New member from Down Under

[AussieBobJ]

G'day (Hello) 

I am a 15 year CPAP user and thought it was about time to get serious about understanding and optimising my therapy.

I'm 67, about 160Kg (360lb), 1.88m (5' 10") and bearded. I use a Dreamstation Auto with an Aptiva Large Wide nasal mask. My initial diagnostic sleep study reported AHI of 100+ but is now generally under 5. I had septoplasty surgery shortly after the sleep study.  I had major Atrial Fibrillation problems along with other heart issues from June 2018 until January 2022 when surgery managed to restore my heart to 'normal' - although it is only the last couple of months that the brain fog and cognitive impairments seem to have largely lifted.

I do not have a sleep therapist and all the settings on my subsequent CPAP machines are a mix of leaving my initial prescribed settings intact along with occasional user error in changing things without knowing why. 

A week ago I decided to lower the minimum pressure from 13 to 11.5 - it seemed sensible to reduce pressure because my system spent about 97% of the time at the lowest pressure. In the week since the pressure reduction, the pressure is still mainly at the lowest setting, should I reduce it further? if so, how far? 

For about 50% of nights, my CPAP reports the night as being broken into session lengths of 1hr - but the other 50% of nights have sleep sessions of about 3hrs which is when my bladder wakes me up. 

I would appreciate any insights into my current situation along with any suggestions of reading or research that might move me nearer my goal of improved health.

[Gideon]

You've heard this at least a million times, but it's true, Lose Weight. That's all I'll say about that.

Your flow rate looks very irregular so I'm suspecting UARS. For having a drreamstation you are holding a pressure relief of around 2.5 which is in and of itself remarkable.

Post several random 3-minute views so we can get a better view of what is going on.

[AussieBobJ]

Post several random 3-minute views so we can get a better view of what is going on.

[Gideon]

Chart 1:
Some flat tops show flow limitations.
An arousal prior to the hypopnea resulting in holding your breath
overall not too bad.

Chart2:
Significantly lower peaks for this segment indicate (see below) a combination of oral/mouth and nasal breathing or The amplitude says flow-limited breathing this entire segment.
Going with the above this also shows classic expiratory mouth breathing.

Chart 3:
Reduced volume to start with indicating flow limited breathing leading to
again holding your breath, This is a period of obstruction leading to
you once again to holding your breath
then a obvious flow limit
followed by a period of tapering down then
repeating a recovery period
Your Dreamstation reported this entire segments variable breathing.

Assuming these segments are typical I think you may benefit from a Bilevel with a greater difference between exhale and inhale (PS) than your DreamStation can provide.

[AussieBobJ]

Gideon pid='498010' dateline='1704512940']For having a drreamstation you are holding a pressure relief of around 2.5 which is in and of itself remarkable.

I don't know enough (yet) to understand this.  Do Dreamstations have problems with EPR? 

I have a Resmed Airsense 10 sitting in the cupboard, should I swap machines? 

A week ago I dropped the minimum pressure from 13 to 11.5. Every night since the Min and Med pressure has been 11.5 - the 95% is 12.5 and the highest 99.5% through the week has been 13.0 - 13.5. I'm thinking of lowering it again, probably to 10-17; would you suggest I don't do that?

[Sleeprider]

YES! It's fantastic you have Resmed. The Philips machines use "Flex" to make the transitions between inhale and exhale smoother, but they don't really provide a bilevel pressure like the Resmed with EPR which acts like bilevel with inhale pressure (IPAP) up to 3-cm H2O higher than exhale (EPAP). It is the pressure difference that allows the device to effectively treat flow limitation and hypopnea by giving a pressure boost (pressure support) during inspiration. If your Resmed is the Autoset model, the auto-pressure algorithm is much more responsive than Philips and will ensure a lower likelihood of obstructive events.

Post back with information on what model of Resmed you own, and whether you know how to access the clinical menu (home button + control knob). If you have the Autoset, then a pressure range of 9.0 to 12.0 with EPR full-time at setting 3 should work great. If it is the Elite, then fixed pressure at 11.0 with EPR 3 should be a good start.

[AussieBobJ]

2 nights ago I swapped from a DreamStation to an AirSense 10 Autoset

Pressure was further dropped from 11.5-17 to 11.5-17

Last night was 3 sleep sessions - 2 bathroom visits. I clearly have issues with my sleeping position I don't normally move at all when asleep, I wake up where I went to sleep. Sessions 1 and 3 I slept on my left side, session 2 on my right side. 


During the 6hrs on my left - 9 Obstructive apnoeas
During the 3hrs on my right - 9 Obstructive apnoeas, 8 Hypopnoeas, 6 Large leaks 

   

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Oops - pressure was  dropped from 11.5-17 to 10-17