[Treatment] Help regarding CPAP settings for treating UARS

[PeaceLoveAndPizza]

Apologies for the time it is taking to figure this out. It takes a bit of experimentation to find the correct settings.

Let’s review what we know so far.

• You have no centrals in your sleep study, so they are caused by something related to the therapy
  
• Most of the sleep study events were arousals/RERAs
  
• You need an IPAP pressure of at least 10 to effectively treat the OA and H events
  
• EPR seems to exacerbate the CA’s
  
• The CA’s remain clustered which implies chin-tucking
  

While you are waiting on the collar, I think it would be worth trying a fixed pressure of 9 or 10 with no EPR. That will help narrow down the cause of the CA’s. If you still have CA’s at those settings then we know it is not EPR causing it.

One other thing to consider is whether a bilevel machine with its trigger controls would be worthwhile. By setting the trigger to high or very high it is probable most of your CA’s would go away. I think we can make the case for your insurer to change out your machine if we get to that point.

One other thought is if you happen to have a full-face mask or hybrid, to give that a try. I know when I use nasal pillows my flow rate gets choppy looking and my CA’s increase. Another thing to ponder.

For now give those settings a go and think about the other options.

[sleepytan]

Apologies for the time it is taking to figure this out. It takes a bit of experimentation to find the correct settings.

Let’s review what we know so far.

• You have no centrals in your sleep study, so they are caused by something related to the therapy
  
• Most of the sleep study events were arousals/RERAs
  
• You need an IPAP pressure of at least 10 to effectively treat the OA and H events
  
• EPR seems to exacerbate the CA’s
  
• The CA’s remain clustered which implies chin-tucking
  

While you are waiting on the collar, I think it would be worth trying a fixed pressure of 9 or 10 with no EPR. That will help narrow down the cause of the CA’s. If you still have CA’s at those settings then we know it is not EPR causing it.

One other thing to consider is whether a bilevel machine with its trigger controls would be worthwhile. By setting the trigger to high or very high it is probable most of your CA’s would go away. I think we can make the case for your insurer to change out your machine if we get to that point.

One other thought is if you happen to have a full-face mask or hybrid, to give that a try. I know when I use nasal pillows my flow rate gets choppy looking and my CA’s increase. Another thing to ponder.

For now give those settings a go and think about the other options.

EDIT - By mistake I had clicked post reply, without completing my reply.

I think it might be the chin tucking that might be causing the CA's , not EPR. See this chart of therapy so far, I have marked the days on which EPR was on. Regardless of EPR on or off CA'S have been more or less the same.

    The black lines are the days with EPR on.

I am buying out of my own pocket, right now I have Resmed Airsense 10 Autoset for a trial period of 1 month. If the therapy helps I was planning to buy Airsense CPAP Elite , as I dont respond well to APAP anyway and it is much cheaper (about half the price of autoset , in India).


I hope the  SCC helps. If that does not help then I will have to think about trying another mask or a bilevel machine. Though I really hope I can find a way to work with the CPAP.

[sleepytan]

    Last night was better, less centrals and I am  also feeling better in the day.

Unfortunately there is some delay in shipping and the SCC will be now delivered by 16th Jan.

I noticed that while I sleep on my back , air does not enter my mouth but when I sleep on my sides air enters my mouth frequently and that wakes me up , to either open my mouth a bit to expel the air or to gulp the air. I do tape my mouth. Does anyone know what I can do to alleviate this or is it something that will go away with time?

[PeaceLoveAndPizza]

For the time being, try reducing your EPR to 1.

The air entering your mouth is from the inside, not the outside. Practice keeping your tongue on the roll of your mouth whilst awake. I expect it will go away with time and practice.

[sleepytan]

UPDATE : 

I reduced the pressure to 9 , keeping EPR to 2 as I thought decreasing EPR would lead to increase in flow limitations. I have also been practising to keep the tongue on the roof of the mouth. 
After reducing the pressure to 9 , no more problem of air entering the mouth.

Since the last 2 dyas, my sleep has been a lot better and in the day I can see a significant change in my energy, mood and cognitive functions. Had forgotten what feeling 'normal' is like.

I am now going to stick to these settings(pressure 9, EPR 2)  for some time. Thank you all for taking the time to help me out.

SCC UPDATE :

Yesterday I tried to sleep with the SCC, no problem sleeping on my back but it was difficult to side sleep, at some point in the night I ended up removing it. Going to try again with some adjustments and see if I can get more comfortable with it.

Last 2 nights sleep data -
1) Without SCC-     
2) With SCC -