[Pressure] New to CPAP - trying to titrate

[Sleeprider]

That's good to hear you have a number of useful features on your Vauto. I do want you to start in Vauto mode with Easybreathe enabled. If we see centrals, our first adjustment would be to increase the trigger sensitivity to high. Other than that, I'll wait to see the initial results from your trial and we can go from there.

[grubsztyl]

Okay... I'm confused. I set the settings back to min. 9 and EPR 1 just to see if I can reproduce better AHI. Surprisingly I did, see the attached screenshot. I experienced one OA, one hypopnea and a clutter of 3 OAs around 4 am (already wearing a cervical collar so it is what it is)... as expected, flow limitations rose as well.

I don't understand. Both IPAP and EPAP are higher in min. pressure 12 and EPR 3 than in min. pressure 9 and EPR 1. In overall, last night looks more troubled than previous one because the flow limitations were more severe. I can't really tell whether I feel better with fewer OAs and more FLs or the other way around. All I can say is that exhaling is way easier and comfortable with EPR 3 even with higher IPAP. 

At this point I don't know what settings to use. It's illogical that I get more OAs with higher pressures. 

I've made arrangements to rent BiLevel. It'll arrive in a week or two.

I'm posting a link to the SS because I've hit the quota. https://imgur.com/a/3qLZ0UO

[TechieHippie]

Well, every night will have variances unrelated to pressure. Maybe you had more stress or more exposure to airway irritants or whatever. Plus, after a pressure change (and especially EPR change) you may have some adjustment time needed....that's just to say take the number on average and with some salt so to speak.

Here's my (newbie also) thoughts: Since you are trying to go to the bi-pap it makes sense to keep EPR steady at 3. Then you'll probably go to PS 4 on Bipap, just one level up from EPR 3. You also were more comfortable with EPR 3, so maybe get your system used to that while fine tuning the pressure.

On the 10th you had min 12 EPR 3 = EPAP 9, or (12/9). With Feb 11, you had min 9 and EPR 1 for an EPAP of 8 (9/8). You liked the EPAP of 8 but you want the relief of EPR 3. You could combine EPR 3 with the lower EPAP of 8. So for an EPAP of 8 with EPR 3 you would set your pressure to min 11, EPR 3 (11/8).

Then adjust the pressure min slowly if needed; the bigger the change the longer the adjustment to it. Once you find a sweet spot, and you get your bi-pap, to compare apples to apples calculate it so the EPAP is the same sweet spot but with a higher differential for PS. So for example, if you like 11/8 on the CPAP, maybe try EPAP 8 + PS 4 (12/8) on the Bi-pap for the equivalent EPAP with a little more exhale relief. Note that you can't get 12/8 with the APAP.

Hope that helps more than it confuses!

[grubsztyl]

TechieHippie, thanks for your valuable tips. I am definitely guilty of changing settings too often. EPAP of 8 seems to hit the spot but there was some improvement to be made in regard to FL... I decided to take it step by step and last night increased the pressures from 9/8 to 10/8. It looks like it worked?!

I didn't sleep long enough to really appreciate it but honestly.. this has to be one of the best nights I had. Still a bit drowsy but I got this weird relaxed feeling that I don't usually get... Most of the time I'm very tense.. looks like I simply lacked good night's sleep.

EPR 2 is not as comfortable as EPR 3 but it's definitely sufferable. I'll leave the settings for a few days to gather more data. I'll keep increasing IPAP, maybe next week, and hopefully once I get the bilevel I'll be able to set PS to 4.

I still get these weird OA clutters that look like positional apnea but I've already employed every possible solution - soft cervical collar, knightsbridge chinstrap, sleeping on my side.. I don't think a single clutter is going to be very disruptive since rest of the night seemed rather calm so I'm not going to dwell on it.

https://imgur.com/a/VNTYTo4

[TechieHippie]

I'm the same way - I have periods with clusters too despite what I've tried so far....looking forward to seeing how you progress.

I think you could go to IPAP 11 with EPR 3 next and pretty soon (1-2 more nights), so you get that relief, and it might help your clusters.

Lisa

[grubsztyl]

Consider this SS:

https://imgur.com/a/duuKsif

I slept worse and AHI is higher. I'm trying to identify the issue... is the pressure rising and my mask is leaking or is my mask leaking and thus pressure is rising to compensate? I keep reading that AirSense handles leaks below 21l/min well but that doesn't seem to be true in my case. I don't really feel any leaks while sleeping and I'm wondering whether this is my P10 or I'm mouth leaking... though that'd be unlikely because I'm wearing a chinstrap to prevent just that. Perhaps I should try mouth taping? Or maybe I'm shifting my mask with the pillow.

