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04-01-2023, 10:06 AM (This post was last modified: 04-01-2023, 10:18 AM by Sorfosh.)
Sorfosh - Therapy Thread
So I finally got my CPAP machine yesterday. I set it up immidietly and used it last night. The night was a little rough, woke up a few times. I did not like the starting pressure, I feel like I need higher than 5, it was a little hard to breath for me. I know this is my first night so it is not representative but perhaps something can be said.
A Note: I did wake up at night feeling like air was coming into my mouth, I needed to sort of "burping" it out? I am not sure how to describe it, is that normal?
I should also add that I was sleeping on my back (or at least fell asleep on it) most of the time. I know that my Sleep Study showed that is worst for me but sleeping on the side with the mask was too much for first night. I may try it if my charts indicate its positional apnea.
04-01-2023, 11:07 AM (This post was last modified: 04-01-2023, 11:08 AM by staceyburke.)
RE: Sorfosh - Therapy Thread
Welcome to the board. You did have 2 episodes of positional apnea. So trying to sleep on your side would be a good idea.
O, H and flow limits are all the SAME type of apnea the are classified differently by how much obstruction and how long the obstruction lasts. You can see how they are defined In my signature.
Your flow limits are high and a Resmed machine raises the pressure when it finds flow limits to stop them from becoming larger O and H events. That causes problems with mask leaks and disrupted sleep.
I would change your settings to:
Mim 8
EPR full time 3
That will help with getting you more air and help with the flow limits.
I think we can make you more comfortable with some setting revisions and then we will talk about positional apnea noted by staceyburke. Your sleep study shows a mix of OA and H events, and in that study, your apnea occurred mostly in three clusters. Your first night Oscar results with pressure of 5-20 with EPR on ramp-only featured a lot of flow limitation, RERA and hypopnea, all of which are related. There were also CA events, but we're going to ignore those for now. I'd like to see you revise settings to minimum 7.0, maximum 12.0 and EPR on full-time at setting 3. EPR is exhale pressure relief, and is actually a bilevel capability your machine has that provides lower exhale pressure and higher inhale pressure. With a setting of 3 that means inhale is 3 cm greater than exhale, so the suggested settings will give you a range of 7.0/4.0 to 12.0/9.0 (inhale/exhale). The pressure relief actually treats flow limitation, so I expect this will significantly reduce the flow limits, RERA and hypopnea, as well as greatly improve your comfort.
The sensation of having to burp out air is actually air going the wrong way into your esophagus and stomach, also known as aerophagia. The lower pressures we recommended of 7-11, EPR 3 should help to avoid that issue. Finally, I think you might occasionally sleep in a position that obstructs your airway. Chin-tucking caused by pillows too high or sleeping in a fetal position with the chin tucked, or any position that causes you to bend the neck at an acute angle can increase resistance or cause apnea. That may explain why most of your apnea was clustered in the sleep study, and can continue to affect therapy. Read the Positional Apnea article in the Optimizing Therapy wiki, and take it into consideration whether it might apply to you. http://www.apneaboard.com/wiki/index.php...onal_Apnea
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.
First of all, I feel much better than yesterday, I am not a zombie! I slept on my side and adjusted the settings as recommended. I did wake up at night a few times though. One reason was there was some water on my nose, a droplet and it was bothering me it seems. Is that humidifier working too hard?
I attach OSCAR data which looks much better, at least form AHI standpoint.
Looks much better. Your median pressure is 8.0, so that would make a good minimum eventually. There is no rush to make this change, and your machine is responding well at current settings. I don't see any big clusters of events, and the improvement in your comfort big step in the right direction. Not only has your AHI dropped from 6.5 to 1.5, but your flow limitation, which you feel with every breath, has dropped from a 95% of 0.14 to only 0.05, which is very good. This accounts for the significant drop in RERA and hypopnea.
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.
I did not fiddle with the settings and slept on my side last night. Took off the mask in the middle of the night and passed out before I could put it back on. Overall, even though AHI is low I do feel tired, perhaps the unrecorded period had many events?. Adding graphs for posterity.
Flow limits continue to be low and AHI is reasonable. Usually the trade-off is a few CA events for the higher EPR, but the CA events are normally much less disruptive t sleep than the increased respiratory effort, hypopnea and RERA. I like where you're at and expect it may improve without a lot of intervention.
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.
Thank you for all your help Sleeprider and Stacy. I guess I will check-in in a few weeks with an update? Unless I have a terrible night then I might post an update.
I do have a quick question about humidity. After some googling it seems it is called rainout. I wake up once a night with water in the cushion and nose that I need to wipe off. I am attaching OSCAR data from last night just because. Would anyone recommend some manual settings temperature and humidity? Perhaps that is an individual thing that I just have to tinker around with myself?
