CA/central flags for now because they aren't obstructive but the other stuff is obstructive and the machine only responds to obstructive stuff) which makes me wonder why isn't it responding more aggressively and the only thing I can think of is that you aren't having the other things happen that cause the machine to think the airway is collapsing for real.

We could do the knee jerk reaction and tell you to increase the minimum again but if the bulk of these events are SWJ then more pressure isn't going to help.

What I would really like to do is examine the air flow zoomed in and see if the air flow looks like you were asleep right before the flagged events or if it looks like arousal/awake breathing which would then make the flagged events fall into the SWJ category.
I would need a copy of your entire SD card to do that though. So that I could plugged your data into my software and poke around and just look and actually maybe even plug it into Encore because it makes the poking around much easier.

In the meantime I think you need a crash course in learning how to spot SWJ yourself. Go here and watch all the videos.
http://freecpapadvice.com/sleepyhead-free-software

I will send you a private message in a little bit with instructions on how to get me a copy of the SD card.

Here's an example below of what I can see using Encore...lots of flagged events but this person doesn't even have OSA and 99% of the flagged events are SWJ.

At this point in things I am not so sure that more minimum is going to fix the problem because I am not sure what the problem is and I would prefer to try to identify the problem first if at all possible.

Folks...I have a copy of the SD card now and it works with SleepyHead after some fiddling and I need to fire up Encore but I am short on time and it will have to be later before I get a chance to look at the flow rate up close but from a quick glance at a few events that were flagged they appear to be post arousal SWJ flags and would explain why the machine didn't respond more aggressively with more pressure. The other stuff that is part of the auto adjusting algorithm causing it to increase the pressure probably wasn't there.
After all the machines respond more to the other stuff than they do random flagged OAs or hyponeas.

The wake ups apparently preceded the starting of cpap and why the sleep study was done in the first place.
So some sleep maintenance insomnia going on that they were hoping could be fixed by cpap and as we all know it can only be fixed if sleep apnea was the primary cause of the wake ups and maybe sleep apnea wasn't the cause.

Going to need to do some more digging and I am short on time at the moment.
Will report back once I have done more digging.