CorruptAlligator - CPAP Problems

[Sleeprider]

I agree you are probably set to auto. There is a very brief break during ramp at the beginning, then when you started again, the pressure went up very quickly as sleep breathing was detected. It must be the way Oscar is getting the settings.

When it comes to feeling better, we are all different, and many members can take a long time to realize the subtle improvements have made a difference in how they feel. Here is a comment by a member after a couple months http://www.apneaboard.com/forums/Thread-...you--31800 When you think about treating any long-term condition, it can be difficult to track how you really feel and where you stand with regard to full recovery. I don't want to discourage you, but the majority of members we help here don't wake up the next day and feel great! Results seem to be more gradual, and having realistic expectations might help you with the patience you will need to persevere.

[CorruptAlligator]

Just checked and the setting is on Auto.

Question, how do you determined what pressure to recommend based on the chart? The member you posted link to uses minimum pressure of 5, but I was recommended higher, why is that? How come somw people are recommended EPR of 0, but some like me 3? EPR of 3 seems to work really well for me, but how was this determined?

[staceyburke]

Centrals are made worse (more) with an increase between the exhale and inhale pressure. EPR (exhale pressure relief) takes down the exhale pressure to make it easier to exhale. But that increases the difference between exhale and inhale pressure and can cause more centrals.

People that do not show many centrals are advised to raise the EPR while people having more centrals are advised to lower EPR.

A benefit of EPR is it helps with flow limitations so for some it is suggested to raise the EPR of flow limitations seems to be effecting sleep.

[SarcasticDave94]

All the various pressures and other settings are based on the individual's needs. Some of this is determined by sleep study data, titration, OSCAR usage data.

If someone has lots of CA we're going to minimize Ramp and EPR as those make events higher. Min pressure needs vary per person as well. Myself, I look for trends that I can see what the results from seeing one person's PAP a certain way results in x. If the next person is similar, I may suggest the same action, then see what happens. If it's good on result OK. But if the result is not good, we back up a step and try a different action. So a lot is seeing many posts and digging out trends to this. Some is also applying my own actions for my therapy into others that are in a similar therapy need.

[CorruptAlligator]

Just out of curiosity, EPR is related to exhale right? It's the relief of pressure for exhale, and since you cannot have two values of pressure at the same time, the inhale and exhale pressure are timed in a cyclical manner right? Like, pressure of 7 for inhale, and then pressure of 7 - 3 = 4 (5 since lowest machien pressure is 5) during exhale cycle. If so, the rythem of this cycle timing carried out by the APAP that I have to follow? I have to inhale when it makes me, and exhale when it makes me?

Because I've been having issues with abrupt pressure inhale in times of when I'm in the verge of falling asleep, and I think it's due to rythem of my breathing changing at the point of when I'm about to fall asleep, and perhaps not in sync with APAP's inhale/exhale rythem. This is causing sleep disturbance.

So, what I'm saying is, when I get this abrupt pressure inhale, it is due to my rythem of breathing out of sync with the machine's? Because the high EPR setting has to bring the pressure by up to 7. I maybe out of sync when I want to exhale at a moment, the machine's state of rythem is inhale of pressure of 7, and causing an abrupt pressure that disturbs my sleep?

Let's say my EPR was set to 0. The pressure will not lower in a cycle. There would be no low pressure/high pressure cycle to accommodate exhale. Then, there will be nothing I have to be in sync, so I do not have to be in sync, so therefore, I will never be out of sync and get a abrupt high pressure inhale when I expect to exhale?

When I had my EPR at 2, my AHI goes up, but perhaps I don't run into this abrupt sleep disturbance?

[SarcasticDave94]

You can change settings to whatever you feel that you must to maintain comfort. The pressure differences can be disturbing if you're not used to it, but realistically these are on the low end of CPAP therapy. But to keep it in perspective, for you these may feel higher if again you're not used to it. The 20 CPAP setting that I was supposed to get used to was very difficult with no support in understanding. No I didn't make that one succeed, but hindsight says I should have tried a bit harder.

Unless I'm mistaken, your inhale and exhale are spontaneous on the AutoSet. This means it's contingent upon breath input from you. This isn't timed breathing as in an ST machine where it may be either spontaneous or timed.

[Sleeprider]

CorruptAlligator, the best way to visualize EPR is to look at Mask pressure and Flow rate in close proximity on the charts. With Resmed, being out of sync just doesn't happen because the increase in pressure during inspiration follows the spontaneous effort and immediately responds if you hesitate during inspiration. EPR is identical to pressure support of the Aircurve bilevels but limited to 3-cm.  When we refer to IPAP and EPAP on a Resmed CPAP it is exactly the same as the Aircurve 10 VPAP.  Tis is not true of the Philips CPAPs which provide expiratory pressure relief, but return to CPAP pressure before inspiration begins. The difference is significant, and it is far more likely you will be out-of sync with a Philips CPAP using Flex than a Resmed CPAP using EPR.  Anyway, this is the kind of view to look at. Notice how mask pressure exactly matches the respiratory flow rate leading it.

[CorruptAlligator]

Hey guys, I've recently switched back to F30i mask, and I'm getting inconsistant results.  AHI is generally around 3 or so, but sometimes it shoots up, and as you can see from the first image, it's possible to go down to a good number.  I really have no idea why it goes up so high on certain days, and so low on certain days to the point of hardly any CPAs?  Please take a look and let me know what occurs to you from my data, and if there are any recommendations what to do.  

I tried higher than minimum pressure of 7, but it was uncomfortable to fall asleep.

First image is the best AHI I've gotten with this mask.  

Second and third images are the worst AHI I've gotten, and the avg being about 3 AHI usually.

Is it possible my machine is faulty? I'm looking into getting a replacement.

[Gideon]

AHI is shooting up because you are tucking your chin, 'kinking' the 'hose' going to your lungs. The tell is the clustering of obstructive events. It's not your mask, unless for some odd reason it is causing you to tuck your chin, and your machine is fine.

The 'fix' (or cause) may be as simple as a pillow alteration. The goto fix is a soft cervical collar, see the link in my signature. This is a form of positional apnea in that it is caused by your body position. This is not the same positional apnea that is reported on your sleep study which is side vs back sleeping. Pressure typically does not work. You would see a difference overnight if this is a regular occurrence.

[CorruptAlligator]

What do mean by 'kinking' the 'hose?' You mean the air passageway in my body to the longs? Not the actual cpap hose right?

I'm looking into cervical collar. What can I do with my pillow to position me right? You mean get a proper pillow? Wouldn't not using a pillow aleviate chin tucking? Would you advise not using a pillow?