[Treatment] Am I Getting All The Benefits of My Machine?

[semaj81]

Hello Apnea Board! I am new here as you will likely see this as my first ever post. I've been reading and reading, ingesting data to the point my brain is flooded! So let me get to the point. I've had sleep issues for years, and I mean years. Mostly falling asleep is my main issue but my doctor scheduled a sleep test and here we are. I've been reading a lot about APAP and CPAP and finding the right setting but I assume just leave it up to my doctor? Either way, I'm glad I found this forum thanks to the folks over at /r/CPAP and I've attached some OSCAR data for review.

But my main issues seem to be feeling rested. The first night on the machine I woke the next day feeling like I haven't felt in years. It was an amazing feeling! But slowly as it went, I started to feel more and more like I always have; tired, foggy, dull. So what happened? I don't know. I told the doctor and he said to just keep up at it. I do have a habit of taking my mask off during the night so that likely isn't helping the cause. Any tips, tricks, and help is greatly appreciated!!

   
   

[SarcasticDave94]

Welcome to Apnea Board.

You're off to a good start. You have OSCAR up and running, and have been able to post a chart. You've also had rather little leak issues in the chart, which tends to be an area most newbies have an issue. Overall the chart looks good. Now for the test, how do you feel regarding therapy? Are you sleeping better? Further, are you feeling benefits of the PAP therapy? If the answer is yes, then keep using the PAP and go forward.

I would probably do a few things to maybe improve therapy just a bit, if it proves through use to benefit and not hinder comfort. I would consider turning off Ramp. It is a comfort feature, however it can hinder therapy by getting in the way of therapy. This chart didn't indicate it did so, but it may have, or may do so later. Ramp dictates less than optimal therapy pressure control that may allow apnea events to sneak in. Lower pressures such as yours do not require Ramp either.

Since you have some Obstructive Apnea events sneaking past the machine, you may want to consider bumping your low 6 pressure up a bit, maybe to 7 and see if it gets better overall. Besides controlling events, your EPR of 3 cannot be fully effective with pressure of 6 as EPR reduces pressure from your low number. 6-3=3 but your PAP machine cannot go to 3; 4 is the lowest it will drop to. So to kill 2 birds with one adjustment, going to 7 may control a bit more apnea and make it more comfortable at the same time.

NO absolutely not on leaving the therapy up to the doctor. Lots of patients are represented here on AB. Almost none of their doctors manage their therapy very effectively or accurately. Plus they cost money to you and insurance. We can suggest self advocacy and control of your PAP therapy, more accurately and better results for free. And in the comfort of your easy chair on the PC. We do know and understand your own Dr. Dolittle needs to be involved in your PAP therapy, and yet your PCP or even your dentist can script your PAP machine and supplies if he/she is willing to do so. Self manage your therapy and you will get 1,000% better results for far less money and stress.

To your successful PAP therapy

[semaj81]

I will do just that! Thank you for the post and input! I saw amazing benefits in the first few days of use but slowly I've gone back to feeling like I did before the machine came into my life. I understand about the doctor aspect. My most recent appointment with him was a waste of time and could have been done over the phone. Didn't look at any numbers that I know of, though my machine does phone-home so maybe he has them somewhere? Either way, I'll try the settings you mention and see how that goes.

[Sleeprider]

The charts show that with a minimum pressure of 6.0 and maximum at 10.0, EPR 3, you are experiencing obstructive apnea, hypopnea and considerable flow limitation. Your median pressure is over 10 cm, and that is probably a good starting place to set your minimum. Your current minimum pressure is simply too low, and with EPR even your median pressure is 10.2/7.2 (IPAP/EPAP) which is fairly low. You will see improvement at this higher pressure.

Your 95% flow limitation of 0.13 is in a range that we have observed to result in respiratory effort related arousals and less than satisfying sleep. We tend to focus on flow limitation because it is disruptive to sleep. To visualize the problem, zoom into the Flow Rate chart to where you can see the shape of the individual respiratory waves. Flow limitation is a flat-topped inspiration wave that represents increasing airway resistance as the inhale progresses. This slow the rate of flow resulting in the flat top. You can improve the graph by right clicking near the Y-axis and adding a dotted line at zero. Everything above the line is inspiration, and everything below the line is expiration, and the line is the zero-flow where transition occurs. Where a lot of flow limitation is present, we find people can improve comfort and sleep using bilevel therapy. You are currently using bilevel pressure support of 3, but a bilevel machine can go higher.

Let's work on your therapy for a while. I don't think you are going to benefit a great deal from a sleep study at this point, and most doctors don't do the deep dive on your results to see things like flow limitation. I think we can improve your machine optimization and how you feel by working on the settings and sleep hygiene. As you can see, your bedtime and time of use is quite variable.