DavidAM - Treatment

[DavidAM]

Hi! I've finally gotten my SD-card reader, and I've plugged my sleep data into OSCAR. I'll be periodically uploading it in this thread. This has been my 3rd night with the APAP, and I wanted to ask if it's normal to feel breathless and a difficulty to exhale with my pressure settings (8-15), after upping them from those I used the previous night (4-13); also, my EPR is set to 3 for all the sleep duration and my ramp time to 15 minutes, so I can transition easily into the higher pressures. 

Today, I'll only be uploading last night's data, as it's the one with the pressure settings that were recommended to me by @staceyburke. I woke up with a little headache and feeling tired, so I don't know if my current settings are right for me, or not. The data in the screenshot is fragmented in the afternoon and evening because I took a nap and also because I wore the APAP so I could adapt to those new, 8-15, pressure settings.

I'm excited to hear your feedback!

[Narcil]

looking good i think. don't worry about the CAs while you were testing apap, awake breathing is quite different and irregular compared to sleep breathing and the machine gets "confused". i think it's normal to find it difficult to exhale a bit at the start since you raised pressure but you will quickly get used to it. epr is already maxed out so can't help it more outside of lowering pressure back down again.

only thing i would change is the mode to autoset and not autoset for her if your profile is correct. even for women it doesn't seem great because it responds slower to events.

i think you would benefit from a higher min pressure to deal with the remaining flow limits but i would get comfortable with the current settings first.

[PeaceLoveAndPizza]

Agree with Narcil on the “autoset for her” setting not help you and to bump up your pressure a wee bit.

Consider the following:

Mode APAP
Min pressure 9
Max pressure 12
EPR 3 full-time
No ramp

If will likely feel a bit strange when you start, but you will get used to not have ramp quickly. Keeping a bit higher min pressure will help with the pressure swings and should be more comfortable.

[DavidAM]

Thank you both! I'll switch to the normal autoset, althought I thought the "For Her" mode was a little better for treating flow limitations; which seem to be more important to treat in my case, since I had 300 spontaneous arousals at the in-lab PSG, and an RDI much higher than my AHI in the at-home test. Anyway, I'll try your suggestions out and I'll post the results!

[Sleeprider]

Here is our wiki discussing the difference between Autoset and Autoset for Her https://www.apneaboard.com/wiki/index.ph...Algorithms I don't find the Autoset For Her to be beneficial for most people, and it has no effect over a pressure of 12. At pressure 8-15 and EPR 3, your AHI is fine, but flow limits moderately high. Based on a median pressure of 9.5, I think you need a higher minimum pressure. This will reduce the changes in pressure and be less disruptive to sleep. In the long-run, you may do better with bilevel therapy and higher pressure support, but let's see where we can take the CPAP.

You can see your flow limits are not consistent and there are periods where they are much higher than others. This clustering of obstruction may be positional. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[DavidAM]

Thank you for your response, Sleeprider. You're right in that I have what seems to be positional apnea, as my event count was much higher in a supine posture in both my sleep studies.

About the BiPAP: what do you think would make us conclude it as a better fit for me than my current APAP? And how much time could it take to get to such a conclusion? I'm currently renting my APAP, on a 1-to-2-month trial, in order to see if it's worth for me to buy it, and if it is a good treatment option for something that none of my doctors until now have been able to properly diagnose. Thus, it'd be good to know, before the 2-month mark, if switching to bilevel therapy would be best.

[Sleeprider]

David, the use of pressure support almost always resolves the issues you're experiencing with poor sleep and arousals. CPAP is fine as a dumb therapy to keep your airway stented to prevent OA events, but if you want to overcome flow limitation, pressure support is the ticket. Compare your flow limitation and RERA statistics without EPR vs with EPR and you can prove it for yourself. Pressure support is an increase in pressure during inspiration that helps overcome any airway resistance (flow limitation) and create a normal breath using a bit of mechanical assistance, to overcome the airway resistance that limits peak flow. That's a pretty complicated concept, but all we need to do is look closely enough at your flow rate, and we will see, instead of achieving a normal peak flow, your flow rate flattens or reduces just as it is supposed to be peaking.. That causes more respiratory effort to get the breath you need, and results in respiratory event related arousals. Zoom into about a 3-4 minute period and look at the respiratory wave.

Fortunately, insurance allows your doctor to decide to try bilevel therapy without any testing. We went into considerable depth on Deborah K's thread here. So rather than repeat all that, I'd like you to take a look. https://www.apneaboard.com/forums/Thread...to+bilevel

[DavidAM]

Hi, last night was a struggle. For the first 2 hours, I felt I was suffocating, I had a hard time breathing; so I upped my pressure several times until I settled for 11-16 and that's what I fell asleep with, although it may have simply been because I was more tired, not because it's a better range for me, idk. I don't know what made it harder for me to breathe last night, but I went to sleep at 3 am - everything before 2 am, in terms of data, is a mess due to me constantly switching the pressure settings and taking the mask off.

I don't know if this is the right mask for me, even though I've tightened it a lot it, it still leaks. I'm with a Philips DreamWisp Nose Mask. It is comfortable when not so tight, but it just keeps leaking.

Also: thank you, Sleeprider, for your help. I'm going to be including a 3-4 minute zoom into my flow rate. And I'll take a look at the thread you shared, thank you again.

[BoxcarPete]

Probably not the right mask for you. A good fit for a mask has the seal formed by the air inside trying to escape but instead pushing the silicone skirt flush to your face. The straps are just to keep it from losing contact with your head when this happens. If this does not describe a leak-free fit to you, then you don't have the right mask. Everybody has their own preference based on their unique physiology; don't discard a mask as an option just because someone you respect thought it was horrible. It might be just right for you!

[Sleeprider]

Flow limits dropped slightly to 0.06 and pressure remained very close to the minimum pressure setting. The zoomed flow rate shows normal respiration with minor flow limitation indicated in some flattened inspiratory peaks. There was no FL flagged for that time period on the full-night chart. I'm sure the period from 08:46 for about an hour looks very different.