Do I have to readjust pressure settings after losing weight?

[AntKo]

Hi,

I have been using CPAP for almost two years now, after some trial and error and the help of some members of this forum I managed to succesfully set the settings to my machine. For the last one year and a half I had the following settings to my machine:


ResMed
AirSense 10 AutoSet
PAP Mode: APAP
Min 7.6 Max 14.0 (cmH2O)


I didn't have any problems so far (apart from some leaks every now and then) and my AHI was almost always below 1. The last months I have lost some weight, 10kg (22 pounds), and the last two weeks my AHI has increased slightly to 2-3 with most of them being CA. I am waking up really tired everyday the last days and I am wondering if my weight loss affected my pressure needs at all. Just to try it I have reduced my min pressure to 7.2 a few nights ago and didn't see any improvement (if not worse). I have attached a screenshot of my data from yesterday night. Do you have any clue if I need to adjust my seetings again? Thanks!

[Sleeprider]

I don't see a need for lower pressure in your current results. With a minimum pressure of 7.2, maximum 14 and EPR 1 you are above the minimum for the entire night based on flow limitations and what appears to be a persistent leak, mostly below the large leak threshold. The pattern of CA events is not typical for someone with hyperventilation or physiologic related CA events, and appear to be more related to sleep arousals. Hypopnea is also present and hard to tell at this scale whether they arise from flow limitation or are more central in nature. My impression is that you might benefit from an increased EPR setting of 2 and maybe a new mask or improved mask fit. Congrats on the weight loss, but it appears mask fit has been affected.

You may want to edit your profile in the User CP and update your machine settings.

[AntKo]

I don't see a need for lower pressure in your current results. With a minimum pressure of 7.2, maximum 14 and EPR 1 you are above the minimum for the entire night based on flow limitations and what appears to be a persistent leak, mostly below the large leak threshold. The pattern of CA events is not typical for someone with hyperventilation  or physiologic related CA events, and appear to be more related to sleep arousals. Hypopnea is also present and hard to tell at this scale whether they arise from flow limitation or are more central in nature.  My impression is that you might benefit from an increased EPR setting of 2 and maybe a new mask or improved mask fit.  Congrats on the weight loss, but it appears mask fit has been affected.

You may want to edit your profile in the User CP and update your machine settings.

Thanks, last night I tried setting min 7.4 and max 14 with EPR 2 and reducing my leaks. I feel kind of ok today although not perfect but I still got more CA apneas than usual. Do you think it is a good idea to keep these settings for now?

[Sleeprider]

With CPAP we are more concerned with the efficacy of treating obstructive events, and will try to avoid triggering centrals by avoiding excessive ventilation. CPAP does not treat CA so unless they are a problem, we tend to ignore them and they typically diminish as you adapt to the therapy. Becoming comfortable and feeling better can be a gradual process, so be patient. I think sticking with these settings is fine for now. The remaining obstructive events are spread out through the night with a bit of a chin-tuck at 05:15 and some flow resistance as you began therapy at the beginning of the night which drove pressure upwards. The improvement in leaks is probably a major factor for reducing sleep disruption.

[AntKo]

Hi,

I have made some attempts to improve the leaks but I am having a hard time since I have a beard and this does not go well with full face masks. Therefore I attempted using a nasal pillows mask last night. I kept the pressure as it was with the fullface mask 7.4-12 but increased EPR to 3 because I am having a hard time exhaling with a closed mouth while sleeping. I also taped my mouth last night because it keeps on openning while sleeping, but no matter how hard I try to tape it completely shut it always finds a way to open a very small gap to exhale through   

So last night I didn't sleep very well and was waking up many times during the night when my mouth was opening. The weird thing is that I had an increased number of CA events last night (AHI 6.01 ). You can check my data from yesterday below.

I am really determined to get used to the Nasal Pillows mask because it is way more convenient for me than the full face mask. Do you have any suggestion on adjusting the pressure and/or EPR to make it easier to adjust to the new mask? Also is the assumption that after some time I will eventually get used to the nasal pillows mask realistic although I am a mouth breather? For the record I have done an operation in my nose some years ago and fixed a deviated septum and I should not have any issues breathing through the nose.

[Sleeprider]

Try reducing EPR to 2 to address the CA events. Otherwise, this looks good for a first night on nasal therapy. I have used nasal pillows for many years, and still have occasional nights with leaks and dry-mouth. The main objective is to get comfortable and avoid a lot of sleep disruption. A little trick for leaks is to pull a corner of your pillow between your shoulder and jaw. It will often apply just enough pressure to keep your mouth closed.