New APAP user without sleep study looking for advice

Hello,

I've been having terrible sleep apnea like symptoms for a year (exhaustion, headaches, sleep deprivation despite number of hours slept). I originally intended to get a sleep study done but that's really difficult to do at the moment due to the Covid situation and because where I live there's only one hospital that offers it.

Anyways, I decided to rent a APAP for a bit and see how it goes. Yesterday was my first sleep with it. It's a Philips REMStar Auto A-Flex 550P. I've set it on auto mode with a pressure range of 7-12. After my first night of sleeping using the machine, the stats today show me the following: AHI of 6.7 with 90% pressure at 8.5. However, I'm not sure how accurate this would be because I had a very poor sleep last night (I think I must have slept about 3-4 hours max out of the 7.5 hours the machine has recorded).

I'm just looking for any recommendations. I do intend to insert an SD card today so that I can analyse my data (after hopefully having a better sleep tonight). In the meanwhile, should I let the pressure settings be as they are? I did notice air filling up my stomach after a while with the mask on; there was some discomfort and very slight pain but it went away after a while after waking up.

Where do you live?

Unless your stomach issues are horrible...yes, keep the current settings and don't go increasing the pressure right now.
Did you turn on A Flex exhale relief? If not, turn it on and set it to 2 and see how that does with the belly issues.

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

Once you sleep with the SD card in your machine use the above software.

viewtopic/t158560/How-to-post-images-for-review.html

Pugsy wrote: ↑

Mon Apr 26, 2021 6:31 am

Where do you live?

Unless your stomach issues are horrible...yes, keep the current settings and don't go increasing the pressure right now.
Did you turn on A Flex exhale relief? If not, turn it on and set it to 2 and see how that does with the belly issues.

Thank you so much for the quick response. I live in Pakistan. Ok, I'll keep the current pressure settings. And yes, I do have the A Flex settings on. I actually find it quite comfortable while exhaling. The stomach issues aren't horrible, just mild I guess, so I'll continue with the current settings and see how it goes.

Also, the pressure feels very mild when I breathe in - is that how a pressure of around 7-8 feels like? I ask because I read about people describing breathing through a CPAP like sticking your head out of a moving car. I found it to be nothing like that. The 'large leaks' option showed large leaks at 1%, so I'm guessing there's no leakage I need to worry about?

The "dog sticking its head out the window" thing is common comparison and I have seen people say it about 4 cm pressure as well and other say that 4 cm pressure makes them feel like they are suffocating. It's all in how you perceive it. For some it's like a hurricane and others it's like a gentle breeze. When you combine 7 cm with AFlex...it is a much more natural breathing feeling and most people won't have a huge problem with it.

1% large leak...not enough to worry about but I will say this....any leak that wakes a person up is unwanted if for no other reason than it is disturbing their sleep ....not matter how big or little it might be.

Sleep is your number one goal right now and when first using cpap lets face it....good solid sleep is going to be elusive if for no other reason than the newness of it all. I think it took me about 3 months before my brain quit waking me to tell me that I had an alien plastered on my face and I was good with the pressure and the mask....but to my brain the newness made it nervous.

Don't worry too much about the AHI right now especially since you know you didn't sleep so great.
The machine doesn't know if you are awake or asleep and it can and will flag awake breathing irregularities as some sort of apnea event and it will also respond to awake breathing.
So we need to to sleep solidly for the most part so that the data reported isn't muddied up with awake false positives.

I see, thank you! Yeah, I guess it will take some time getting used to. I do need to be able to get a good sleep so that I can analyze my data and take it from there. I'm not even sure if I even have sleep apnea at the moment since I haven't had a study, but I guess the data could give some indication. I'll update this thread with the data once I have installed a memory card and have had a fair amount of sleep.

I do agree that it feels like an alien strapped on to your face. The mask was getting somewhat uncomfortable for me gradually but I think it was too tight so I loosened it a bit which felt better. It is a full face mask so I guess there's only so much comfort you'll get. And I can try out other masks if I do end up needing the machine.

For some people, the period of adjustment goes more quickly and smoothly if they set the machine up outside their bedroom and use it during the day or evening while they do something like watching TV or reading. Just a thought.

Thank you. That sounds like useful advice!

Also, I'm not sure if anyone knows, but after you insert a memory card into your CPAP and it has detected it (I have a Philips REMStar Auto A-Flex), do you need to do anything more or will it start recording on to it automatically?

Just make sure the SD card is in the machine when you use the machine.

You don't have to do anything special.

Pugsy wrote: ↑

Mon Apr 26, 2021 1:42 pm

Just make sure the SD card is in the machine when you use the machine.

You don't have to do anything special.

Ok, great. Thank you.

Pugsy wrote: ↑

Mon Apr 26, 2021 6:33 am

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

Once you sleep with the SD card in your machine use the above software.

viewtopic/t158560/How-to-post-images-for-review.html

So I did not have a good sleep today either, but anyways I am sharing my data for today and yesterday to have some indication of what's going on. The only problem is that I'm not sure at what points I was awake and when I was sleeping, since I think I was awake for a fair bit of time. Also keep in mind that I'm sleeping in the morning these days due to a messed up sleep cycle, so that's why the graphs show morning times.

I'm also not sure why the results are different both days since my sleep was more or less the same.

When you are having prolonged times with difficulty falling asleep just reach over and turn the machine off and then right back on again.
This will show up in the graphs as a break in therapy and make it easy to know that anything flagged around those breaks in therapy you were awake and not asleep and if you aren't asleep you have to ignore those flagged events when it comes to evaluating therapy itself.

I suspect you had a lot of trouble falling asleep probably at least an hour or so with lots of tossing and turning and probably sighing in frustration...all of which can cause false positive flagging.

