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First of all: I have had Cpap for a few months, and have been so Grateful for this forum, and everybody who is sharing tips and information here. I am still struggeling With leaks and pressure. I startet With pressure 6-11. The max pressure was later set to 13, then 15, and finally 17 because the Controls showed that the pressure just wasnt high enough. In my last visit to the hospital, the nurse suggested that I could turn of the EPR. Later I read that the EPR makes the pressure lower than the actual max pressure. My EPR was set to 3, and I turned it off and felt that it was much easier to breath without it. Then I read that it might be better having a Shorter range between min/max pressure. In the beginning of april I changed the min to 7, which went well. I few days later I went to 7.6. It became a bit uncomfertable, so I reduced it to 7 again. At the same time I set the max pressure from 17 to 16 because it seemed that without the EPR, my Maximum pressure went Down to 13-14 at night. I have before and after these changes have trouble With leaks most Nights. I can see that I have manage to make them smaller after I made these changes, but they come more often. I Wonder why? I have tried to tighten the mask better, but I still get leaks. Does the encreased pressure make it harder to avoid leaks? I also have clusterapnea, some of them over 60 second long. Sometimes it happens when the leak is on a minimum and the flowlimitation is zero. Why? What would be the best min/max pressure for me? I can see that in 95% of the time over a long periode the pressure was lower than 15. But on Nights With large leaks it seems like it isn't high enough max pressure 16.
I would be very greatful for tips on how to do better. Usually I am at 2-3 AHI now. But I am still so tired. I Wake up several times during the night, somtimes I feel exhausted when I Wake up in the middel of the night. That happens when I have had a night With 10-15 OSAS in a row.
Thank you!
04-15-2018, 06:35 AM (This post was last modified: 04-15-2018, 06:45 AM by Walla Walla.
Edit Reason: Added sentence.
)
RE: Trouble with leaks and pressure
The clusters may be positional. You might want to try using a soft cervical collar to prevent your chin dropping. When the chin drops towards the chest it cuts off the airway. The collar prevents this. A small horseshoe shaped pillow placed under the chin can also accomplish this.
As far as leaks, yes higher pressure make it harder to control leaks. But I'm pretty sure if you use a collar you'll find you don't need the higher pressures anymore.
Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
04-15-2018, 10:01 AM (This post was last modified: 04-15-2018, 10:02 AM by Ron AKA.)
RE: Trouble with leaks and pressure
(04-15-2018, 05:40 AM)Kristin Wrote: Does the encreased pressure make it harder to avoid leaks? I also have clusterapnea, some of them over 60 second long. Sometimes it happens when the leak is on a minimum and the flowlimitation is zero. Why? What would be the best min/max pressure for me? I can see that in 95% of the time over a long periode the pressure was lower than 15. But on Nights With large leaks it seems like it isn't high enough max pressure 16.
Walla Walla has a good suggestion to try to determine if you are causing obstructive apnea due to your neck position. Well worth trying.
I believe your observations on pressure and leaks is generally correct. The higher the IPAP (inhale pressure) the more the mask leaks. If you use EPR it will require a higher IPAP pressure setting. And when you use EPR the variable IPAP to EPAP (exhale pressure) that you get can move the mask around, and make it more difficult to seal. So, if your objective is to reduce mask leaks turning EPR off is a good thing. On the other hand exhale pressure will be higher, and some people find that uncomfortable. That is kind of the tradeoff in my experience lower mask leakage vs comfort.
Just based on your one posted chart I would suggest two changes to your setup:
1. It seems your cluster events are occurring when the pressure it at your current maximum setting of 16 cm. Leakage seems very good during this time also. I would change the maximum setting to 20 cm as a first step, and then see where pressures go to. Keep in mind that the machine will not run the pressure up to 20 unless it needs to. You are setting the maximum, not the actual pressure.
2. SleepyHead reports that you have the mode set to "Auto for Her". While the Auto for Her mode has some advantages for those who are needing lower pressures, it may not be the best settings for you. The limitation of this mode is that it will not respond to OA events after the pressure is above 12 cm. Your median pressure is 11.3 cm, so probably about 40% of the time you are above 12 cm pressure, and the For Her mode is limiting what the machine can do for you. I would suggest changing the the Mode to AutoSet. That will allow the machine to respond to OA events which occur above 12 cm. In your posted image all those events occurred above 12 cm. The Mode is the first setting you should see in the Clinical Setup menu.
Hope that helps some. Also try the cervical collar as suggested. It may work, and may be more tolerable than increased pressure.
Thank you.
I will try a collar and the pillow, and come back to you. I think you are right about the clusters, it makes sense. Thanks again for good advice!
Kristin
Welcome to the group Krisin! Glad you found us, lots of knowledgeable helpful people here!
Mask fit is usually a problem. Sometimes people tighten their masks too much and that can cause leaks too. Maybe this can help you with achieving a better mask fit:
Oh, and don't be surprised if it takes a while - months even to feel less tired. xPAP therapy will help but it takes time.
Good luck!
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Thank you so much for your responses to my problem. I am just starting to learn, and it is alot to learn! I wasn't aware of the different modes on my machine. I have changed it to autoset. Does this mean my machine is two different types of machine depending on the mode they are in? Sorry if this question seems stupid. I have alot to learn!
I will try to rise the maxpressure too, but thought I might wait and see what happens after having changed the autoset first?
And yes, I have tightened the mask alot lately, probably too much. I thought that it would fix the leaks, but no. It did not.
Thanks alot for your help. I will post again later when I have tried out Your advices!
