New user - Tired despite improvements with CPAP

[GuyIncognito]

So to preface I'm only three days in, but despite improved sleep I'm still feeling exhausted during the day and can have a nap if I want.
Suggestions on pressure settings would be welcome too.

Previous to cpap >

I'd wake up every hour or so and have to get up to use the toilet.

My smart watch blood o2 report would drop into the low 80% range during the night.

Sleep report from smart watch would show frequent wakings and minimal deep (5-10mins) and REM (15-30mins) stages.

Chronic loud snoring


Immediately after starting cpap >

I either sleep through the night or wake once to use the toilet - still getting used to mask.

Blood o2 hasn't dropped below mid 90% during the night

Sleep report from smart watch reports hardly anytime awake and plenty of time in Deep (50mins) and REM (2 hours) stages

Snoring greatly reduced, much quieter.



I understand the data from my smart watch is unlikely to be accurate - but I assume it is consistent, and therefore the delta difference is significant.

However I still feel pretty tired, almost more exhausted than before. Is this common?



OSCAR data from past two nights attached - any suggestions for pressure? 

Looks to me like it peaks near to or is hitting the upper limit of 14 but without flow limitation so not sure I need to increase. 

Lower setting looks like it could be upped to perhaps 9 or 10 to smooth out the ramping up and down?

[SarcasticDave94]

Something to try is EPR at full time, from there it's 3 cmH2O levels. It's up to you, but up to 3 may be most helpful. You can choose to gradually introduce it if that's better for you. You may have to increase min pressure as well, to keep your overall minimum at about 8. EPR stands for exhale pressure relief, so if you're at your current 8 minimum, EPR 1 reduces to 7 on exhale, 2 and 3 reduces by those respective levels.

If you feel you need to increase base pressure minimum, possibly match the increase to EPR. Such as EPR 1, increase min by 1 to 9, EPR 2 increase pressure to 10, EPR 3 increase pressure to 11. All three of these still results in absolute min being 8.

The reason I think EPR may be needed is the flow limits chart has some moderate activity. FL are the precursor to hypopnea and full apnea events.

[GuyIncognito]

Thanks for the quick reply

Was reluctant to try EPR as was led to believe it was a comfort feature rather than therapeutic and didn't want to throw too many variables in at start of treatment.

Curious though to understand how EPR can help with flow limit activity? Is it a case of making it easier for inspiration / expiration by having a pressure differential?

Happy to give it a go at some point and report back. I'll adjust the low pressure setting to take into account the epr, it'd be easy to miss that.

[Old Steve]

Another thing you could try is putting you machine into CPAP mode with your minimum pressure set at 10cm and the EPR at 2 or 3.

[SarcasticDave94]

The differential is mostly why EPR helps. Adding EPR is advertised as comfort, but members here have demonstrated effectiveness as therapy. The effect is going to be simpler to turning the AutoSet into a limited to 3 PS bilevel.

[Deborah K.]

Another thing to realize is that most people don't feel better right away. It takes some adjusting to sleeping with a foreign object on your face. Your tiredness, etc. also take time to go away. Hang in there. It is soooo worth it!

[OpalRose]

Looks to me like it peaks near to or is hitting the upper limit of 14 but without flow limitation so not sure I need to increase. 

Lower setting looks like it could be upped to perhaps 9 or 10 to smooth out the ramping up and down?

There is certainly flow limitation that may be increasing pressure.  Look at the left sidebar under statistics.  The 95% Flow Limitation is reading 0.14.  We like to see that number a lot lower.  To tackle FL, you may want to consider using EPR.  

Also, noted are the snores.  Line up the snore graph (the peaked lines) and compare to where the pressure rose to max pressure.  Snores (along with FL) will cause pressure to rise.  I wouldn't raise the max pressure because other than that, your max pressure hasn't gone above 12cm.  You may however, benefit from an increase in minimum pressure.

My suggestions based on graphs:

Minimum pressure set to 10cm
Maximum pressure keep at 14cm
Set EPR at 2

Give this a few days to settle and repost.

[GuyIncognito]

Deborah K - this makes sense, thanks for the encouragement to keep going. I'm amazed I'm suddenly sleeping through the night, sleep was so fragmented before.

Thanks OpalRose

I missed your reply, but I did happen to set my machine to

Min 11
Max 15
EPR 2

Have also changed my mask from an airfit f20 to an airtouch f20 and still need to dial in the fitment as seem to be getting some leaking. 

Attached last two nights.

[OpalRose]

Good that you're sleeping better. I was hoping to see the FL drop a bit more, but as long as you're sleeping well, stick with the current settings.

[SarcasticDave94]

... The effect is going to be simpler to turning the AutoSet into a limited to 3 PS bilevel.

Typo by Dave, this post to correct the thought to help it make sense.

Sentence should have been this, noting the bold edit

The effect is going to be similar to turning the AutoSet into a limited to 3 PS bilevel.