Help adjusting therapy (cheyne-stokes)

[adm1jtg]

Have posted a few other times but my situtation has changed so decided to start a new thread. Been adjusting my therapy and have been running into MINOR issues.

What I have established so far as a good baseline.

Set mode to cpap
Pressure of 7 seems to work well
EPR 2 seems to create CA's though not excessively
Last night went to EPR 1 and got cheyne stokes
In the past EPR 3 also seemed to create ca's

Not sure I understand what created the cheyne stokes last night as in the 45 days or so I been on therapy I have never seen those.

Is the cheyne-stokes likely a result of the presuure or the epr setting? or maybe just a fluke?

Last 2 nights are attached. 

       

[Gideon]

The real question here is how do you feel? And be critical and make the evaluation BEFORE you look at your results/numbers. You are at a point where comfort, how you feel is more important than the numbers.

Yopu do NOT have CSR, a bit of periodic breathing is all, that is hoe ResMed labels any periodic breathing.

[adm1jtg]

Believe it or not thats not an easy question at all. As stated in my previous threads....
Comfort....
Do I feel like the mask is keeping me awake or that its uncomfortable or affecting my sleep at all:
NO
Do I wake up feeling good in the morning:
Also NO
I actually on a typical morning feel pretty lousy even though I dont feel like the mask is keeping me awake or making me uncomfortable at all. I dont even know its there most of the time.
Thus why I keep messing with settings, not for comfort which I think is already there but to FINALLY wake up in the morning and not feel horrible. So far I have only managed to get lesser versions of horrible.

So far here is what I have figured out:

It SEEMS with cpap (static pressure) I feel less awful in the morning. I would surmise that even the small pressure changes of a range of lets say 7-9 disrupt my sleep a little. I may go back to that range however, really not sure what to try at this point.

Constant Pressure of 7 seems to easily keep the AHI below 5 usually below 3 sometimes below 1, CA's are usually the only thing above 1

Again a lower pressure like the above mentoned 7 allows me NO large leaks so I tend to worry less about the mask as i roll over in my sleep. When I was up around 8-9 I would get larrge leaks and would have to make the mask so tight I lost huge amounts in the comfort department. I also found myself having to consciounsly moving the mask everytime I adjusted position to try and keep the leaks to a minimum.

All things equal and not looking at numbers epr 3 just seems to be the most comfortable. That said my ca's on my worst night with epr3 have hit 20, Thus why I am looking at 1 or 2, all about compromises.

Is there any benefot to going higher then 7 based on my AHI and all being kept so low? Maybe a higher pressure will allow a higher EPR or less CA's?

Oh I also played very briefly with "for her" and "soft" settings but obviously took the static pressure cpap route this time. i could also re-investigate either of those but there is very little information on what they specificially do and more importantly if they would help my situtation.

Am open to suggestions,

Just as a reminder I have TRIED to work with my doctor and he is no help he is basically like if the ahi is below 5 there is no issue or change he could/should make even though I tell him I feel absolutely horrible most mornings. Thus why I am here.

Thanks in advance for all your help

[Gideon]

Often times a higher pressure works for comfort.
Try 9. No other changes. Do note which is better in comfort, only then look at your results. (I don't want you to bias the comfort results)

[adm1jtg]

ok so cpap mode 9 (static) and what EPR... 2? As thats the one I test with most but honestly never tested with EPR 3 and CPAP (Static), only with apap 7-9

[Gideon]

Your flow limits are a little high so try EPR=3, we will watch what happens to CA events

[adm1jtg]

Well that didnt go well at all...

I honestly cannot say what happened last night I simply could not fall asleep. This has not happened before. Unfortunaately desperate to get some sleep I ended up trying to adjust the pressure just so I could hopefully fall asleep.

On the graph you will see multiple "stops", you can likely tell what I changed but I will outline it just in case, The changes are as follows:

I started as we discussed at 9 with and epr of 3, Couldnt sleep so went to 8 and epr 3, still coiuldnt sleep and went to 7.6 asnd epr 3, Still no luck so I tried 7 and epr 2 (what I had been using the night previous), still no luck so decided if I am going to be this misreable I would at least give the 9 and epr 3 as long a test as i could.

and here we are. This morning I feel by far the worst I have yet. Extremely nautious and dizze and of course exhausted.

There is one other thing I should mention and that is that I was reading through forums last night and found that the n20 mask I use should be set as pillows and I was set as nasal, so I did also change that before bed last night.

I dont know if that setting is responsible for all the trouble, i kinda doubt it but who knows, I am not even sure the settings change are responsible for how I feel, we all have bad nights and maybe this was just one of mine, I have never had trouble going to sleep in the month and a half i been on therapy now so its all just a big unknown.

       

[Dormeo]

"We all have bad nights." That's an astute observation, and it's a good reason to try out new settings for more than one night if possible. You may have been sleeping poorly because of anxiety around the new settings, and once you started changing settings during the night, things were bound to be choppy. -- Your choice if you want to try the experiment another night, of course, or some version of it.

You tend to spend quite a while in bed, it seems, and your times for going to bed and getting up aren't very consistent. For better sleep, you might try regularizing your timing and restricting your time in bed to, say, 8.5 hours. (Pulling a number out of a hat there.) And be sure you get some natural sunlight in the morning. Double-check yourself against the full list of recommendations for better sleep:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

I really hope something will turn out to be the magic bullet for you.

[adm1jtg]

It's funny until I saw your post I didnt realize just how much last night was off my norm. Long story short I do and have been doing most of the things on that list. I went to bed early last night as I was so tired but almost always go to bed and wake up at the same time and only about 8 hours to 8 1/2 hours sleep.

Not a total loss though looking at the numbers, even with a grain of salt, on 9 the large leaks rerurned where as on 7 not only didnt I have any at all but had a good amount of headroom before I would get into large leak territory.

It took me a while to get the mask tightness to a truly comfortable level and thus will write off 9 for now as to high.

The other thing I see is that as expected flow limit with epr 3 did look much better then when I had it on epr 2

Following the original gist of the advice given I would guess that means I should next try pressure level of 8 with an epr of 3  tonight, Previously was on a pressure of 7 and epr of 2 but just was not feeling good in the mornings, though in comparison I did feel much better then this morning.

Seems like I am getting close to narrowing down the best choices.

Would there potentially be a benefit to going back to a very narrrow range (maybe 7-8) on apap and maybe changing the algorithym to "for her" or "soft"

[Dormeo]

"Would there potentially be a benefit to going back to a very narrrow range (maybe 7-8) on apap and maybe changing the algorithym to "for her" or "soft"."

Potentially, sure, but no one can say how likely any of these change will benefit you. You would need to experiment carefully.

Go ahead with a constant pressure of 8 and EPR of 3 and give it at least a couple of nights. From there, introduce just one change at a time, giving each one a couple of nights. Otherwise you won't know which change made the difference.

And do post more charts as you proceed. I'm sure board members will be happy to help you.