Good reports (I think), yet extremely tired

[mesenteria]

Just an additional word of caution: I agree with all the proposed changes, and would urge you not to jump to conclusions based on a single night's evidence.  You're going to raise your max pressure substantially, and not without good guidance and reasoning.  I would try that for three nights running to see if there is some stability and reasonably robust improvement.  If your machine doesn't seem to help, even with the new settings, then I would agree that you need a different form of therapy, and that the bilevel is going to be it, based on crimson nape's experience and to what I believe Sleeprider is leaning.

[Sleeprider]

First of all, don't jump to conclusions until we try EPR 3 at higher pressure. Compare bonjour's and my post and we are both on the same page. This can be dealt with one step at a time. My starting pressure is 13/9 and averages 15/11. It is hardly noticeable because my 95% flow limit is about 0.02 or less. If I had your results, I'd be desperate for better sleep. You will get there, one step at a time.

I would still like to see a proper chart without the monthly calendar. We know your flow limits are messed up, but we still have not seen inspiratory / expiratory times an other stats. All of that is an important metric in comparing your progress. Please give us a good screenshot based on the Organizing Your Oscar Charts in my signature links.

[ppca]

Here are all the charts:




The charts are from last night.

Today, after chatting with you folks here, I cranked the pressure up to 10.4 (from 9.6) and took a nap (about 2 hours long). It did not feel good at all. I felt almost as I'm getting too much air in, without the ability to properly exhale it. Checked the AHI number on the machine when I woke up, and it was showing 2. Usually, during these naps (typically 1.5-2 hours long), the machine shows either zero, or very close to it.

I know that 2 hours only is not nearly good enough to draw any conclusions, so I'll see what the rest of the daily report will be tonight. Although, I'm a bit concerned that it may be a really bad night, based on this short experience. Did I possibly make too big a jump, increasing the pressure by 0.8?

Thank you for your help!

[Gideon]

One of the things to possibly discover is that pressure has little to no impact on your flow limits. That is why I said 11, to get a large enough change to see.
Note that I tend to be conservative in my suggested adjustments, Sleeprider tinds to be more aggressive, but we both tend to target the same changes, mine just take a little extra time to get there.

We will see what your charts show tomorrow.
I do think a BiLevel is in your future.

[ppca]

Here's my last night's report. What is also included this time is the SpO2 report (a little bit more than 4.5 hours of recording). I did lower the pressure to 10, after having a not so great experience with 10.4. You will see that the first 2 hours (afternoon nap) are with 10.4 pressure, and then the rest is at 10, still a bit higher than what I used to have before (9.6). Flow limits are obviously high, so I guess I should be increasing the pressure more. For some reason, I feel more comfortable doing it in smaller increments, rather than jumping directly to 11, or higher.

And one more question with regards to BiPAP machines, compared to APAP's. From what I'm reading, BiPAP's are mostly prescribed to patients who need higher pressure levels, which I don't think is my case (could be wrong though), or those patients who have respiratory problems, like COPD for example. Not my case either. On the other hand, my understanding is that APAP machines adjust the pressure automatically, based on patient's needs throughout the night. Why wouldn't an APAP help me?

Here's last night's report, and thank you for your help.

   
   
   

[Gideon]

BiLevels are also the machine of choice to treat excessive flow limitations, AKA UARS. This is where you fit in.

[Chequebook]

How did you get on?

I, too, feel bad during the day despite excellent AHI and the generous contributors here finding that my machine settings and results are probably as good as I'll get.