HELP with CPAP settings, not feeling rested in the morning!

[jc1996]

Hi Everyone, 

I've been on CPAP therapy for a while, but have experienced a deterioration of sleep quality over the past few years.  Over that time, I've seen a few sleep doctors and they have been patently unhelpful!  I've also tried changing to a Bipap machine (on recommendation of one of the sleep doctors) - that did not help at all.  I'm now back to a Resmed AirSense 10 AutoSet CPAP Machine.  I do feel slightly better than when I was on the Bipap!  However, I'm still waking up quite unrested, and depending on the day, I'm dozing off while watching TV in the evening (even during exciting shows!).

Ironically, I recently purchased a Airmini, which I used on a work trip.  I actually felt slightly more rested in the mornings, despite it being quite loud, not having the humidx, and waking up 4-5 times over night.  

I took a home sleep study in 2021, and AHI was found to be 40.7.  Based on the past 2 nights, AHI was < 2 but I still did not feel rested at all in the morning!  The difference between the two days was I adjusted the EPR from 2 to 1.  

   
   

I'll attach my sleep study in the next post.  Appreciate any thoughts you might have that might help!!!

---

See the below for the sleep study!!

   
   
   

[PeaceLoveAndPizza]

Welcome to the conundrum! Like many of us you have good numbers, but still feel groggy in the morning. Overall you have gone from an AHI of 40 to less than 2, which is pretty bloody good. 

Based on your flow rate, you have quite a few arousals during the night. This is the biggest challenge many of us face. It looks like you are trying the right things.

I suggest you stay with your current pressure range, but give EPR 3 a go. You still have some flow limitations, not much, but enough that reducing them a bit may help.

Something else worth trying is setting it as fixed, either in CPAP mode or a fixed APAP setting. Something like

Mode CPAP
Pressure 14
EPR 3 full-time

Or

Mode APAP
Min pressure 14
Max pressure 14
EPR 3 full-time

Both do the same thing, but there is a more information available when in APAP mode. Choose whichever or give both a try. 

Give your overall sleep hygiene a review. Here is a good article on it.

https://www.sleepfoundation.org/sleep-hygiene

Depending on how things go, we can consider other things to try.

[jc1996]

Thank you PeaceLoveAndPizza!  I'll try both these setting changes separately and report back!

[jc1996]

Welcome to the conundrum! Like many of us you have good numbers, but still feel groggy in the morning. Overall you have gone from an AHI of 40 to less than 2, which is pretty bloody good. 

Based on your flow rate, you have quite a few arousals during the night. This is the biggest challenge many of us face. It looks like you are trying the right things.

I suggest you stay with your current pressure range, but give EPR 3 a go. You still have some flow limitations, not much, but enough that reducing them a bit may help.

Something else worth trying is setting it as fixed, either in CPAP mode or a fixed APAP setting. Something like

Mode CPAP
Pressure 14
EPR 3 full-time

Or

Mode APAP
Min pressure 14
Max pressure 14
EPR 3 full-time

Both do the same thing, but there is a more information available when in APAP mode. Choose whichever or give both a try. 

Give your overall sleep hygiene a review. Here is a good article on it.


Depending on how things go, we can consider other things to try.

Hi

Reporting back on the results of the first suugestion (change EPR to 3).  Felt better this morning, through still not thoroughly rested, ironically the AHI increased to 4.

Will try the fixed pressure tonight and report back.
   

[jc1996]

Have tried the APAP with min and max = 14.  Felt moderately better this morning, will continue to stay with this and report back.  If you have any further suggestions to tweak, let me know!

[jc1996]

Hi,

Still feeling groggy in the morning, and struggling in the evening after 9-10pm... any other suggestions on tweaks?

[PeaceLoveAndPizza]

Please post OSCAR charts.

[jc1996]

Please post OSCAR charts.

Here is the chart from a few days ago with min and max set to 14 and set to APAP.  Wanted to take another more recent one, but I forgot to reinsert the SD Card last night!  I will take the reading again tonight, if that's helpful.

Any help would be much appreciated!!!

[eok361]

Or

Mode APAP
Min pressure 14
Max pressure 14
EPR 3 full-time

i'm curious as to what extra input you get setting the machine this way?

[PeaceLoveAndPizza]

Thanks for your patience and willingness to try things out. One request for future charts is to replace tidal volume with respiration rate. I like to use the respiration rate chart as an indicator of sleep quality, so having it would be helpful rather than trying to discern it from the flow rate. 

Here is what we know so far. The best pressure for you from a numbers perspective was your starting pressure of 11-19 EPR 1, with your median being 12/11 and 95% 13/12. Pressure was swinging around a bit in response to flow limitations, with your arousals tracking the pressure ups and downs.

The tested pressure of 11-19 EPR 3 was buggered. Not a comfortable night even though FL’s were reduced slightly. I’m not pleased with what I see in the chart, but the comfort factor is your decision.

The testing of fixed pressure (both variations) yielded good results in terms of how you felt. Still a bit higher AHI, but FL’s are good and other indicators, other than the I:E ratio which is upside-down, are good.

So, if you are willing, here is one more thing to try. I think zeroing in on the good range (12-14) from your original settings with EPR 1 will be the next place to give a go.

Min pressure 12
Max pressure 13
EPR 2 full-time

This will reduce the amount of pressure swings, maintain reasonable FL’s, and hopefully give a better nights rest. We may want to decrease EPR from 2 to 1 if there are comfort issues. We will know more once you have given it a go.

One other thing to ponder is sleep hygiene. Here is an article we use to help folks understand things.


https://www.sleepfoundation.org/sleep-hygiene

You are so close to finding a good place I hope this will be one of the last steps to get you there.