You won't get a flow rate graph if the card isn't inserted in the machine while you are using the machine....the flow rate is very important so make sure SD card is inserted at all times when you are using the machine.

The Sunday report...I would bet my last dollar you didn't go to sleep until 09:00.

Monday report...actually decent enough especially since most likely some of the flagged events aren't real asleep since you know you didn't sleep well.

Just continue working on becoming good friends with the mask and machine so you sleep more soundly. It will take a bit of time.
Patience.....

Pugsy wrote: ↑

Tue Apr 27, 2021 9:49 am

When you are having prolonged times with difficulty falling asleep just reach over and turn the machine off and then right back on again.
This will show up in the graphs as a break in therapy and make it easy to know that anything flagged around those breaks in therapy you were awake and not asleep and if you aren't asleep you have to ignore those flagged events when it comes to evaluating therapy itself.

I suspect you had a lot of trouble falling asleep probably at least an hour or so with lots of tossing and turning and probably sighing in frustration...all of which can cause false positive flagging.

You won't get a flow rate graph if the card isn't inserted in the machine while you are using the machine....the flow rate is very important so make sure SD card is inserted at all times when you are using the machine.

The Sunday report...I would bet my last dollar you didn't go to sleep until 09:00.

Monday report...actually decent enough especially since most likely some of the flagged events aren't real asleep since you know you didn't sleep well.

Just continue working on becoming good friends with the mask and machine so you sleep more soundly. It will take a bit of time.
Patience.....

Thank you for the reply! Yes, I've been having a lot of trouble falling asleep and staying sleep since the past two days. Not sure if it's related to the CPAP or because of a medicine that I am taking - could be the latter.

I only inserted the SD card today morning before going to sleep and I didn't expect it to show yesterday's results as well. But I'll keep it inserted now so that it shows the flow rate graph.

Yes, you're absolutely right that I did not go to sleep until around 9 AM on Sunday. I was surprised by the cluster of CAs around the 7AM to 8.30 AM mark so I decided to look at my browsing history and I found out that I was using my phone until about 8 AM.

I have just one question though - since the CPAP works to prevent obstructions etc, would there be any way to know through the data (once I have had some good sleep) whether I am experiencing apneas? Or is it more of a subjective judgement, i.e. if I am feeling more refreshed using the CPAP? Thanks.

Pugsy wrote: ↑

Tue Apr 27, 2021 9:49 am

When you are having prolonged times with difficulty falling asleep just reach over and turn the machine off and then right back on again.
This will show up in the graphs as a break in therapy and make it easy to know that anything flagged around those breaks in therapy you were awake and not asleep and if you aren't asleep you have to ignore those flagged events when it comes to evaluating therapy itself.

I suspect you had a lot of trouble falling asleep probably at least an hour or so with lots of tossing and turning and probably sighing in frustration...all of which can cause false positive flagging.

You won't get a flow rate graph if the card isn't inserted in the machine while you are using the machine....the flow rate is very important so make sure SD card is inserted at all times when you are using the machine.

The Sunday report...I would bet my last dollar you didn't go to sleep until 09:00.

Monday report...actually decent enough especially since most likely some of the flagged events aren't real asleep since you know you didn't sleep well.

Just continue working on becoming good friends with the mask and machine so you sleep more soundly. It will take a bit of time.
Patience.....

Ok, I had a much better sleep today. I have actually woken up feeling a fair bit refreshed and not overly tired - haven't woken up feeling like this in a long time recently. My sleep was fragmented though (there was a power outage in between and then I woke up for about an hour).

I lowered the minimum pressure to 4 and now I can see that the median pressure remained at about 5.20 cm, with the highest being 8.80 cm.

However, are 19 Flow Limitation events and 35 Pressure Pulse events of any concern? And does it seem like from my data that I might have mild apnea, since I felt a lot better with an average pressure of only 5.20 cm while sleeping? Thanks!

The pressure pulse events don't mean anything so ignore them for now. It's just the machine trying to figuring out what is going on with what it senses is happening with the airway. Pressure pulses are used to help distinguish open airway events from collapsed airway events.

Flow limitations...19 isn't a horribly high number but flow limitations could mean some airway collapsing going on that doesn't grow up to be a full grown OA or hyponea. So we watch them with one eye.

Auto adjusting mode includes the pressure probes...1.5 cm (approx) increases in pressure to just test things out and not necessarily because the machine is thinking there is a problem.....so part of your overall pressures seen are those probes in action.
But the response during the pressure probes does tend to make me believe that the machine is wanting to fight something.

Those little spikey saw tooth pointy increases you see? Those are the pressure probes in action but you also see some flattening of the increase and even sometimes a little pressure probe on top of the plateau. The pressure isn't changing rapidly but it looks rather rapid at this scale. If you were to zoom in on the pressure graph you would see the pressure actually changes more slowly.
So the pressure probe "spikes" I expect to see but the pattern of spikes as well as the pressure change at 10:30 really makes me think that OSA or at least some airway issue is going on.

I know you would like a definitive answer since you are trying to use the machine to know for sure if you have OSA or not and unfortunately there is therapy value even at 4 cm pressure so the absence of a high AHI with these rather low pressures doesn't really mean much. BUT....based on what I see here the machine is indeed responding to something going on that it doesn't like in the airway and it only responds to obstructive stuff....

Let me go try to find a report that doesn't show much change and you can get an idea what I am talking about. Your change isn't huge but it is there especially after the 10:30 mark which is probably REM stage sleep kicking in. It's very common for OSA to worsen in REM and have us need more pressure during REM. I am that way myself....in non REM sleep I had maybe 12 to 15 OAs...but in REM I had over 50 apnea events. This was documented in a sleep lab setting.