Cant get it right! Please help

[Geronimo]

SarcasticDave94 pid='517833' dateline='1717898283']Basic OSCAR chart of that nap. There's gotta be some info to glean insight.

Here it is. I woke up with the pressure blowing so hard up my nose  it really hurt. I am thinking of setting the EPR to 'ramp only' and reducing the starting pressure to '5' which seems comfortable for me?

   

[SarcasticDave94]

Look at the uncontrolled leaks at the end. This is about time 2:07 onward. That will prevent effective therapy. You need to control this.

You do realize EPR is helping you stay away from higher pressure at times, correct? In part EPR will reduce or minimize flow limits. That short nap displayed good FL control, very likely thanks to EPR 3. If FL increase, so does the pressure.

Your CPAP pressures ranged from a low of 4 to a high of 8.72. You might think this was pretty high, in reality it's not. I'm not belittling you, however I think you'll prohibit decent therapy if you remove EPR and lower pressures.

Regardless of what I think, if you want to run the pressure at 5 without EPR, you can. I do believe your therapy effectiveness based on this 90 or so minutes OSCAR, you'll have higher events and less effective therapy.

Try it and look at the chart. Maybe I'll be proven incorrect.

One thing though, you cannot have leak rates of 30 + L/Min and maintain anything resembling good therapy.

[Geronimo]

Look at the uncontrolled leaks at the end. This is about time 2:07 onward. That will prevent effective therapy. You need to control this.

You do realize EPR is helping you stay away from higher pressure at times, correct? In part EPR will reduce or minimize flow limits. That short nap displayed good FL control, very likely thanks to EPR 3. If FL increase, so does the pressure.

Your CPAP pressures ranged from a low of 4 to a high of 8.72. You might think this was pretty high, in reality it's not. I'm not belittling you, however I think you'll prohibit decent therapy if you remove EPR and lower pressures.

Regardless of what I think, if you want to run the pressure at 5 without EPR, you can. I do believe your therapy effectiveness based on this 90 or so minutes OSCAR, you'll have higher events and less effective therapy.

Try it and look at the chart. Maybe I'll be proven incorrect.

One thing though, you cannot have leak rates of 30 + L/Min and maintain anything resembling good therapy.

I don't take offence at all, I know nothing about this, to me it all seems complex. So I want is a decent night's sleep. What do you guys suggest I do now?

[SarcasticDave94]

OK, your choice, set the machine to what you can tolerate. Use the CPAP, working on leak control, and trying to extend your usage time. Then slowly add in more pressure and EPR.

EPR only has off, ramp, or full time, then 1-3. Eventually you'll probably want it back to full time 3.

Pressure has whole numbers but also what I'll call fractions, actually meaning the decimal, such as 5.2, 5.4, etc. So you get .2 cmH2O steps. If you want to start at 5 ok. Start there. That's where you'll begin, you'll try to get used to this. Then move the number to 5.2 and get used to it. Repeat until you can be comfortable with min pressure 7 and EPR 3 full time.

You'll want to include minimizing Max pressure for your comfort, with again the goal to move it up to about 10-12 after a time period.

[Geronimo]

OK, your choice, set the machine to what you can tolerate. Use the CPAP, working on leak control, and trying to extend your usage time. Then slowly add in more pressure and EPR.

EPR only has off, ramp, or full time, then 1-3. Eventually you'll probably want it back to full time 3.

Pressure has whole numbers but also what I'll call fractions, actually meaning the decimal, such as 5.2, 5.4, etc. So you get .2 cmH2O steps. If you want to start at 5 ok. Start there. That's where you'll begin, you'll try to get used to this. Then move the number to 5.2 and get used to it. Repeat until you can be comfortable with min pressure 7 and EPR 3 full time.

You'll want to include minimizing Max pressure for your comfort, with again the goal to move it up to about 10-12 after a time period.

Thank you. I think the problem, at least for me, is dealing with so many variables and not knowing where to start, how long for etc. In other words it would be great if I had a 'schedule' or plan that had various steps that would then hopefully resolve my individual 'puzzle'. what might seem easy to experts in this field is utterly complex and confusing to a newcomer (like me).

If my AHI is less than 5 per hour with a green smiley face for leakage rate than am I to assume that is 'gospel' denoting good therapy?

