Need help with pressure change using Bleep

[Kathy14225]

Which part is not new? It's been a Year long journey of not getting enough sleep and feeling horrible. And I slept good and felt fine before CPAP! That's what's so frustrating. I should have it figured out by now. The bleep certainly was blowing my mouth open, It happened right away, I couldn't even stick with it the first night and that was over 3 months ago now. It was impossible. And before that I would open my mouth a few times a night. What is your suggestion for my pressure? I only have another week to make any changes and see if it makes a difference.

[Kathy14225]

But my AHIs are the same or slightly better with the lower pressure, and with the EPR at 3 the flow limitations are better too. Don't you want to use the lowest pressure possible That both comfortable and keeps your events down?

[PeaceLoveAndPizza]

But my AHIs are the same or slightly better with the lower pressure, and with the EPR at 3 the flow limitations are better too. Don't you want to use the lowest pressure possible That both comfortable and keeps your events down?

That is indeed the question to ask. What is the lowest pressure you can use, with the least EPR, to get the best nights rest. 

Looking at the chart with leaks, the leaks began around 23:00, which is around 20 minutes after the device got to full pressure. You don’t show a pressure graph, so we have to derive it from the mask pressure graph.

Use what EPR feels comfortable. It is fine to have some flow limitations. Having an occasional leak is fine as well. If either disturbs your sleep, then you need to deal with it through pressure, pressure support, SCC, mouth tape, etc.

If you want to use a fixed pressure you should self-titrate as you are doing. Your median looks to be between 8.5 and 9 based on what you have shown. You could just set it to 8.5 and see where it goes. Easy enough to tick it up or down a bit if needed.

If you want a range, the 8-9.2 chart looks fine.

Your therapy, your choice…

[Kathy14225]

Thank you so much for your reply. I thought I was supposed to be looking at the mask pressure graph so I will pull up the pressure graph and see what it shows. My pressure was set at 8.6 and wanted to verify if this was high or low. So it sounds like what you're saying is that I had it set right to begin with. Below that didn't seem to be enough. I will take a good look at Oscar and compare. I was looking at the AHIS and I didn't seem to change, I will take a better look at the limitations. Is there anything else I should be looking at that could be causing the symptoms? Does it really matter if my inhalations are longer than exhalations? Would lowering the EPR help with that? I thought the higher EPR would, changing that didn't have any effect on the AHIs either

[PeaceLoveAndPizza]

I:E ratio is backwards, but that is typical of someone with significant flow limitations. You need some form of pressure support.

I suggest running it in APAP mode with a pressure range of 7-15 or 8-15 with EPR 2 full-time, no ramp. Consider it a form of self-titration. That will tell us whether EPR helps with the flow limitations, how much pressure is needed with pressure support, and how well it manages the pressure swings. 

If you want to stay where you are with a fixed pressure of 8.6 and no EPR, that is fine as it manages things fairly well. Chances are good you would end up back there regardless, but we would know with more certainty what works best for you.

[Kathy14225]

Not sure if you saw my other reply answering your questions. I'm not exactly sure how these threads work. Short answer, nothing going on when I wake and can't fall back asleep. In answer to another reply I don't use ramp, EPR 3 seems more comfy than 2 but I could go back and try it. I thought that should be up for flow limits. It's definitely higher since I went on a range and I am trying to self titrate  I'd rather it start at 8.4 so it doesn't go any lower so won't burst up when I need it, that has startled me before and I know woke me up. Attaching graph so you can see pressure and time at pressure. What do you think? I would like as short of a range as possible if at all.

[PeaceLoveAndPizza]

If I had cracking results like that chart, I would call it a victory and stop tweaking. No reason to faff around any further.

[Kathy14225]

Maybe all this time that I wanted to be on a set pressure I just needed to have a one-level range. It's been a few nights now that I have slept through and long enough. And not having a bunch of centrals the last couple hours means I was not tossing and turning so I was sleeping! Thank you so much and I will continue to monitor this. Hopefully with the string of nights like this I will start feeling better.