Open full view…

When will I notice an improvement in sleep with CPAP as a New User?

Fri, 11 Jun 2021 12:05:40 GMT

This question came up on Reddit and I put this in as a reply. Thought I would share it here as well. There is a very different bridge to cross for all new CPAP users. Some gravitate to therapy quickly and others do not. Your experience may vary and you should understand that, as well as take ownership of finding out why: Depends on the level of apnea and how consolidated the sleep becomes after starting CPAP therapy. If you are in the severe category with an AHI (Apnea/hyponea index or how many times it's noted you stop breathing) of 70/hr and an arousal index of 60/hr (amount of times you wake up per hour with the apnea, snores, RERAs, etc) and you start CPAP and those number are reduced to say 4 for AHI (take you machine AHI with a grain of salt, as no EEG is available and no O2 tracking can make it exact) and your arousal index drops from 60/hr to 8/hr, you are probably going to notice an improvement pretty quickly as you are improving all aspects of sleep. Now, if you're a mild patient with an AHI of 10/hr but your arousal index is 20/hr between the apnea, snore aro usals and RERAs waking you up and you start CPAP and your AHI drops 4/hr, just like the severe patient above, and you arousal index drops to 8/hr, well you aren't improving as much as the severe patient, so it may be harder to notice as much improvement. It's why controlling leaks with masks and mouth breathing are important, because the milder you are the less noticeable, in many cases, it can become, as CPAP can cause it's own set of arousals or force the new user into positions they are not comfortable with. KNOW THAT STILL 30-40% of patients quit therapy in the first 90 days and most of it's mask related. It may take you buying several masks to learn what works best for you. The thing to remember is that apnea is, more times than not, better controlled laterally (side sleeping) or toward the stomach, as gravity becomes your friend and your jaw falls away from the face, requiring less pressure to stabilize and splint the airway open. Less pressure means it's going to be easier to breathe on and less likely to cause mouth breathing, which can fragment sleep. Do not start with a FULL FACE mask, regardless of what anyone says. Enough clinical data and studies have been conducted to know this. Do not fall for the TRAP Question from an RT or sleep tech asking "Are you a mouth breathier?" and forcing you on a full face mask without ever really knowing if you need to be or not. This is akin to Magic 8-Ball Medicine..."It's highly Probable" is not an actual answer that is fact based. You wouldn't look at someone and say "It's highly Probable" you have cancer and just start on chemotherapy. It's no different for finding the right mask. Full face masks pull the jaw back and require more pressure and relegate more people to their back than necessary, causing pressures to go up and leaks to escalate, as well as the terrible algorithms in some machines try to compensate for leaks by driving pressures up even higher and exacerbating leaks even more. This is not to say full face masks are not needed. Plenty of people do. But they account for less than 20% of the entire PAP market and Resmed's and F&P's annual reports suggest this. Start with nasal and prove to yourself you can't use it and your sleep is worse before switching to full face. Also, know your pressures and data, and if you are on a AUTO CPAP (lots of people are now with HSTs) and your settings are 4-20, it's good to start for a couple days, but you need to absolutely own knowing what your leak rate is on a daily basis, your AHI and your 95% pressure. Download Oscar and look at your leak graph (hypnogram) and match up spikes with increases in pressure. If you are seeing leaks and pressure spikes matched up on their respective hypnograms, then your machine is most likely giving you more pressure than you need. If it's high, you will almost certainly be having arousals and you'll need to address that. There are more solutions out there than just chin straps. Join a forum and learn to post screen shots of your data and know how to adjust your own cpap settings to dial in your pressure yourself, as, clinically, you are not going to get daily support at optimizing your pressures for you. RTs can't change settings without a doctor's approval and sometimes it's a week or two before something is done. Demand a tight range on your Min and Max AUTO settings that is no further apart then 3-4, after a week of use. Then begin the process of documenting on a daily basis your statistics and tracking how you feel during the day, as much as you are paying attention to you data. It's okay to go down on pressures to dial in your settings. Plenty of patients are in limbo waiting for help as they struggle or spiral away from compliance. Work with your support team, but take ownership of your therapy. Too many people are over-titrated on CPAP and are not supported properly, and certainly not on a daily basis, as they really should be when new users. There is literally no reason someone should be on 4-20 for more than a week. It's too low to start and has the opportunity to be too high in the end for loads of reasons. Good luck!

Sat, 03 Jul 2021 13:34:36 GMT

Excellent advice!