With regard to EPR, I have seen 'experts' say that ideally this should not be used as it can cause more central apneas etc. A lot of contradictive info out there. The level of expertise at the Resmed clinics here is absolutely shocking. I have little knowledge but it often seems I know more than the average employee (who are often very young and seem less than well trained).

I am rambling, I know.  What I do know is that I rip of the mask because it feels like my nose is being molested and once it is off I drift off in what seems a happy deep sleep and wake up a wreck the following morning. I am very restless too during my sleep. What gets me is that I have finally embraced CPAP therapy and it is proving so hard to get these settings correct. I was given a home study to do some months ago and my settings are a result of that I suppose. Would it be better to do a sleep study off site, in a proper lab/hospital?

[Deborah K.]

You sure are having a rough time.  I'm so sorry.  Let's try something different to see if you can get some sleep tonight.

1.  Set your minimum and maximum pressure both at 7, still using Autopap mode.  This will stop the machine from going too high.

2.  Leave your EPR set at 3.  This makes breathing easier and keeps flow limits down.  Not using it or using low settings is only for folks with really high CAs, which you don't have, and even then it's not always the best choice.

3.  Your last chart showed a lot of leaks.  I know that's not always the case for you.  Do you usually mouth-breathe?  I do, and for me, the only thing that prevents it is using mouth tape, which sounds horrible but really isn't.  I'm not suggesting that for now, but it's something to consider for later if the high leaks show up frequently.

Make sure you get some exercise today.  I find that I sleep best when I get some exercise during the day.  It doesn't have to be a lot but don't be a couch potato because you're so tired.  

Let us know how this works tomorrow.  I'm praying that you have a great night's sleep!  

p.s. I don't think another sleep study is needed.

[Geronimo]

Thanks! I will try this tonight.

I just woke up with 1.11 hrs of therapy and a headache (:

[Geronimo]

Deborah K. pid='517940' dateline='1717960416']You sure are having a rough time.  I'm so sorry.  Let's try something different to see if you can get some sleep tonight.

1.  Set your minimum and maximum pressure both at 7, still using Autopap mode.  This will stop the machine from going too high.

2.  Leave your EPR set at 3.  This makes breathing easier and keeps flow limits down.  Not using it or using low settings is only for folks with really high CAs, which you don't have, and even then it's not always the best choice.

3.  Your last chart showed a lot of leaks.  I know that's not always the case for you.  Do you usually mouth-breathe?  I do, and for me, the only thing that prevents it is using mouth tape, which sounds horrible but really isn't.  I'm not suggesting that for now, but it's something to consider for later if the high leaks show up frequently.

Make sure you get some exercise today.  I find that I sleep best when I get some exercise during the day.  It doesn't have to be a lot but don't be a couch potato because you're so tired.  

Let us know how this works tomorrow.  I'm praying that you have a great night's sleep!  

p.s.  I don't think another sleep study is needed.

So here is the interesting thing:

- I did as you asked and started with both min and max pressure at 7.0  I only had just a couple of hours of therapy and woke up with a sore nose. The air blowing up my nose felt so sharp and painful.

- I took the mask of and was going to go back to 'sleep' without. As I couldn't fall back asleep I was trying to figure out why this seems to hurt my nose so much and clutching at straws decided to go back to the setting of min 5.0 and max 9.8 (I have no idea how I orginally arrived at the latter number). I also turned the humidifier and hose temp to 'OFF'.  Additionally, I loosened my mask considerably so it wasn't sitting right 'up' my nose.  I woke up and seemed to clock about 7 hours of therapy! 

So, there's quite a few variables here but I think I might be one of those people where the humidifier doesn't seem to 'agree' with me?  early days and I woul;d appreciate and value your feedback!


hat

[SarcasticDave94]

OK I'll only comment on what I know, modern pillows masks should not be inserted into the nose, only resting on the nares. Second, and it's just a note that EPR 3 won't have the full effect until pressure increases due to events.

The chart didn't look terrible, with some occasional moderate level leaks, and the several sleep segments.

[Geronimo]

OK I'll only comment on what I know, modern pillows masks should not be inserted into the nose, only resting on the nares. Second, and it's just a note that EPR 3 won't have the full effect until pressure increases due to events.

The chart didn't look terrible, with some occasional moderate level leaks, and the several sleep segments.

I didn't insert it, it was just very tight