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07-13-2023, 07:01 AM (This post was last modified: 07-13-2023, 07:10 AM by overzero.)
Please Help
Good morning everyone,
I have been trying to use CPAP for the past few months, and can't for the life of me stay asleep throughout the night. I was using EPR but my sleep therapist told me it was collapsing my airway, so i turned it off. I am having big difficulties without it, including aerophagia, difficulty with exhalation etc. My pressure was told to me to be at least 11, and to be on CPAP, not APAP. I have recently ordered a V-COM and attached it to my machine-it does help a lot with mouth leak and aerophagia when EPR is off I can definitely tell the difference. But for some reason i cannot seem to stay asleep throughout the night without waking up 3+ times... I was wondering if any of you can point out any issues you see that is causing me to awaken, or any suggestions for pressure changes? I do use an N20 airtouch and mouth tape. Any help is appreciated.
I will say I feel MUCH more comfortable with EPR, but according to my therapist it is not helpful for my actual therapy. I can definitely stay asleep better with EPR on, but anytime I get above 10 in pressure it is just uncomfortable either way because of aerophagia. anything helps, and thanks so much.
AHI 5.7, but i don't trust this number-i see far far more obstructives than that on OSCAR that are not flagged.
Results look very good at fixed pressure of 11.0 cm. EPR does not collapse the airway, but it does reduce the pressure during exhale which may require some pressure compensation. The advantages of EPR include a lower flow limitation, fewer arousals and easier respiration and comfort, improvement in aerophagia and a more stable pressure when using Autoset pressure. Based on your comments, I think you should resume using EPR, but use the Autoset auto pressure to ensure your airway remains protected. If EPR causes your airway to "collapse" or creates flow limitation, the Autoset algorithm works to put you back in an effective range very quickly. Even without EPR, your flow limit is apparently very low, so this suggests a lower pressure may be viable using EPR to relieve your aerophagia.
If you would like to try re-introducing EPR, try the following settings, and post a chart so we can monitor whether you need further optimization. If your airway is indeed collapsing, we can very quickly identify the problem and resolve that. Somehow, I think that was an off-the-cuff dismissal of EPR by your therapist and not based on data or actual results. Hint: if a change doesn't feel good, it was the wrong move.
Mode: Autoset Standard
Minimum Pressure 9.0
Maximum Pressure 13.0
EPR: On Full-Time
EPR Setting 2.
Try it and post results and subjective comments on how you feel tomorrow.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
A V-com is a flow reducer that overrides the proper function of your CPAP machine. Get rid of it. It is a lot easier to properly titrate and optimize your machine without the interference of that device. Your machine has several different ways to perform the same function. This is like a flow reducer on a shower. Rarely satisfying and defeats the purpose. Your therapy looks pretty smooth, but more will show in Autoset mode than fixed CPAP. In Autoset mode your machine relies on flow sensors that provide feedback from your respiration and affect the pressure, flow and trigger/cycle of your pressure. The V-com is a gimmick that directly interferes with your machine's sensor and function. One of our members actually did a 7-day trial and recorded data and reported qualitative results. It sounds to me like V-Com is everything you are trying to avoid. https://www.apneaboard.com/forums/Thread...#pid480829
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
"1-should I remove the V-COM?" - Absolutely remove the V-Com, it will counter the therapeutic effects of using EPR, basically negating each other, further degrading the efficacy of your therapy.
"2-do you notice anything that might be causing my frequent arousals?" - Sure! Just starting CPAP is enough to disrupt your sleep for quite awhile, it took me 3 months before I was able to get contiguous sleep. The main thing to keep in mind as we adjust to therapy is the sleep we do get is far better than what we were getting before. As far as disruptions go, for me even a small leak will wake me up as will pressure above 8 to 9 for an extended period. Looking at the chart given, the arousal at 01:25ish corresponds with a decent leak, the one at 02:45 corresponds with a bit of a spike leak that I imagine could have been blowing into an eye. Just guessing, but on my charts those would wake me up.
The biggest thing you need to find early in therapy is comfort, that leads to better sleep and better treatment. EPR is the primary tool for reducing Flow Limitations, increasing APAP efficacy and increasing your comfort. You say yourself that you are more comfortable using EPR, unfortunately your sleep therapist isn't onboard with your being comfortable, but you sure can be.
Sleeprider is absolutely steering you in the right direction, his advice is golden as far as I'm concerned, he helped me get on the path to better sleep quite some time ago.
As for the V-Con I did two rather lengthy trials with it, neither successful for improving comfort. Its primary use would be for those who suffer large numbers of Central Apneas (the reason I tried it), not general Clear Airway events, those are many and varied. If you are interested in reading my take on it go here - https://www.apneaboard.com/forums/Thread-Using-Vcom-do-i-adjust-my-EPR?page=7
Good luck, keep at it because that's how we get good at it!
@sleepyrider thank you so much for the advice! Unfortunately being the silly forgetful person that i am i did not re-insert the SD card last night... I will do the same settings you suggested and repost tomorrow!!
@sleepy_quixote I really appreciate the support!! My therapist I believe just said that EPR reduces therapeutic efficacy, which obviously I want the best treatment for my sleep I can get... But it makes perfect sense that compliance should be paramount as well!! I can tell you if I had to continue with the V-COM and no EPR I would be throwing this sucker in the garbage within a month for sure. Thanks for your support and I will repost tomorrow!!
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
@sleeprider For some reason, when i put my SD card in the machine before turning it on it did not record the detailed graph of information last night.... I will try again tonight. I can say that it was MUCH more comfortable and my RDI was 0.20. sorry for the delay, I'm unsure why it didnt record appropriately. I'll post back tomorrow!
@Sleeprider here are the results from last night... Please keep in mind that I did go to bed later than usual because of work. I woke up and took the mask off temporarily because my mouth tape came off for some reason which is not a common occurrence... but I was able to fall asleep much much easier than without EPR, it felt much more comfortable. I woke up a total of two times, even though I probably had more arousals than that. The second time I think I woke up because my airtouch N20 rode up on my nose and was uncomfortable. I took the mask off at that point, it had taken enough effort to take the mask off, put the tape back on and put the mask back on to go to sleep earlier on lol.
It is definitely an improvement from the other settings I had, getting closer to a full night's sleep. If you recommend any adjustments please let me know! it looks like I might need to start at a little higher pressure because when I zoom in I can see some hypopnea's prior to my REM period. Thanks again!!
The new data looks very good. Your median pressure is 9.5 and remains below 12.0, so it is varying in a range of 3-cm. This is good because the auto pressure range is working well, and still not contributing to arousal or sleep disruption. Basically, the machine is providing higher pressure when and as you need it, then returning to more comfortable levels. Notice that the maximum pressure of 11.6/9.6 closely resembles your fixed pressure titration, but results in a much lower perceived pressure. The median pressure of 9.5/7.5 avoids the comfort issues that made your fixed pressure therapy unsuitable. In my opinion the choice of a minimum pressure of 9.0 was right on target. Your original results were very good, and the results remain very good but with better comfort and less aerophagia. We are not here to pursue perfect numbers, but to achieve a useful therapy that satisfies both therapeutic needs while not getting in the way of your sleep. I think this shows we are close to that objective. At some point you may want to try EPR at 3 simply to decide what works best, but I have no problems with you continuing with the current settings as long as they are working for you.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
