Just started CPAP therapy, diagnosed years ago.

[critical_nexus]

Hello,

I have OSA as per a overnight sleep study at a clinic, and i was told it was severe with a AHI in the 79 range. I was told at some points my O2 dropped below 50%. Despite being told this i ignored trying CPAP because i couldn't stand the mask. The machine i had (S10) was broken and infested with cockroaches and is now in the garbage. after dealing with multiple health issues that put me in the hospital, I'm starting CPAP again, but i haven't been able to afford it. I was offered a never used ResMed S9 elite from a family member who didn't like CPAP and i set my pressure (9cm) and my EPR(3). It has been two days and i never expected any improvement to how i feel in the day. I thought id try out OSCAR as I'm a nerd for these things, and read what the machine has to say about my sleep. it's reporting that i still have quite a elevated AHI around the 30-44 mark for the two days, and mostly obstructive apneas. My prescription expired in January of this year, so i need to get another sleep study, but is there anything i can do in the meantime, or is it best to wait for a professional and not screw around?

Here's some info on me:

Age: 34
Weight: 380lbs
Medical Conditions: BPD, GAD, IIH secondary to sleep apnea
Tests done: Sleep study (2023) CT/MRI/MRV/MRA of head, CTA of lungs (2024), Echocardiogram, holter monitor (pending), ultrasound of the caroid artery (pending)

medications: lamotrigine, Latuda, Cipralex, Diamox

[Miss Emerita]

Welcome! Would you post an Oscar chart? Be sure to close the calendar and pie chart. Include the left panel and all and only these graphs:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

This will help us try to figure out how to help you.

[critical_nexus]

[robysue1]

Based on the chart you posted, it's clear that 9cm of pressure is not enough to prevent your upper airway from collapsing.

Since you're on your own for the time being, it would be quite reasonable to increase the pressure to 10cm and see if the data gets any better after a few days.

If the AHI is still way too high, then keep increasing the pressure by about 1cm every 3-5 days until you either get an AHI that is less than 5.0 or you reach a pressure that you simply cannot tolerate for the time being.

For what it's worth: The S9 Elite was considered a really nice fixed pressure machine when it was new. And while most of us here use APAPs, there's nothing wrong with using a straight pressure machine like the S9 Elite.

[Pugsy]

Are you experiencing any nasal congestion?

You are going to need more than 9 cm pressure with EPR at 3. Start with 10 cm for a few nights then maybe try 11 cm for a few nights...then 12 cm for a few nights and so on. See if you can get that obstructive index (OAs and hyponeas) down to below 5.

If you start seeing a really dramatic increase in CAs/central apnea come back here straight away and report.

[critical_nexus]

Are you experiencing any nasal congestion?

You are going to need more than 9 cm pressure with EPR at 3. Start with 10 cm for a few nights then maybe try 11 cm for a few nights...then 12 cm for a few nights and so on. See if you can get that obstructive index (OAs and hyponeas) down to below 5.

If you start seeing a really dramatic increase in CAs/central apnea come back here straight away and report.

Thanks for the info to both of you. Would raising the pressure cause CA? is that why there is a concern? i know CA is a serious concern in general.

[Pugsy]

Would raising the pressure cause CA?

Maybe...maybe not. About 10 to 15 % of the people who start on cpap will develop some level of central apneas happening.
A few is normal and no big deal....a truck load of centrals means we get to have a different discussion.

While a lot of people think that centrals are only a problem with pressures over 10 cm....I have seen people develop treatment emergent central apnea and their pressures are a measly 6 cm. While maybe a bit more common at higher pressures it really can happen with any pressure.

[critical_nexus]

Would raising the pressure cause CA?

Maybe...maybe not. About 10 to 15 % of the people who start on cpap will develop some level of central apneas happening.
A few is normal and no big deal....a truck load of centrals means we get to have a different discussion.

While a lot of people think that centrals are only a problem with pressures over 10 cm....I have seen people develop treatment emergent central apnea and their pressures are a measly 6 cm. While maybe a bit more common at higher pressures it really can happen with any pressure.

