Oscar CPAP Optimization Results-Awesome!?

[SeePak]

Hey Pizza,

i meant to say, how bout 7.8 cm and EPR3  as a setting

Also, i feel restriction, as i have in the past, in my nose, throat all day.

feels like something stuck at back of throat

thinking my OSA is acting up lately

Suspect inflammation

Diet ( too much wheat products )

will modify diet

[PeaceLoveAndPizza]

Interestingly thought about the diet. I have gluten sensitivity issues myself and definitely sleep better when I don’t cheat with too much gluten. I have not thought about how it affects sinuses, so now I have another rabbit hole to chase down.

On humidity, use what works for you. I personally prefer to use auto temp and humidity, but there is no gold standard. If it works for you, Bob’s your uncle.

Regarding pressure, I think you are close to as good as you can get with your current machine. Using EPR of 3 gets you the best flow limitation and AHI numbers we have seen, but triggers those recurring centrals. I do not believe they are true central sleep apnoea events, rather are caused by the pressure support differential and may abate a bit over time. 

I do not think going down in pressure will do much, at least nothing lower than 7 with an EPR of 3. Increasing pressure by around 0.2 cmH2O or such nightly may help for a short period, but long-term you need to consider options like moving to a bilevel which allows for trigger control to manage the CA’s. If you feel good where things are, then no reason to move to a new machine. You show the same pattern as many of us with increasing CA’s in the latter part of the night as you enter deeper sleep stages, which is why I expect a more sensitive trigger setting will clear that up.

One important thing is don’t faff around changing things nightly unless it has gone sideways. Give any change a few nights to settle in.

[SeePak]

Okay thank you Pizza.

I have to get another sleep study done because they don't have my original anymore and that will be my first step to seeing if I will qualify for a new bi-level machine.

I have the feeling in my throat which I had forgotten about from years past whereby it feels like something stuck in my throat nose area and it definitely affects my breathing.

[SeePak]

   

Hey Pizza, heres where i am at.

I have contacted my doctor, but after reading the post by Deborah about how to upgrade to bilevel, i think i screwed up!?

I will be calling him back today to say i do not need another test, just a machine!

I have most of the OA under control, feeling much better now, but still waking a lot thru the night.

I need the bi-level cause my UARS is up and down, sometimes i can get by with 6 cm and sometimes need 8cm, maybe even more here and there!?

i have been doing this for 30 plus years, and i have definitely lost that great rested feeling i used to have.

Anxiety has crept in, some depressive moods(mostly better now)

Comments welcome!?

[SeePak]

   


Hey Pizza, et al.

I have meeting this thursday with sleep clinic doctor to discuss my sleep health.

But i have really been going downhill and now i dont know what to think.

I have kept numbers same on my machine, very little adjustments.

Not sure how some of this is possible !!??

Any comments welcome, thanx.

[PeaceLoveAndPizza]

I do not think you can do more with your current machine. We can continue to faff around with the pressures, but I do not think there is going to be much improvement.

BTW, the last chart is an anomaly to others, don’t get too worried about it as something was wonky. Also, turn off ramp as it is doing nothing at these low pressures.

For now the best results we have seen are in the range of fixed pressure 7 EPR 2 and 8 EPR 3. Anything above that and things go off the rails. Any lower and the pressure support is of no real value. 

My suggestion is to show some of the OSCAR charts to your sleep doc. I think you can make the case for needing a bilevel to have extra pressure support to manage the flow limitations as well as the ability to manage the trigger sensitivity.

For now, stick with one of those pressures and remember some nights just are bad nights.

[SeePak]

Hey Pizza.

******Finally got my results from sleep study couple weeks ago.******

******I can post if interested?  *******

They do NOT suggest Bi-Level machine unfortunately, but....

I am sending email tomorrow to say that i get much longer exhale times when i use EPR2 and 3.
But with my airsense 10 elite, and the low pressure i need to use, puts me below snoring and some OA, i think.
So pretty sure with bilevel i can have the 5 cm +3cm pressure support as/if req'd when i am a bit more plugged up in nose.

I have been doing breathing exercises, tongue and cheek exercises, watching my diet, good sleep hygiene and finally making progress getting some rest and some consistency.

For me, low pressure and NO EPR seems to work, as long as i am NOT plugged in nose.

And, that is now much better with keeping my mouth closed BOTH day and night !! ( mouth tape, cervical collar, chin strap sometimes during the day when i notice i am gaping my mouth open.

