[Pressure] Brand new CPAP user with questions

[Jabi]

What is the breakdown of your events?? Maybe you are getting more centrals with the higher pressure.

Buckeyedog - going by memory, as I didn't write the settings down, my AHI was right at 14, AI = 13ish, Central = 6ish. My Centrals have remained between 6 and 9 for all of the 9 nights. other than the one night with the AHI of 7, my AHI's have been between 10 and 15. I have the EPR set to 3 now. I tried it at 2 and then 1 with the higher pressures (14.6), but found that I wasn't exhailing fully so I had to set EPR higher so I could exhale. I am hoping I will get used to the pressure so I can lower the EPR. I'll begin a chart with my settings and report results. I guess that will help. The sleep report also shows that the pressure was at 14.4, so it basically went up to my max.

[surferdude2]

What sleep position, side or back?

[Jabi]

Use your ramp and your EPR to make yourself as comfortable as possible but note a couple of effects already eluded to:

My own EPR I played with to get the absolute minimum AHI (not really useful once you get effective treatment, just "playing a game" with seeing how low I could get it).

While on the subject, there is similar effect with humidity. Generally you want to set it high enough to avoid drying yourself out, however some people get MORE CONGESTED if they set it TOO HIGH or TOO LOW.

So if you are facing congestion problems (especially new problems you didn't already have) then try changing the humidity away from the extreme or toward the other extreme even.

Herbm - Thanks for the reply. I like the ramp as it brings on the pressure slowly. Does using the EPR lessen the effect of the pressure? I am finding it very difficult to exhale at a pressure of 14.6 and even 12.5 without the EPR. At 14.6 I had to set the EPR at 3 so I could fully exhale against the pressure. Setting it to 1 and 2 didn't work for me at that pressure. So my problem is that if I need a higher pressure to lower my AHI I don't know, at this point, if I can handle it higher.
I live with congestion all day every day, but with that, I have my humidifier set to 78 now. Tried 73, then 80, and have now settled on 78. It doesn't congest me at all. Doesn't congest me more anyway:-)

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What sleep position, side or back?

I sleep on both my sides and my back. Used to sleep on my stomach some, but can't with the mask on now.

[herbm]

So how are you choosing your pressure?

Do you have numbers to support your choices or are you just leaving your machine "wide open" to choose for you?

(Or something else?)

[surferdude2]

Then pay particular attention to what pressure is being applied when you are side sleeping for at least 1 hour continuously. That could be the key info that might allow you to get on with your therapy with a lower pressure so you can tolerate it better. That is not to say you will never be able to sleep on your back again, you may very well be able to do that once you solve all of the newbie issues you are having (mainly the high pressure requirement).

[Jabi]

So how are you choosing your pressure?

Do you have numbers to support your choices or are you just leaving your machine "wide open" to choose for you?

(Or something else?)

I did a home sleep study so I didn't get a beginning pressure or a titrating study. I am trying to zero in on my optimum pressure on my own. After researching the different machines I figured the S9 Autoset could help me achieve that. My study showed Moderate Apnea with 15 to 30 events per hour. It was a 3 night study. I didn't leave the machine wide open, but I wonder if that is a way to let the machine find the best pressure for me?? Would that work?

[Jabi]

Then pay particular attention to what pressure is being applied when you are side sleeping for at least 1 hour continuously. That could be the key info that might allow you to get on with your therapy with a lower pressure so you can tolerate it better. That is not to say you will never be able to sleep on your back again, you may very well be able to do that once you solve all of the newbie issues you are having (mainly the high pressure requirement).

Surferdude2 - I did notice for the first time last night that when I was trying to fall asleep while on my side I found it harder to exhale against the pressure than while on my back. Once I moved to my back I could exhale easier. I'll try to note your suggestion. Thanks!

[retired_guy]

"The last 2 nights I have had it set to min 6 and Max 14.6. I am still up around 13 to 14 AHI. What was interesting was that last week I had it set to min 6 and max 12.6 and my AHI for that night was 7."

Basically, there are a few rules:
1. When you change stuff, make small changes. Large changes will encourage an increase in Centrals.
2. When you change stuff, leave everything alone for a few days to see how the change impacts you. Otherwise your cute little body will get confused and encourage an increase in Centrals.
3. When you increase pressure significantly, say more than a 1/2 point at a time, you will see an increase in Centrals for a day or so.

So.......

At this point I'm not sure where you're at. Your sleep study came in with an ahi of, if I remember correctly 15? And your last night was 13? That's not much improvement. The good news (sort of) is that the increase is because of Centrals which are probably transient.

I'm concerned that you are reporting so much difficulty exhaling. That sounds to me like you either have respiratory issues (like mine) or you are over inflating (a term I really don't like) your lungs, and having difficulty exhaling. I believe your pressure is too high, and the range between your minimum and maximum is too great. I think you need to take that pressure back down to 10 or 11, leave the minimum at 6, leave the epr at 3 and use the machine for a few days to see what happens. Then after a few days you can think about increasing the pressure by 1/2 point at a time if that seems appropriate to help drop the remaining OA's without overly encouraging the CA's.

But even there, I'm not comfortable with your reporting how difficult it is to exhale. So I'm wondering if perhaps you should consider a different type of mask. Either a nasal mask or a pillows mask. At the bare minimum I think it would be a good idea for you to find your favorite comfy chair recliner (hopefully) and sleep in it for a day or two at the new settings until you get used to exhaling as much as you inhale.

[Jabi]

Retired_guy - Great information! Thanks. I didn't realize that the CA's could go up as a result of increasing pressure. I'll dial it back to what you suggested and make small changes from there. I was actually looking at nasal masks on line yesterday thinking that that may work better for me, so I may try one soon. I don't believe I have any respiratory issues as I am in pretty good shape, at the proper weight for my height, never smoked, don't drink, and I stay active and excercise. I just feel like when I exhale that I am not putting out as much exhailation pressure during the last half of my exhale as the CPAP is forcing into the mask. Kind of like trying to fill a tire when the tire has more pressure in it than the air compressor is putting out.
Thanks for the suggestions. I'll put them to work!

[PaytonA]

But even there, I'm not comfortable with your reporting how difficult it is to exhale. So I'm wondering if perhaps you should consider a different type of mask. Either a nasal mask or a pillows mask. At the bare minimum I think it would be a good idea for you to find your favorite comfy chair recliner (hopefully) and sleep in it for a day or two at the new settings until you get used to exhaling as much as you inhale.

I find it very difficult to believe that the mask is making it difficult to exhale. The Mirage Quattro has a lot of vent area compared to masks of other types and so should make it a little easier to exhale. I would look at pressures first and a medical check up.

Best Regards,

PaytonA