Finally, SUCCESS after almost giving up on CPAP (retitled)

[Computerdoc]

Trying once again to use my CPAP and I have about two weeks of nightly use.  I continue to experience grogginess when I awake and generally do not feel refreshed after a night's sleep.  In fact, I can only recall two or three instances in my whole life where I felt refreshed and rested after a night's sleep.  I also continue to have low energy and considerable daytime sleepiness.  I originally went to a sleep doctor for insomnia, and she has prescribed nightly Klonipin (.25 mg) to address my REM sleep behavior disorder, along with 3 mg Melatonin.  She describes my OSA as mild to moderate with mild when I'm sleeping on my side and severe when on my back.  Can't sleep using the positional devices.

Please help me interpret the most recent Oscar report and thanks in advance for any recommendations for improvement.

[attachment=25922]

[staceyburke]

2 things. Firsts low of 4 is to low, you need to raise it, I would go to 6. Second I don’t understand the left column shows 0 for large leaks BUT you show large leaks on the graphs. I don’t know why the graphs shows 50? Check your. Mask fit during your sleep position not just sitting on the bed.

[Sleeprider]

Stacyburke picked up the important points. A higher minimum pressure is essential to getting good CPAP therapy, and by using the minimum pressure of the machine of 4.0 cm, your pressure bounces all over the place and fails to resolve events before they happen. His recommendation of a minimum of 6.0 is conservative, an I would have gone to 7 or 8, but it's a much better solution than 4.0. Leaks are out of control, and you need to make adjustment, find a different size or a different model of mask. This may be mouth breathing rather than a mask leak but it is a very high leak rate. The apnea are clustered, which suggests a possible positional apnea, so a soft cervical collar may serve two purposes, control leaks and resolve the occlusion of your airway from chin-tucking. Take a look at the Soft Cervical Collar wiki link in my signature, and the positional apnea link in that wiki. This is very common and easy to fix.

Increase minimum pressure, iIf you are using Flex do not exceed 2, use a soft cervical collar for positional apnea and hopefully that will help resolve the large leaks.

[staceyburke]

You have one of the best on the board giving you his opinion, go 7 or 8.

[Computerdoc]

Will a minimum setting of 7 or 8 affect the ramp setting of 4?  Also, the CPAP titration study I had last December reported that the CPAP should be set to 6.  I see no 6 in the settings, only the 4 minimum and the 10 maximum.  When I reset the minimum, is that the Auto Min setting on my Dreamstation Auto CPAP machine?  Thanks for the help!

[staceyburke]

4 is now set as your min. because of that when you start to have an event the machine must increase up from 4 to the pressure to stop the event. If you have it at 7 or 8 as was suggested the increase is only from 7 or 8 to the pressure needed to stop the event so it takes less time to relieve your event (H or OB or Flow limit) That is why you want that low number to be higher. It has nothing to do with the "ramp". Most of us that have been on CPAP for any time do not use the ramp at all, we just turn on the machine. You are NOT getting any therapy during the ramp it will not go any higher than the ramp setting for the entire ramp period. So if you have the ramp set for 30 minutes you have 30 minutes that is not offering any therapy. I suggest you turn it off and not use the ramp.

[Gideon]

4 is considered a pediatric setting by most. Many adults have trouble Breathing at that pressure and thus a recommendation for an initial pressure of 6 to 8. Personally I feel starved for air with anything under 10.

[Sleeprider]

To access the pressure settings follow this tutorial https://www.apneaboard.com/dreamstation-...structions

[Computerdoc]

i tightened my Dreamware nose pillow mask last night, and today have gone into the clinician's menu and changed the Auto minimum setting to 7.  I will also look into the cervical collar. I will keep the Ramp at 4 for 20 minutes for now, as I have claustrophobia reactions to the pressure.  I'm quite surprised at the advice to increase the minimum pressure and that I have mask leakage, but the explanation makes sense.  The Dreammapper software has never shown anything lower than 98% mask fit.  I've been trying and quitting the CPAP now for about 3 years because I just don't feel I am getting anything out of it.  Hopefully this will help.  Still looking for that elusive "waking up refreshed."

[staceyburke]

As far as the ramp goes - do whatever makes you feel better but please try one time just turning on instead of using the ramp. Each of us is different but for myself I felt better at pressure instead of struggling to get my breath at a low ramp pressure. Now for feeling better, I wish it is go to bed for 1 night and boy do I feel great. It takes several weeks and at some point you will feel better just hang in there for awhile!