[Diagnosis] How's my chart looking?

[outasleep]

Hi all first time on the forum, and wanted to thank everyone responsible for such a great community. 

First week using my AirSense 10 (APAP?), it's set to 4-20 auto mode and I wondered what the thoughts were on the chart. 
Should I change the min/max settings? I feel it's not enough sometimes when I first turn it on, although ramp is off.

My sleep study said I was on 27 AHI.

I may give it a while before tinkering, as I'm not sure if my NHS clinic will look or not (probably not!). Any advice appreciated! 

Regards
outasleep ;-)

   

[Melman]

Welcome to the forum. It’s not surprising that you feel starved for air. Most do at a minimum pressure of four.  Also your getting no EPR because it’s set for ramp only. It should be changed to full time. Increase the minimum pressure to 7 to assure you don’t feel air starved and to get full advantage of EPR. At a setting of 3 EPR lowers the exhale pressure to 3 below the inhale pressure so with the minimum pressure at 7 the exhale pressure is f4 which is as low as the machine will go. EPR should reduce you flow limitations and hypopneas. Post data again after a night with the changes. You can find instructions for making the changes here https://www.apneaboard.com/resmed-airsen...setup-info

[outasleep]

Thank you! I will report back soon after making the changes :-)

[outasleep]

Hi @Melman I changed the settings and here is the new chart after last night (daytime nap not included as it was before you recommend I change the settings).

It felt a bit stronger than I expected, it felt like my sinuses were being inflated and my nose was inflating a little, but as I settled my breathing it felt good and those feelings went away. It was so nice feeling the pressure drop away as I exhaled :-D

I woke up today feeling refreshed and don't recall waking as much during the night, other than the 5am pee break! I have a little sinus headache but I did have that before I went to bed so may be a false indicator.


What do you think?

If I did feel need to lower the setting tonight should I try maybe max 6 minimum and set EPR to 2? 

Thanks for you help!


   

[Melman]

Your flow limitations look much better. I think lowering the starting pressure and EPR would be counterproductive. It actually may be better to increase the minimum pressure to 8 or 9.

[Sleepy Quixote]

@outasleep


Absolutely agree with Melman, reducing either pressure or EPR would be counter productive. If you are a little uncomfortable at first but as you say once you settled it felt good and feelings went away indicates to me you just need to go with it for a little while and get used to the new sensations. Once you become accustomed to it and "I woke up today feeling refreshed and don't recall waking as much during the night" becomes a trend, its time to improve those Flow Limits even more by increasing your minimum pressure. You don't have to jump straight up to 8, you can go in small increments, 7.2, 7.4, 7.6 etc monitoring your Flow Limits with each bump, you may find that you hit a sweet spot around 7.4 or 7.6 where you are seeing 99.5% FL of .06 or so consistently, if not keep bumping up till you find it. Making small incremental adjustments lets your body adjust gradually improving your overall comfort while increasing efficacy.


Good Luck, keep at it, that's how we get good at it!

[outasleep]

Thanks both, for now the pressure is 7 with EPR 3, I set the ramp from 6-7 for 5mins to allow my sinus' to adjust as I seem to get ear pain on the one side strangely.

How's this looking now do you think? Should I up min pressure to 8? 

   

[Sleepy Quixote]

@outasleep

That short ramp should be fine. I wouldn't start further adjusting pressure until you get those leaks taken care of. Leaks undermine the machines ability to manage your airway, up to a certain point it can adjust by flowing more air to make up for the loss, but in the long run leaks reduce efficacy of treatment and decrease quality of sleep by constant disturbance.

Once the leaks are minimized start bumping minimum pressure up in the smallest increment possible and run each setting for a few days to be sure the results are consistent. Pay more attention to flow limitations than AHI, lets get that 99.5% number below .10

Looking at that chart, reducing leaks will reduce your pressures along with smoothing out some flow limits, notice how both follow to some extent the leak arc.

Good job on making adjustments and follow through!

Good luck, keep at it, that's how we get good at it!

[outasleep]

@Sleepy Quixote

Thank you! I will work on minimising the leaks and getting the flow limit <0.1 @ 99.5%, it's good to have a direction to head in.

I'm using a P30i the same as you I think, have you any tips for limiting leaks?

At the start I found having the pillow a bit tighter gave me an aching septum, so I loosened it off quite a bit. And also I use lanolin around the nostrils which seems to help with soreness of inside nostrils, and I'd hoped stopping leaks! 

Maybe a different pillow might help when lying on side? Strange as the mask leaks quite a lot when I'm lying only on my back, I can't roll onto my side because I wear headphones during naps (see chart with nap shown as well).

Will also have a search of the forum for any tips!
Thanks again 


   

[Sleepy Quixote]

@outasleep

Yep, I use the P30i too. I tend to get the small annoying leaks around the nostrils, your big leaks look like mouth leaks to me. I ended up having to get a Respironics chinstrap and use Cover-roll Stretch tape for my mouth. You might try starting with a chin strap to see what difference it makes then bump up to taping if need be.