[grubsztyl]

https://imgur.com/a/bypDmAX

My screenshot shows it's AirSense 10 but I'm actually using AirCurve 10 Vauto... I forgot to erase old data from the SD card and reused it in new machine and Oscar still thinks it's AirSense. Nevertheless, I think I'm close to identifying the issue.

My therapy gets worse whenever my IPAP is increased with EPAP staying the same, so it could be either overall increased pressure or just the differential causing the issues. I notice leaks when my AHI is higher. I've identified that they're small mouth leaks. My chin strap keeps my mouth closed but air still escapes through my lips. This also causes me to experience terrible aerophagia. It's a pattern I've noticed from many different nights experimenting with the settings. When Oscar reports no leaks, I sleep well, AHI is low and there's no aerophagia.

I tried taping my mouth last night but I have facial hair and I'm unable to secure corners of my lips. I could feel air leaking when I woke up in the middle of the night. 

It seems there's nothing I can do to control it. It's a shame because I really enjoy using P10. Looks like I will return to my F20 and see how it goes. Fortunately I have an unopened Padacheek that I hope will reduce discomfort. I'm also hoping that PS of 4 will make it more comfortable... I'm really saddened because I do feel a bit claustrophobic with F20. I have F30i as well but was never able to use it. There's no size that would fit my nose well. I got mediums because it was the closest to my nose shape but I find it compresses my nostrils too much and I'm unable to breathe through my nose. Other sizes are too short. What a shame...

[TechieHippie]

In my experience it takes time and practice to get mouth tape to work comfortably and reliably and you shouldn't give up after just one try. Try different tapes and different sizes and shapes before you give up on the mouth tape. Also, purse your lips before applying it to avoid a little strip of opening. My dad had facial hair and successfully used the mouth tape. Buteyko brand is my preference because you can cut to size in both directions. He used a much wider strip than I need and shorter; he found it most effective to go right up to the corners of his mouth but not over. Also for some reason putting the tape on plain skin and removing once or twice to take the stickiness down helps in some cases. It would think making it less sticky would be a bad thing, but it seems to make it more manageable. Maybe not with facial hair though.

[grubsztyl]

https://imgur.com/a/dvO2iQG

My overall sleeping has improved, I think...

Im no longer completely exhausted and recently I've noticed that after 7.5-8 hours of sleep I feel pretty okay. There's a few things that do impact my overall mood: aerophagia still annoys me. It's more manageable while using FFM than nasal pillows but I do have to let gas off (sorry for the details...) in the morning and feel discomfort in my abdomen later in the day. I've also been experiencing daily tension headaches.. so while I feel more rested I can't say it's all roses and daisies.

For now I've settled at 10 EPAP with PS of 4. PS keeps my flow limitations low and I'm noticing diminishing returns of increasing EPAP at this stage. I still get OAs, mainly in my REM sleep I think but I'm beginning to doubt whether increasing EPAP is going to change anything... at my current settings falling asleep is already not fully comfortable, I do feel a bit air starved on higher pressures. Perhaps I need to get used to it.

One thing I want to try in the nearest future is another hybrid mask, namely Fisher & Paykel Evora Full. I was never able to make F30i to work - I actually managed to position the mask so that I had clear airflow to my nose but it leaked heavily at the bottom and no adjustments were able to fix the leak. I'm hoping that perhaps Evora is going to fit me better and more direct airflow into my nose than in F20 is going to decrease my events. The best results so far were with P10 but unfortunately I was mouth leaking hard but you already know that story.

[grubsztyl]

https://imgur.com/a/Kf0TZS5

Things are getting interesting...

I've raised pressures once again, teehee... EPAP 11 with PS 4.. IPAP of 15 seems crazy as I very rarely see anyone on these forums use such high pressures but surprisingly it does reduce number of OAs in my case... It really does seem I get most OAs in certain phases of sleep (look how consistent my OAs were last night) and I need surprisingly higher pressures to handle them than outside these phases.


I've also put the trigger on very high. This resulted in exactly 0 CAs. Nice.

Unlike some people I don't wake up due to high pressures but starting at EPAP 10 falling asleep is increasingly harder... Breathing becomes harder and I feel like I'm lacking air. I'm reluctant to raise PS because that'd raise already crazy high IPAP...