AHI vs RDI

[TechieHippie]

I see two things you can work on to start. First, it looks like you are trying to use EPR 1, but either your settings don't support it so you only got the value of it for the last part of the night, or you added it midway through the night.. maybe try raising your minimum pressure to 4 + EPR, so that your exhale can be 4, which is the minimum treatment level.

Second, it looks to me like you are having a lot of interruptions to your therapy, possibly taking off the mask and the machine stopping. If you are taking off your mask during this time, that might suggest and pressure increase because lower pressures will cause air hunger. Do you have auto start on? I recently read that with the machine you have auto start and auto stop are on the same setting so you may want to turn that off if you can push the button easily.

Another way you can improve this is, if you have ramp on, every time you have one of those breaks in the flow rate, your pressure start again at the beginning. If you can turn off ramp entirely (I can't quite tell if it's on), you will get a more even therapy. The machine cannot do less than four so it doesn't make sense to ramp it with your settings. It will be purely comfort and no treatment during the ramp less than four.

Your low AHI looks great, but that could be artificially deflated by the starting and stopping of therapy and the low pressure. If you are sensitive to pressure, you could increase your minimum very slowly.

Lisa

[Burrells5]

Thank you so much for your help.  So that night I changed the epr setting to on half way through the night.  I can upload last nights which was on all night.  The ramp is turned off.  I do have LOTS of interruptions. I just don't sleep well at all.  I don't sleep over an hour at a time.  On this night I slept from 230-6 which is the longest stretch I have slept in many months.  I get up to go to the bathroom very frequently.  I either leave machine on and take mask off or turn off machine (I saw a video where you were supposed to do turn off but I don't know).  I move a LOT and wake up.  I honestly don't know what to do to be able to sleep better.  I have had this problem for years.  I have tried everything I can think of or that is suggested to sleep better.  I didn't realize I even had apnea until a few weeks ago.  I don't snore, my bmi is under 19, I am very athletic so no one thought was apnea.  I had back surgery in dec so now I move even more because I can't lay long in one position.  I really am trying to make this work, as I keep my mask on all night even when I am not asleep.  I really don't have any help from the medical supply so I have made adjustments myself.  I still am not happy with my mask as it blows air in my eyes all night.  Someone said to stop switching masks and give one a long try so I am trying.  I really don't feel any better before cpap and some days actually worse.  I was very excited that I had that long stretch of sleep but last night back to the same ordeal.  I also have extreme gas from air swallowing.  I have tried elevated pillows, gasx, pepto, etc.  Sometimes I hear something like a gurgling that wakes me up.  It is just a few seconds and i suppose is almost like a gas bubble is in my throat.  

---

last one

[TechieHippie]

That all makes sense. It might just take time. Hang in there - you are doing the right thing for your health and it will almost always get easier. One step at a time! And that you had the longest stretch in months is promising.

You could see if creeping your min pressure up helps, even though it makes sense that it's low given your parameters. If you can get to a min of 5 it will support your EPR 1 better also.

I'm not sure about the advice to pick a mask and stick with it...yes and no You don't want to be keeping yourself awake fiddling with something. But if something is just not working and is making you anxious, it can be worth switching. What I do is have my mask options all ready to go and just snap in if I get frustrated in the middle of the night. I have heard that the Dreamwear nasal pillows/cushions might have better exhaust patterns than the Resmed; I love mine. It doesn't blow into my eyes, but it's not perfect either. I can usually find a position of pillows and sheet so that I don't feel it on my arms.

My "gut feel" is that even while playing with settings and other enhancements, you might switch now into "settling in" mode and getting out of analysis mode for a while. Have some fun during the day, take care of yourself well and stay hydrated but take some focus off of sleep.

On the topic of wakings - could you zoom into the stretch right around one and show flow rate, just the first screen is enough. Look through to see if any patterns occur right before you wake, and if so screenshot one of them.

I had my first night with zero bathroom trips, maybe the first for a very long time. For those wakings, something posted here helped me a lot. When you wake in the night, ask yourself if you can wait a little bit before getting up to go to the bathroom, or even go back to sleep. Even just delaying and relaxing my breathing sometimes makes the urge go away. Even if it doesn't, it may slowly train your body that whatever is waking you up is not a threat. I used to go by the theory that if I was already awake and had to go to the bathroom, I should just go instead of holding it because it was just going to get worse. Don't torture yourself, but you might be able to train away the wakings.

Lisa