[Pressure] New to CPAP - trying to titrate

[Sleeprider]

Your pressure range is not unlike mine. I have moved to an EPAP min of 10, but will often see IPAP reach 18. The pressure does not bother me. Your results are looking a lot better than when we started.

[grubsztyl]

https://imgur.com/a/p4SJcJL

Yesterday I received my F&P Evora Full.

I'm impressed though I must admit that it's not without downsides. I've got excellent AHI but the mask will take some time to get used to...

My leak rate was rather high, getting a good fit is hard and I suppose it will take me some time to figure it out. Compared to my F20, Evora is extremely loud... I absolutely hate the vents. I read that some people put some filter in front of the vents to diffuse the air more, I will try doing that. I also experienced some nose pain but honestly, F20 and P10 hurt like hell too but then I guess either the silicone softens or skin becomes tougher. For the first time my nose felt congested, I think I need to turn up the humidification.

F20 continued to deliver very inconsistent results. One night could be AHI below 1, then the next one above 3. Hybrid Evora looks like an improvement and I think it could be due to two reasons:

1) More direct airflow to the nose
2) More efficient use of air pressure. I didn't lower my settings after switching to Evora.

I will be experimenting more.

[grubsztyl]

It's been a few days since I last posted. I'm becoming increasingly frustrated with my therapy.

My results continue to be extremely unpredictable. After initial enthusiasm with Evora bringing my AHI around 0.5 the subsequent nights showed AHI in range 2-3 with worse sleep. It's very clear to me that I feel best with AHI under 1 and such nights are the best I've had in my life.

Consider this screenshot:

https://imgur.com/a/EcSuQCA

I continued to increase EPAP to clear stubborn reappearing OAs. With EPAP of 14 and IPAP of 18 with max. pressure set to 25 you can see my 95% EPAP is 16.68 and EPAP is 20.68. I don't have any respiratory disease that could warrant such high pressures... still they're ineffective.

I'm torn. I tried switching for one night back to pillows and taped my mouth but I still experienced mouth leaks and excruciating pain due to aerophagia. My aerophagia with Evora full is still there but it's much less painful.

I've tried scheduling a consultation with an ENT who specializes in sleep apnea but apparently he's in such a high demand that it's nearly impossible to do so.

I'm not sure whether I should continue to increase my EPAP to clear the OAs... when does it end?!

[Sleeprider]

Grubsztyl, please update your profile at this link to reflect the actual equipment you are using https://www.apneaboard.com/forums/usercp.php  

I think your residual obstructive apnea are positional, and pressure alone will be unlikely to clear it. It does not happen every night, and I think you may want to try keeping a journal to compare your nights that are relatively free of OA, to those like you just imaged above. I think it would be most helpful to figure out why your events are higher, with higher pressure.  It seems if pressure was the solution, we would not see this paradox.

[TechieHippie]

I'm glad Sleeprider chimed in. I notice something similar; I was just looking at your past pages. Over and over, you seemed happier with lower max pressure around 15. I'm not sure what caused you to go up to 20 at the beginning of Feb, but I'm wondering if reducing the max might help. Who knows, it might be causing anxiety, leaks, over tightening of your mask, etc.

Overall though, what I noticed is you've been making a lot of changes for a couple months, and you have gotten yourself down to the 3AHI range when you probably had 12 or more originally (doubling the amount the sleep test was able to determine on a poor night just as an estimate).

I know it's super frustrating and depressing when you can feel how much difference it makes and then it's all taken away. But remember, this didn't get created in a month and it's not going to go away in a month. There are residual effects that ripple through subsequent nights. You are actually slowly healing even with the bad nights , would be my guess. You are in a range where even though it can be miserable, you have stopped the decline of your health and turned it around. It just doesn't feel like it yet.

There's also a weird effect where focusing so much on the treatment and changing it so often can degrade your quality of treatment. It sounds like you have an intense work schedule also.

