Picking up where I left off - My CPAP Therapy Thread

[SwirlySauce]

Hi ApneaBoard!


I took a long break from using CPAP out of frustration over a year ago when the Philips recall hit the news.  At the time I was struggling with compliance and had difficulty finding a mask and settings that allowed me to get a whole night of sleep.  I called it quits at least until I got a new machine without the poison foam.  A few weeks ago I decided to take apart my Dreamstation 1 and remove the foam myself rather than wait for Philips to send me a replacement.

I've been using the machine again with much better success this time around and am actually able to sleep through the night with the mask on most nights!  I am a bit disappointed that I haven't noticed much improvement in my daytime fatigue, although I know that it can take some time to resolve.

I'm hoping that I can get some guidance on where to go next with my therapy and settings.  Some notes:

- Throughout August I used a pressure of 9.0cm2 and Flex 1 with decent results.  AHI below 5 on most nights and I felt decent.  I did see consistent Flow Limitations and RERAs during this period in OSCAR.  (I can upload OSCAR screenshots for this time period if needed)

- Flow Limitations/RERA/Hypopneas lead me to increase Flex to 3 as I heard pressure relief can resolve this.  I read that Philips Flex does not work for this like EPR does for Resmed machines, however, so this may be pointless.

- I've been using 9.5cm2 and Flex 3 for the past week but I can't tell if its made a difference at all in quality of sleep, hypopneas, RERA, flow limitation.  I feel like my AHI is higher overall and I've been feeling lousy.  The 3 screenshots attached are of this period.


I'm not entirely sure where to go from here with my settings.  How concerned should I be with Flow Limitations, hypopneas, and RERAS?  I'm not sure what an acceptable number is for these.

What should my pressure be set at and should I bother with FLEX at all?


Let me know if you need any further information.  Appreciate your help!

[SwirlySauce]

August - 9cm2 / Flex 1

OSCAR screenshots

[Gideon]

Two things, you are stating your pressures incorrectly the correct units are cmw (cm water), not cm squared

Your numbers are good overall but your flow limitations are high. Try Flex=2 or 3, the highest you are comfortable with.

RERAS should be zero and is easily done with ResMed.

Beyond using s much flex as you can your options for treating RERAS, flow limitations, ( and hypopneas) is to increase pressure or get a ResMed AutoSet or a BiLevel.

[SwirlySauce]

Two things, you are stating your pressures incorrectly the correct units are cmw (cm water), not cm squared

Your numbers are good overall but your flow limitations are high.  Try Flex=2 or 3, the highest you are comfortable with.

RERAS should be zero and is easily done with ResMed.  

Beyond using s much flex as you can your options for treating RERAS, flow limitations, ( and hypopneas) is to increase pressure or get a ResMed AutoSet or a BiLevel.

Thanks for the explanations Gideon!

I tried using a higher pressure of 10.5cmw (with Flex 1) last night but had to take off the mask after a few hours as it was too hard to breathe against the pressure.  I'm not a huge fan of how Flex 3 feels but I was able to manage it at 9.0cmw.

Between using (10cmw + Flex 3) or (9cmw + Flex 1) which would theoretically be better to combat FL/RERA/Hypopnea?   

I feel I may be out of luck at least until I'm able to get a ResMed or BiLevel but that probably won't be any time soon.

[Gideon]

Many have issue with flex=3 so try Flex =2.

A practical experiment to understand extreme CPAP pressures.

Get a tall glass of water and a straw. Place a straw near the bottom of the glass. Now blow bubbles.



Assuming 8 inches of depth you just exhaled against the highest pressure a CPAP can produce. That is not saying you are not having pressure issues, aerophagia for example, but many do mistake flow for pressure.

[SwirlySauce]

Hi Gideon & Team,

Its been a few months since my last update.  I've steadily increased my pressure over the last several months and now am hovering around a pressure of 13.00 - 14.00 cmw .  I've gotten better accustomed to this pressure and can fall asleep and sleep through most of the night.

However I'm still seeing flow limitations most nights.  In fact, I don't believe this number has really decreased at all.  My AHI is lower on average - usually under 1.0.  I was hoping that an increase in pressure would have resolved the Flow Limitations but no luck so far.

Can it be concluded that these flow limitations are positional and that further pressure increases wouldn't have much of an impact at this point?

OSCAR screenshots are attached.  Let me know if you need any further information.

Thank you!

Edit: I will add that I've been using no Flex or Flex 1 - that feels the most comfortable. I never liked Flex 2/3 but I know you had recommended that in prior posts so I will give it a try.

[Gideon]

It is differential pressure between inhale and exhale that best manages flow limits and hypopneas.
Flex is a variable application of this that depends on how hard you are breathing. It will do some good so try flex=2

Better would be to switch to a ResMed or a BiLevel. Be aware your numbers will not qualify you for a BiLevel.
Your regularly removing your mask, indicating poor performance specifically on hours of use may qualify you for a BiLevel.

[SwirlySauce]

I pulled the trigger on a refurbished ResMed S10 AirCurve VAuto I can't wait to give it a try and finally get away from my Dreamstation.

I'll be reading through the S10 AirCurve Clinical Guide the next couple of days. Are there any settings that you recommend I start with based on settings I used with the DS?

[Gideon]

Assuming a used machine start with a factory reset to for e all settings restored to default.

Mode: Auto
Min EPAP=8
Max IPAP=25 ( machines max)
PS=4

This will start your inhale at 12 vs your current 13. Don't be surprised if we lower MinEPAP later.

[SwirlySauce]

Thanks Gideon, really appreciate it! Will let you know how it goes.