[Treatment] Settings adjustment help

[ispotato]

Hello, I have just had my first night with an APAP and it actually went pretty well for a first night, I think. I did wake up at one point and feel incredibly hot in my mask, which was helped by turning the heat on the heated tube way down. 

During my sleep study, my numbers were 7.5 AHI and 10 RDI, without any central apneas and mostly clustered during REM and later in the night. Last night, it went down to 2.87 AHI, but I started having central apneas, it seems. Though all the CA flags seem to be clustered? I downloaded OSCAR and am looking at the data and am not totally sure what exactly it is telling me.

The current settings on my machine are APAP 6-15, EPR 3, with ramp set to auto. It came just set from 4-20, but I adjusted it a little based on reading here and feeling like 4 felt restricted when I was testing the machine out. It looks like the machine had to bump the pressure later in the night.

   
   
   

[ispotato]

Actually, looking at it more closely, I think the CA events might be an error - they're clustered right after I woke up and had to briefly take off my mask to wipe the sweat away. (80 degrees as a default setting for the hose seems kind of wild to me). Maybe the machine mistook me adjusting the mask back on as breathing interruptions.

[Old Steve]

For now I would just adjust your minimum pressure to 7cmH2O, you need at least 7cm for the EPR to work correctly.  The cluster of apneas after 4:40AM is most likely positional apnea, caused by chin tucking, you may have rolled onto your back or simply got in a position to cause it.  Pressure alone will not fix Positional Apnea, if you can imagine what happens when you bend over a garden hose cutting off the water, but in this case you are cutting off the air.  See lower on the page for a link to Positional Apnea.  The other thing I see is a high tidal volume that I can't explain, perhaps someone else on the forum will know why it is high and if it is actually a problem.  You are actually doing very good for just starting.   

Good luck with your treatment and welcome to the forum.

[ispotato]

I did swap out my pillow for a different pillow, since the one I was using was kind of high. I also ended up after a couple more nights swapping to try a static pressure, because it felt like changes in pressure were waking me up. Well, I guess it's hard to tell if it's the change in pressure or the event the change in pressure was responding to, I guess. In any case, I was waking up and noticing the pressures were high on the machine and having trouble getting back to sleep and decided to try something different.

   

From an overview, it looks pretty good, but I have a couple questions.

1. Is there any advice to getting comfortable with exhaling against pressure? Even at EPR 3 with pressure not that high, it really feels like I have to work to exhale. It's very hard for me to relax into. I know to some extent it's just getting used to it, and I've been trying to get more acclimated during the day when I'm not trying to sleep, but it's hard to settle in at night.

2. It's not flagging very many events, but if I zoom in, there's a bunch of stuff that looks kind of funky, but just not long enough/bad enough for the system to flag it maybe? This might be splitting hairs to look at, probably, but I'm so prone to waking up at night that I'd like to make sure that I'm setting things up as well as I can here. My poorly educated guess is that if I wasn't on CPAP at all, these would be full events, but they're kind of half-prevented, here. My second poorly educated guess is that perhaps a pressure increase is required, because my 95% pressure on the days I used the auto was ~9ish, but even the jump from 8/EPR3 to 9/EPR3 feels like quite a lot to exhale into.
   
   

[Old Steve]

As to the pressure on exhale, you will have to get used to it, actually the pressure you are using is minimal.  Your exhale pressure of 5cmH2O is equal to having 5 inches of water in a glass and blowing bubbles in the bottom of the glass through a straw...not very difficult at all.



When you zoom in on your flow rate wave go for about 3 minutes of time, at just over a minute it is difficult if not impossible to figure anything out from the wave.

The big question is how do you feel.  It will take you some time to fully acclimate yourself to the CPAP machine, hoses and masks etc.  Just keep at it and you should do fine.

Post another chart with the Flow Rate wave at three minutes in an area where there are no apneas.

[ispotato]

Thank you for your reply. Here's 3 minute views as requested, sorry about the excessive zoom before.

I can't say I feel better than I did. It is obviously early days, and I've had to troubleshoot problems with the machine even with the temp turned way down making me very hot, but I definitely cannot say I am sleeping through the night which was part of the hope in treating it. My first night felt relatively promising, despite the problems I woke up feeling very slightly better than I had after sleeping in a long time. And then the nights after that less so, much more tossing and turning, even with similar settings. Not sure what to make of that.



   
   

[Old Steve]

I am not an expert on wave forms, but I do not see any thing that jumps out at me, perhaps someone more knowledgable than I will see something.

Is your hose heated? What temperature are you running?

I think that I was wrong in my description of 5cmH2O, I believe that it should be more like two inches of water.

Could you put your minimum pressure at 7cm with the maximum at 11cm.  Leave the EPR at 3cm and please put the CPAP back into APAP mode.  
I suggest this because it is very difficult to determine what pressure settings you should be using when you are in CPAP mode.   I personally use my machine in CPAP mode due to the up and down pressure changes, but first we need to determine what pressures you actually need.  After that then you can start on fine tuning.  If you continue waking up at night you may want to consider that it may not be your treatment, but some other health problem causing the problem. 
Anyway, try the new setting for a few nights then post some more charts.
Good luck.