New to CPAP - about a month - what can I do to improve?

[tbp1234]

       

I've attached my stats.  My sleep study AHI was 18. From the treatment stats it doesn't look like the treatment is working as it should.  From how I feel, it's not working.  Ever since starting treatment I feel sleep-deprived.  I had few symptoms before.  At any rate, I don't want the ill health effects of sleep apnea, so I'd like for treatment to work.  Any thoughts?  Currently I use nasal pillows and mouth tape.  I have a full face mask to try.

[OpalRose]

Hi tbp1234,

If you could revise your chart and repost, it would be much appreciated.

Here's the graphs we need to see:  Events, Flow Rate, Pressure, Flow Limitation and Leak Rate.  Include the left side bar.  Leave the other graphs off unless asked for.

Read through this tutorial for guidance on Organizing and posting your chart.

http://www.apneaboard.com/wiki/index.php...ganization

[tbp1234]

            Thank you for responding.  Hopefully I have the right settings now.  Please see attached, three days.  I don't know how many is useful.

[OpalRose]

Some of your Obstructive Apneas appear to be positional.   Look at your graph where the apneas are clumped together.  You are sleeping in a way that kinks your neck or you are tucking your chin to your chest.  This can cut off your air.

Think how you sleep.  Do you use more than one pillow, or a too tall pillow that could push your head forward?  It's best to use one thinner, but supportive pillow.

The next issue is the leak rate.  You may want to try a different tape as it looks like air is escaping.  Also, be sure the nasal pillow mask fits correctly.  Experiment with a larger or smaller size nasal pillow for a better fit.

Also, the high Flow Limitation may in relation to the above issues.  You need EPR to help with FL.

Finally to your pressure settings.  A wide open setting of 4-20 is not optimal for you.
You'll need a higher minimum pressure to help with the apneas.  

I suggest to change the minimum pressure to 10cm with EPR set to 3.

Be aware that without working on leaks and positional sleep issues, that pressure changes may not make a difference.

[tbp1234]

           

Thank you very much for your feedback!

I was indeed sleeping propped up - that was a habit leftover from feeling like I couldn't breathe lying flat due to another health issue that is resolving.  So I switched to one pillow.

I changed my EPR to 3.  It's made a world of difference in being able to fall and stay asleep.  My smart watch isn't yelling at me as much about poor sleep since.  

I did try another brand of mouth tape, unfortunately it wasn't as good as the first one.  I will keep trying.  

I have two full face masks and one nasal pillow all with different sizes.  The nasal pillow I have been using is extra small.  I tightened the straps, but it just doesn't seem to get as good of a seal anymore for some reason.  The only other nasal pillow I have is too large I'm afraid.  I did try the face mask but was unable to fall asleep with it.  I will keep trying.  After a month of new cpap - I'm pretty sleep deprived and it's costing me since I'm self-employed.  The number of hours I'm able to concentrate and produce work product has decreased significantly.  Today was much better thankfully.

I'm posting my 3 day results after the above changes in case you care or have time to review.  I'm thrilled that I'm finally able to fall asleep and stay asleep.  Unfortunately my AHI hasn't improved since.

[upsman]

An EPR of 3 cm is doing you no good with a minimum pressure of 4 cm. 

As OpalRose suggested, you need to raise your minimum to give EPR room to work. In addition, 4 cm is rarely an effective or comfortable setting. 
Your events are primarily obstructive, so a higher minimum pressure may eliminate most of them.

[tbp1234]

Since I have the autoramp feature, is that still true?  It only stays at four for 25 minutes, and I'm usually not asleep before it increases.  I will increase the minimum, though I worry that I won't fall asleep if the pressure is too high.

[upsman]

APAP machines do adjust pressure automatically, but it’s a common misconception that leaving it at the default settings will result in effective therapy.

The time that it takes for the machine to go from 4 cm to say, 8 cm to treat an event is valuable time. If you start closer to the pressure needed to treat an event, it’s much more effective. 

A general rule of thumb is to look at your 95% pressure and set your minimum a few cm below that. As OpalRose suggested, 10 cm would be a good starting point. 

Your EPR setting of 3 cm should help you exhaling against that pressure. 

Give these settings a try for a few night before you come to any conclusions or make more adjustments. Unless others see the need to do anything more.

[OpalRose]

I have a feeling that you have ramp and minimum pressure set the same at 4.

Your settings on your graph clearly states minimum 4 - maximum 20. I can't see your ramp setting as you've cut that off on the statistics.

The ramp setting is meant to ramp up to the minimum setting. If they are set the same, it won't work.

Go into the clinicians menu and change the minimum setting to 9cm, preferably 10cm. For now leave the max at 20.

Since you seem reluctant to do without the ramp feature, then set it closer to the minimum pressure. Set ramp to 6cm. Let it ramp up to 9cm. Keep EPR at 3 (full time)

If you're able to tolerate minimum 10, then set ramp to 7.