04-17-2018, 01:14 AM (This post was last modified: 04-17-2018, 01:14 AM by Kristin.)
RE: Trouble with leaks and pressure
Hello again.
Thank you for your help so far.
I changed the mode to autoset on the 15th and tried to avoid tightening the mask to much by thinking comfort. The result was no major leaks at all! I had a couple of clusters OA, and a few OA was quite long. When changing to autoset, the ERP turned on again. On the 16th I turned it off - again, and sat the max pressure to 20. I woke up a few times this last night because of the noise from the mask. And each time the pressure would start at 7 again. The max pressure was 19.22, but I can`t explain why it went that high. No major leak. I`ve also noticed less flowlimitations these two nights.
I have not been able to get a collar yet.
I wonder if I should rise the min pressure? If so, could using the ramp make it easier to tolerate until I have fallen asleep? What min pressure should I try?
Any advices or tips would be appreciated.
Thanks again!
Kristin
Hello again.
Thank you for your help so far.
I changed the mode to autoset on the 15th and tried to avoid tightening the mask to much by thinking comfort. The result was no major leaks at all! I had a couple of clusters OA, and a few OA was quite long. When changing to autoset, the ERP turned on again. On the 16th I turned it off - again, and sat the max pressure to 20. I woke up a few times this last night because of the noise from the mask. And each time the pressure would start at 7 again. The max pressure was 19.22, but I can`t explain why it went that high. No major leak. I`ve also noticed less flowlimitations these two nights.
I have not been able to get a collar yet.
I wonder if I should rise the min pressure? If so, could using the ramp make it easier to tolerate until I have fallen asleep? What min pressure should I try?
Any advices or tips would be appreciated.
Thanks again!
Kristen, it would help if you would minimize the monthly calendar which would let more useful information show. Just click the triangle in the date box.
Your currerntly using a pressure range of 7.0 to 20.0. Your most recent results show a good improvement over your previous results, however, your exhale time seems a bit clipped, and it would be interesting to take a close-up view of the Flow Rate graph (a 2-minute segment) so we can see what is going on with your respiration that causes exhale to be shorter in time than inhale. I think you are still seeing some positional obstructive apnea. Are you using a soft cervical collar?
For settings, I recommend the following:
Mode: Autoset Standard
Minimum Pressure: 9.0
Maximum Pressure 18.0
EPR: ON
EPR Setting: 2
These settings will be more comfortable as pressure increases by relieving pressure during exhale. The settings will produce the same exhale pressures as you are currently using with your range of 7-16. You are doing pretty good compared to your first post but there is room to improve the clusters of OA. What are you using as a collar?
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Hello, Sleeprider.
I haven,t been able to get a soft collar yet, but it is a priority. I have to find out where to buy one. Any suggestions?
I am posting two segment, I hope it can be of help. I will change the settings as you have suggested. Do I do all the changes at once, or do I make the change over several days? I changed to autoset two days ago, and max pressure was set to20 yesterday.
(04-17-2018, 01:14 AM)Kristin Wrote: I changed the mode to autoset on the 15th and tried to avoid tightening the mask to much by thinking comfort. The result was no major leaks at all! I had a couple of clusters OA, and a few OA was quite long. When changing to autoset, the ERP turned on again. On the 16th I turned it off - again, and sat the max pressure to 20. I woke up a few times this last night because of the noise from the mask. And each time the pressure would start at 7 again. The max pressure was 19.22, but I can`t explain why it went that high. No major leak. I`ve also noticed less flowlimitations these two nights.
I have not been able to get a collar yet.
I wonder if I should rise the min pressure? If so, could using the ramp make it easier to tolerate until I have fallen asleep? What min pressure should I try?
Any advices or tips would be appreciated.
You have made quite a few changes at one time, and I would suggest picking one horse and riding it for a while to see how it goes, and then pick an alternate one. And for consistency I would leave the mode in Auto CPAP rather than For Her. Depending on where you end up, it may be possible to go back and try it, but it looks like your pressures are running too high to use the For Her mode effectively.
First for the easy part. I like the Auto Ramp feature of the A10 machine. It is not really a ramp, but a switch to monitor your sleep status, and then ramp up very quickly to your minimum pressure. I would recommend using the EPR during the ramp for sure. You are awake and you might as well be comfortable. It also gives you the option of setting a ramp start pressure which will be maintained constant while you are awake. I would suggest a setting of about 7 cm. Go higher if you think you are not getting enough air when you are awake, or go lower if you think you are getting too much.
Now for the harder part. I find there are two strategies in addressing apnea with these machines, and the best approach may be personal. I am currently using a strategy of EPR at 3 on during the ramp only. It is a selection when you have the ramp on. Then during my sleeping time the EPR is off. The advantage of this strategy is that it reduces the maximum pressure you need to treat the obstructive apnea. So if you are having trouble with mask leaks and/or discomfort reducing the maximum pressure can be a good thing. But there is no free lunch. It will be a bit harder to exhale with no EPR. This is the strategy I am currently using after trying the EPR route for some time. For me it seems helpful to reduce the mask pressure and I don't notice the exhale effort increasing.
The other strategy is to use EPR and I did for a while set at 3. The advantage is that it become easier to exhale, but the disadvantage is that you have to run the maximum pressure as much as 3 cm higher, or 2 cm if you set EPR at 2. If you choose this method set the EPR to full time instead of ramp only.
I would suggest deciding which is of most concern to you, the mask pressure or the exhale effort and use that to guide your choice. The method will determine your choice of max and min pressures. But I repeat. Ride one horse or the other for I would suggest a week. Try the other method for a week, and then decide how you will go.
