[CPAP] could use a little help

[Eddie702]

my cpap experience is somewhat "inconsistent". sometimes it seams to work great, sometimes not, like now.

I have experimented with different pressures I guess not knowing the best way to set up the machine. I thought I had it figured it out but feeling very tired. The last 50 days June 8 until now my average readings for those 50 days are as follows:
AHI 0.9
Hypopnea 0.5
central 0'4
apnea index 0.4
obstructive 0.1
min pressure 4.0
max pressure 20.0
epr full time
epr level 3.0
pressure median 7.6
pressure 95th percent 14.3
max pressure 16.1
leak median 0.0
leak 95th percent 0.0
leak max 0.6

From what I am able to determine these # look good so I don't understand why I am so tired. using the ResScan software

Thank you for the help

[PollCat]

Did you have a sleep study to determine what should be your settings? You shouldn't start changing your settings until you have been on the doc's settings for a while. Personally, I believe no newbie should touch their settings until they have been receiving the therapy for at least one year.

If, however you are self-medicating, so to speak, I'm not in a position to offer any meaningful assistance.

[zonk]

How many hours you sleep and how many mask events shown on summary graphs
One of your earlier posts talk about stuffy nose, how is it now?

[Sleeprider]

The numbers are good, but you can still experience respiratory event related arousals (RERA) and other problems. You're running the machine wide open, and that is good to get an initial idea of your correct titration. I would raise the minimum APAP pressure to somewhere near your average pressure (7.5) with the expectation that most events would be headed off, and you would be better ventilated. If you were titrating for CPAP, you'd set it near 14 as a single pressure.

I self-titrated, and it is a common occurrence to have a diagnostic sleep study and be given an APAP machine. It will work best if you increase pressure to at least the average pressure you get "wide open". See if it helps, at least EPR will work at that pressure. It is not fully functional below a pressure of 7.

[alby_c]

I am a firm believer of owning your therapy.
I would endorse Sleeprider's comments - increase the min pressure. That alone should help - I feel like I am suffocating at 4 in my mask. I need at least a min 6. The nightly graphs should show you the pressure it likes to get to to keep most events away.

[trish6hundred]

Hi Eddie702,
You might try raising your minimum pressure to 7.5 as Sleeprider suggested and see if that helps you.
Much success to you with getting your CPAP therapy fine tuned to get better sleep, good to hear from you again.

[Eddie702]

Thank you for the replies. My last sleep study was 2 years ago. At that time I was using and had been using a "brick". All they told me was "moderate" sleep apnea and to run the pressure at 8. They said no real change from my original sleep study which was maybe 10 years ago. From my original sleep study up until 2 years ago I did not use cpap...couldn't tolerate it. I now bought an s9 autoset and a new mask and it seems to work well as far as tolerating it and I feel like I am sleeping ok but still tired...not getting good results consistantly right now although at times in the past it has seemed ok.

a few questions if you don't mind. I am using the RESSCAN software. I alwaws thought if the ahi was kept below 4-5 that things should be ok.

Obviously there is more to this than I thought. I will raise the minimum pressure and see what happens

[Shastzi]

Hi Eddie,
Your numbers look good and I think you could follow the good advice above.
You may be turning in good AHI numbers but still not having that good a night's sleep.
At this point you need to tune your machine so it lets you sleep well but doesn't
wake you up while changing pressures, etc.

I'd say, from your numbers, set the high pressure to 16 and low to 12 ( 4 point spread )
Run it like that for a week or two without changing anything.
Keep an eye on the leaks and other things. (humidity / moisture / dry mouth )
See how that works & report back!

[AndyB]

It will work best if you increase pressure to at least the average pressure you get "wide open". See if it helps, at least EPR will work at that pressure. It is not fully functional below a pressure of 7.

Sleeprider, what are your general thoughts on EPR? Your comment above suggests that you endorse it, at least in some circumstances.

I turned EPR and Ramp off very early in my new adventure with CPAP therapy, thinking they were promoting CAs, of which I had many early on, and still do frequently (my AHI is usually comprised 50-75% by CAs, with the balance being hypopneas).

I'm wondering whether I should turn EPR back on (it was set at 2cmH2O during my sleep study).

[Sleeprider]

Sleeprider, what are your general thoughts on EPR? Your comment above suggests that you endorse it, at least in some circumstances.

I turned EPR and Ramp off very early in my new adventure with CPAP therapy, thinking they were promoting CAs, of which I had many early on, and still do frequently (my AHI is usually comprised 50-75% by CAs, with the balance being hypopneas).

I'm wondering whether I should turn EPR back on (it was set at 2cmH2O during my sleep study).

That's a good question, and since it seems to affect individuals differently, there is no right or wrong answer. When EPR makes you more comfortable, and makes exhalation easier, it is certainly a good thing. The problem with it is that it actually turns your CPAP into a limited BPAP (bilevel). The fundamental principle of BPAP titration is the EPAP/IPAP must be high enough to support the respiratory system and prevent OA. EPAP/IPAP are both from minimum pressure (usually 4.0/8.0) to eliminate OA. IPAP is then increased to relieve H, RERA and snores, and the PS can also be increased to optimize respiratory perfusion.

In CPAP and APAP, where EPR seems to have problems is when exhalation relief pressure falls below the threshold necessary to prevent OA and hypopnea from occlusion of the throat tissue. Because it is a subtraction from IPAP, you need to set the minimum IPAP at a level that you do not trigger OA and H at the reduced EPAP pressure. When it is set right, EPR provides exhalation comfort and still supports the respiratory system. However, EPR can have a real effect on apnea, if the IPAP is too low and EPR is too great. Since most patients are not titrated on EPR, there is a risk of that happening.

Changing pressure also seems to correlate with increased CA in some people. It could be due to micro arousals, CO2 washout, or the unstable airway at too low of an exhale pressure...I don't know, but it's common. CA events are not much of a concern unless they are clustered or abundant. Almost anyone can be induced to have CA by too much pressure support (pressure difference between EPAP/IPAP) which washes out too much CO2. I suspect that is why Resmed limits EPR to 3.0 cm, and Philips limits Aflex/Cflex to 2.0; that pressure difference is less than the minimum PS for most bilevel and should minimize that problem. A little bit of CA is not bad if the RDI is otherwise low, and that is the tradeoff I accept in my own therapy.

Sorry for the long answer.