I think your overall progress maybe smoother if you focus less on AHI. I'm not judging, I do the same thing myself, we all do. But you now have a lot of info about your own treatment that you might be overriding because of anxiety to get it right. Ie the feeling that nothing is working. I would suggest you read through this whole thread, take notes on what you tried, without trying to find a final answer or judge your choices. You can even pretend that it's someone else's thread. Just get a picture while noticing the clues, and writing down your observations about what it might mean. Then, go for a walk, have a nice meal, whatever just get your head totally out of the game of sleep apnea. Let your subconscious work on it for a while (hours or days) while you focus on other things that aren't stressful as much as you can. Appreciate life. I would be surprised if you do this and you don't have any ahas or progress. Basically, it's a technique for giving your subconscious the data and observations and then letting it work. If it gives you a clear idea of what pressure and mask you should use, great, otherwise just pick something instinctually and don't stress on it. The goal is not to find the answer, again, the goal is to get out of your head about sleep apnea for a while.

You have been at this for a couple months which is not a super long time, and I have a feeling that you will have some breakthrough soon even though nothing will be perfect. This is a pretty typical pattern from what I've read here.

Lisa

[grubsztyl]

Sleeprider, I updated my info.

You're right, this has to be positional and it can't be corrected with SCC or chinstrap, I'm wearing them every single night. In my sleep study I had significantly more events on my back than on my side. My side/back sleeping ratio was about 50%. My guess is that my soft palate collapses while I'm on my back and higher pressure isn't able to push through it. My nose cavity is probably not helping here either, I often get congested and while I've never been a mouth breather I do breathe through my mouth during physical activity. This is why I'll be seeking help from an ENT because CPAP isn't enough.

TechieHippie, thanks for reassuring words. You're definitely right. However, as I said before, I really do feel better under AHI of 1. I keep changing the settings because of very inconsistent results. But you're right that I'm stressing over the settings too much, especially since raising pressures or switching masks doesn't make me feel better. I will be lowering the pressures to the point where I don't get aerophagia and see an ENT for an examination.

[Sleeprider]

I know Expat21 has used a backpack sort of arrangement to prevent back sleeping. I have seen many members with creative approaches to avoid that position. I'm glad I don't have to avoid my back, or I wouldn't know how to sleep. If that is what it takes for you to make a difference, look for ideas and choose the most comfortable solution possible.

[grubsztyl]

So I've been experimenting... again...

I know that opinions about LankyLeft are very mixed but he's made quite a lot of videos about different ways to improve CPAP therapy... One of his claims is that most people are undertitrated and that CPAP is better than APAP. So I did the following:

- changed my EPAP to 19 cm and IPAP to 22 cm.
- switched to VAUTO S

I'm not going to say that this was the best night ever because I'm not used to such high pressures and I developed a sore on my nose from Evora mask... aerophagia was significant but I get that at lower pressures too. Exhaling is definitely harder. However, the charts are... interesting.

https://imgur.com/a/WCYgt1g

I will need to adjust the mask, probably switch to F10 while my nose is healing. But this is very interesting.

[TechieHippie]

It'll be interesting to see how you progress with this... The mask leaks may have obscured some events but that AHI is certainly promising. I can see the value of constant pressures and higher pressures but (without having reviewed your other charts) why the small PS ie differential? It's the main feature of the bilevel and would seem to be needed to support those higher pressures.

[grubsztyl]

To be frank I was curious what kind of flow I would get with lower PS. I also perhaps went a bit overboard with EPAP... using such high pressures was an act of desperation. Tonight I will be attempting 17 cm EPAP and 21 cm IPAP. I will keep increasing EPAP, perhaps by 0.5 cm and mantain PS of 4 till I clear all the events. I studied the flow graph and definitely there were some disruptions, possibly arousals even though there were no apneas. Looks like PS smaller than 4 is not good for me but I need higher EPAP than I initially thought.

I've also adjusted the straps and tested extensively different sleeping positions to prevent leaks. I will keep you updated with more screenshots.