Newly Diagnosed [DME code questions]

[Koolbreeze]

Next question is I mentioned to the DME that my machine (or mask, I'm not sure which) is making a noticeable noise at inhale. It's very distracting when I'm trying to go to sleep, since I'm use to dead silence. It's an air rushing sound similar to what you may get if you inhale sharply, like a high volume of air rushing through a narrow passage. It sounds more like the mask to me, but it's hard to isolate. The DME thought tweaking the EPR setting to where it's only enabled during the RAMP time might fix it, so I guess I see tonight. So far I've dealt with it by playing white noise but I'd rather eliminate the noise if possible. I've also been taking Ambien which really helps get me to sleep, but I can't do that for long. Are some masks more noisy than others and if so which ones are the quietest?

 This may be the same issue I was trying to describe in my "stupid noob question". I've been working at tracking it down. Last night, it appeared to come at the joint where the heated hose and the plasticky hose that comes with the mask meet.

The P10 is a very quiet mask.

You will get a feel for what a mask leak is, so you can address it easily. With the mask on, gently work a finger around the edge of the mask nearest your face. You will notice a hiss if your finger is near a leak.

The problem is that the leaks are occurring while I'm asleep and most of the time I'm unaware of them until I look at the data the next morning. I toss and turn a lot while sleeping and my most comfortable position is half way on my belly and half on my side, do i could be dislodging the mask while sleeping. But my really think my mouth is opening. 

[Koolbreeze]

I wanted to get a little input from you guys.  I’ve used the CPAP every night since I got it, except 1. It’s been an adjustment but I’m getting used to it. I’m still struggling a little with leaks but I got a new cervical collar a few days ago and it is better than anything else I’ve tried and seems to work for the most part. I’m also going to try a full face mask soon.

When I was diagnosed, the study showed an AHI of just over 5. I’ve never had a lot of the typical symptoms except sometimes I have a difficult time getting to sleep and I usually wake up 2 or 3 times during the night for bathroom visits. That said, I really can’t tell that CPAP therapy has made much difference, if any. There has been a few nights where I’ve slept through the night but most of them, I’ve woke up at least once, sometimes twice, rarely 3 times.

My pulmonologist had me on a set pressure of 10 and that’s where I’ve left it up until a few nights ago. That has worked well, from an AHI stand point. My AHI hasn’t been over 1 but once the entire time and the average overall is 0.29. But I decided to try it on auto for a few nights and that’s where I need some assistance. I tried 7 to 11, then 8 to 11, then 9 to 12 last night. Each night my EPAP 95% is just under the max. Is that typical?

The last couple nights, with it on auto, I think I’ve slept better than normal. Last night I slept over 7 hours straight before I awoke, which is unusual for me. But I can’t say having on auto is the reason for that just yet. What pressure range would you try or should I just leave well enough alone and stick with a set pressure of 10 since it’s working AHI-wise?

Does anything in the charts stand out?

[SarcasticDave94]

Others better versed than I will certainly chime in as well, but it seems the auto setting may be giving better results number-wise. And you say you're sleeping better with it in Auto with a range of pressures. Go with what gives the best results is my answer. What pressure settings to choose? That I don't know, but you seem willing to experiment some, so you could try more combos of Min and Max if you want.

If it were me, I'd do the experiment setting thing with the settings I felt the best results, and then I'd expand that to a few days on that "best feel" setting. Then when that few days have passed, and assuming I still felt like I'm getting better sleep, voila, my new settings are locked in.

Happy New Year

Dave

PS when I was in the PA National Guard, the drill sarge called me Cool Breeze. It's OK I didn't patent the name...

[Sleeprider]

In terms of AHI, all of the above results are good to great, so the decision falls on what makes you most comfortable and rested. I think that in agreement with Dave. It's fine to experiment with auto CPAP and you should do this to find what works best for you. Your results so far seem to suggest your titrated pressure was not very far off. Something you have not tried to introduce yet is EPR which in most cases increases comfort even more. If you use EPR, start at 1 and increase gradually, but keep your machine in auto mode so you have pressure to compensate for the lower exhale pressure if you need it.

Your results are great, and will likely stay that way as you make the therapy your own with minor adjustments for comfort and sleep quality.

[Koolbreeze]

Thanks for the input guys. Here is the last 3 nights, all 0s.







That looks pretty dang good to me. I'm still curious why the 95% pressure is hovering near the max though. Is that typical?

I have not turned EPR on yet, but did play with it a little when I first started CPAP. I may play with it some more but I honestly don't have any issues breathing in/out as it is.

[SarcasticDave94]

For one thing, you're not going to score better than a zero. Negative AHI numbers do not compute. Zero is excellent BTW.

As for the Max pressure setting being just above your 95%: it seems it did that on both max settings 11 & 12. I missed seeing a max of 13, which I'm not necessarily suggesting either. My thinking is that whatever your plugging in at this range of numbers as a max is where it heads eventually, bouncing along just below that max to figure in a 95 percentile.

I'm defaulting back to how you feel. Where did you feel like it helped you the most/best? EPR settings is entirely up to you here. You may find it makes things an even better feel. Conversely, it may make things worse. That's just my take. So call me neutral on the EPR.

FWIW I just did an adjustment myself to optimize feel. At a certain point, that's what counts. Especially if/when you can produce an AHI under 5 consistently.

Dave

[Sleeprider]

That's almost too good. Be sure all flags are on in Sleepyhead, and be sure to power-cycle the CPAP by unplugging, the re-powering.

[Koolbreeze]

I feel good but I never really felt that bad even before I started CPAP. I have a friend that says it's changed his life and he encouraged me to ask my doctor about it since I was having difficulties going to sleep and staying asleep. Plus the Mrs claimed I snored something aweful some nights.

At the end of the day, I think I feel a little better with it on auto than I did set at 10, so I I'll try that for a while. I can remember a time not too long ago when I could sleep 12 hours straight and never move. I guess I'm chasing unicorns and rainbows if I expect that now though.

I think have everything ticked in Sleepyhead except RERAs, but will check. I will also cycle the power just to be sure.

[Melman]

It appears that your not getting EPR. It is set for ramp only and ramp is turned off. You may be more comfortable if the EPR setting is changed from ramp only to full time. Then you will benefit from the lower EPR pressure throughout the entire night.

[dracus]

Looks great, I'm still a noob myself.

The way auto works in my experience is it goes as high as it needs to up to the max.

I have mine set to 9-15. My tritrated pressure was 11. I initially had it set 5-20 but on advice raised the minimum to two below my tritated amount and reigned in the range to make sure the machine didn't have to work too hard.

My 95% pressure is around 10-12 most nights and I do see peaks in the 13 range occasionally. It always drops back to the minimum.

If your 95% is close to the max you may want to try bumping it up 4/5 points. It won't automatically go there.