[Pressure] More tired after pressure increase

[EndarSpire]

           
Hello all,

I've been using PAP therapy for about a month now. I was originally using a machine I got from a family member while I waited for the VA to get the results from my sleep study. I initially started with a Resmed Airsense 10 autoset that was set for 5-15 using nasal pillows. The results were amazing. I wasn't tired all day anymore and didn't nod off at work or home any longer. After about three weeks I got my machine from the VA. It was the same machine but set to CPAP at 8 instead of APAP. After about a week of use, I felt better than before therapy but was still very tired. I asked to change the settings back to APAP and they did. However, they set the pressures to 8-15. After this change I felt a little better but am still tired and by the end of the work day i'll find myself starting to nod off. 

Can anyone help me with my settings and should I just go back to 5-15?

I also noticed looking at the OSCAR graphs that I have a lot more Large Leaks (LL) than when it was on 5-15. Attached are images of the night prior to the change at 5-15 and then the two most recent nights at 8-15.

I would also appreciate some help in understanding how to read these graphs. I have read through the forums and think I understand what each means but I am not sure how to analyze that data to make effective changes. When looking at the 5-15 data, it appears that a set pressure of 8-15 would be better as I go into OH and then pressure goes up to about 8.

Thank you very much for your help in advance.

[Deborah K.]

You can change the settings yourself.  I suggest that you change the beginning pressure to 6.  I think you could probably drop ramp altogether, as pressure set at 4 is not enough air for most adults.  If the idea seems too much for you, leave it for now.  You can drop it later.

See how you do with beginning pressure set at 6, then post a chart and tell us how you are feeling.  You can probably go up to 7 then, if the 6 is working and you feel good with it.  7 is usually comfortable for most adults.

Good luck!  

[EndarSpire]

        So attached are two nights of data. Feel much better. The first is at 5-15 and the second is 6-15. I'm still not sure why it seems like i'm having more leaks though. Could it be mouth leaks? and is there anything I can do to improve these results?

[SarcasticDave94]

I would like to suggest a better pressure setup. Use EPR 3 Full time along with Min pressure 7 cmH2O. EPR 3 (cmH2O) offers a reduction by 3 on exhale.

Leaks, especially those brief peaks may be mouth leaks, signified by the rounded leak trace. Flat leak patterns will be a mask leak.

You'll probably want to turn off the Ramp at some point or at least have it closer to your min pressure, note with ResMed if it's programmed it automatically starts every CPAP start.

[EndarSpire]

Thanks for the reply! I tried turning ramp off last night but seemed like it wanted to make my mouth start filling with air. Also, i've read some risks here about EPR causing Central Apnea? Is this something I should be concerned about turning EPR on? Also, how does it help prevent the leaks? Is it just because there's less pressure in the mask I guess? I was also wondering how the leaks can cause tiredness as there doesn't seem to be any events during the period of leaks. Is it just because it bothers you during the night? I don't recall being woken up or anything.

[BobFromAccounting]

Are you still using the pillows or did they switch you to something else? I ask because both pillows and nasal mask keep my mouth closed, not fill it with air. Are you forcing it open?

[SarcasticDave94]

EPR can induce a small amount of central apnea in those that are new to CPAP, but it shouldn't prevent you from trying it.

Leaks will have to be addressed separately. It looks like a mixture of mouth and mask leaks.

If leaks are high enough it can hinder accurate event reporting.

[EndarSpire]

I am currently using the pillows. They gave a nasal mask to try but the first night it leaked really badly and I went back to the pillows. I may try it again though as I feel I have to have the pillows super tight to prevent leaks. And I'll give the EPR a try and see how that works and report back!

[SarcasticDave94]

If the mask needs to be real tight, it's not a good fit. How to correct depends on the mask.