Ok i will watch out for that, Tonight i will set the pressure to 10cm and see how it is for a few days. Thanks

[critical_nexus]

So i set the pressure to 10CM, and wow what a reduction in AHI as per oscar. its 14 now. i woke up feeling like water was sputtering out the edges of my mask in the night and says i had a large leak. I might have filled the humidifier too much? i also had 2 unclassifed apenas.

[Pugsy]

i woke up feeling like water was sputtering out the edges of my mask in the night and says i had a large leak. I might have filled the humidifier too much?

Entirely possible that the water chamber got over filled a little bit and water got blown into the hose.
Been there and done that myself....and did it just last week.
Also possible that condensation formed in the mask or hose just because of the ambient bedroom temp being on the cool side and let condensation happen.

Be care to stay a little bit below that "max fill line" on the chamber.

large leak. i also had 2 unclassifed apenas.

Were those 2 UAs flagged scored during a period of large leak? If so...very common because with some large leaks the machine simply can't tell what it is recording because the leak was so bad it knew something was happening but couldn't figure out what to call it because the leak made it impossible to distinguish category.

When faced with really, really big leak the machine might even totally miss the apnea event and not flag anything.
Doesn't mean it didn't happen though....just means the machine was clueless.
That's why we don't want to let large periods of really large leak go ignored. We don't know if that nice low AHI score (if you had one) was because nothing happened or the big leak made the machine clueless. Kinda important to know.

[Miss Emerita]

Could you post your chart from last night? Also, could you answer Pugsy's question about nasal congestion?

[critical_nexus]

i woke up feeling like water was sputtering out the edges of my mask in the night and says i had a large leak. I might have filled the humidifier too much?

Entirely possible that the water chamber got over filled a little bit and water got blown into the hose.
Been there and done that myself....and did it just last week.
Also possible that condensation formed in the mask or hose just because of the ambient bedroom temp being on the cool side and let condensation happen.

Be care to stay a little bit below that "max fill line" on the chamber.

large leak. i also had 2 unclassifed apenas.

Were those 2 UAs flagged scored during a period of large leak? If so...very common because with some large leaks the machine simply can't tell what it is recording because the leak was so bad it knew something was happening but couldn't figure out what to call it because the leak made it impossible to distinguish category.

When faced with really, really big leak the machine might even totally miss the apnea event and not flag anything.
Doesn't mean it didn't happen though....just means the machine was clueless.
That's why we don't want to let large periods of really large leak go ignored. We don't know if that nice low AHI score (if you had one) was because nothing happened or the big leak made the machine clueless. Kinda important to know.

I will make sure. The UA's were 2, one was during the LL and one was not. im going to post it in the bottom comment.

[critical_nexus]

Could you post your chart from last night? Also, could you answer Pugsy's question about nasal congestion?

I dont feel like i have that much congestion. I would say i have a bit. when i had a MRI done they found a cyst in my mamillary sinus but said it was not anything concerning.

[Pugsy]

What is your primary sleeping position?

On your back for the first part of the night maybe and on your side later or on your back all the time or on your side all the time???

Some people have a lot of nasal congestion and sometimes that nasal congestion shows up in the FL graph.
Your FL graph is really ugly and the reason I asked about nasal congestion was to figure out if you needed to deal with nasal congestion.
More pressure will help real FLs but not nasal congestion FLs. Doesn't sound like your FL graph ugliness can be blamed on nasal congestion so we have to assume airway collapse and that along with the snore means you need more pressure still yet.

[critical_nexus]

What is your primary sleeping position?

On your back for the first part of the night maybe and on your side later or on your back all the time or on your side all the time???

Some people have a lot of nasal congestion and sometimes that nasal congestion shows up in the FL graph.
Your FL graph is really ugly and the reason I asked about nasal congestion was to figure out if you needed to deal with nasal congestion.
More pressure will help real FLs but not nasal congestion FLs. Doesn't sound like your FL graph ugliness can be blamed on nasal congestion so we have to assume airway collapse and that along with the snore means you need more pressure still yet.

I sleep on my back. I am not a side sleeper. When i say i might have some congestion i say sometimes it's a little hard to breathe through my nose, but I haven't found an issue while awake starting therapy keeping my mouth closed. The Doctor i saw told me to use a nasal mask with a chin strap, and i had a brand new nasal mask but it seems it was thrown out by my partner by accident, but have the chinstrap. would this help as maybe i am mouth breathing in my sleep?