Huge difference in my saliva in mouth and clearer in my nose due to, i believe, breathing exercises AND mouth shut !

[americasclassics]

Sorry deleted post

[SeePak]

   


Since my journey began here at AB i have come full circle, sort of!

In retrospect, i had 3 main issues to resolve, as identified by PeaceLoveAndPizza

Leaks
Positional
Flow Limitation
CA events

I began April 19/2024 with FFM dreamware, Air Sense10 Elite CPAP,  EPR , neck collar off/on

I ended Jan5/2025  with FFM dreamware, Air Sense 11, CPAP, NO EPR, VCOM, neck collar on

In between these dates i tried nasal dreamware mask, nasal mask i originally started cpap therapy with, pillow mask F&P Nova Micro.

Notable dates

July 22/2024 Began Mouth Taping and using Dreamwear under nose mask. Have since stopped totally mouth taping , and only use MyoTape when no FFM.

Nov21/2024  New Resmed Air sense 11 using Fischer Praekell Micro Nova pillow mask

Nov 23/2024 to Jan5/2025  VCOM installed at outlet of airsense 11

Nov 30 to Jan5/2025 Neck Collar Full Time, adjusted tighter than i thought i could use it!

Dec19/2024  to Jan5/2025 Full Face Mask dreamwear, (It was at this point you can see the effect on AHI and CA events)

Dec13/2024 to Jan2/2025 Began using APAP with MUCH HIGHER PRESSURE than i have EVER used!  (7.4 cm min. to 10.6 cm max.)

Jan3 to Jan5/2025  Using CPAP at 9cm then 10 cm fixed pressure, (as determined from the APAP testing)

Each day i woke up refreshed and NOT TIRED or fatigued, with full energy and focus for anything i did.

HOWEVER...I always became tired later in day, sometimes as early as 1100 hrs

This has gotten better as time went by, though still tired later in day EVEN THOUGH AHI<1  !!

Today....
Leaks  Excellent results, At times, none for the whole night! 
Positional   Gone are the clusters of either OA, CA or UA  !! Suspect i was sleeping on my back to get relief from sore hips, and fall asleep that way?
Flow Limitation   <0.1
CA events   Almost Totally Gone!!

The CA events are what i want to focus on and have others comment!?
I suspect the Full Face Mask allows CO2 re-breathing which keeps me from stopping breathing when levels are LOW !? But it has taken a precise combination of things to make that happen, VCOM and higher pressure!?
Also, Leaks cause Hypocapnia, see link below....

https://pmc.ncbi.nlm.nih.gov/articles/PMC3805805/


This has been done WITHOUT BI-Level and VAUTO  only CPAP!

This has been done WITHOUT EPR, (though i am still open to testing EPR in the future....maybe!?)

Last 2 nights, Jan 4-5/2025, i have had trouble getting my FFM to seal, including getting shuddering at sides, so i have a new hurdle to get over and rectify. But even so, leak rate has been zero one of these days! So more a bother than anything else.
I actually slept without CPAP almost all night last night, and i actually feel real good, somehow?
I have also been doing Breathwork Exercises a la Patrick McKeown, and cannot say enough about that, brilliant!

And that leads me to a final word on all my CPAP/APAP years of use.....
I have noted that i can have 'Crazy Town' nights of events, upwards of 150 CA events, tons of OA events, AHI 20 and still feel GREAT on awakening for the day, and for the WHOLE DAY !?


With the plethora of people on this Website complaining of fatigue and tiredness, and even a Thread that talks about this, 
I am beginning to see a much different future.
https://www.apneaboard.com/forums/Thread-AHI-1-0-now-but-still-tired-Is-it-UARS-RERA-arousals-or-FL-in-your-FR-peaks

I am just beginning to Test lowering my pressure until i get a few events, higher AHI, lower Tidal Volume AND feel rested ALL DAY!!

Will see.....?

Maybe I am missing something?

Is another high CA event night on the horizon?

I welcome AND expect and hope to get comments, observations and critique from the Apnea Board Monitors and Experts.



forgot to say,

Notice how the Respiration Rate is much tighter, as well as Tidal Volume AND the minimum readings are NO LONGER ZERO!

[SeePak]

   

sorry, should have posted latest chart.

I'm really amazed that i have zero leaks, no more mouth breathing!?

Not sure how that happened?

Possibly higher pressures are keeping my Palatal Prolapse from happening?

So exhaling thru nose is possible all the time?