Two months in... some concerns

[vsheline]

I've been debating whether or not to raise the min. pressure to 5 instead of 4, and is something I wanted to discuss with the doc. Breathing at 5 feels a little more comfortable than breathing at 4, but more pressure is more pressure.
...
Regarding EPR, is the concern that EPR affects treatment, or that it increases central apneas?

Hi Paptillian,

Yes, EPR can lower sleep quality for people who have a tendency toward central apneas.

Any thoughts on why I would feel like crap after a long night of good sleep? It's been a trend lately and I want to nip it... get back to feeling rested again.

Numbers are useless if you,re not getting a restful sleep, first get decent sleep and then look at the data. Leak numbers might be within the acceptable range but those spikes (also correspond with spikes in pressure) might indicate some mouth leaks, escape air thru the mouth can compromise the therapy. Chinstrap or full face mask may help (full face mask allows to breathe thru your nose or mouth without any compromise)
You've asked for any thoughts ... my thoughts are:
1- Do nothing ... wait for the oximeter to arrive so you can check oxygen desat during the nights
2- Increase the minimum pressure by couple of cmh20 together reducing EPR or even turn it off completely. EPR does not drop pressure below 4 so if the minimum pressure at 4, both inhale and exhale at 4 too

Others things might also help, try to sleep on your side and keep sinuses clear

What Zonk said, on all points.

I don't believe that raising the pressure to give yourself a greater flow of air is advisable. The pressure is used to provide a splint to keep the airway from collapsing, not to force air into your lungs to help you breathe. Even at the lowest possible pressure of 4 cm you're getting a greater flow of air than you do when you're awake and not wearing your mask.

There is a reason why 3 or 4 cmH2O is the very minimum allowed. If the pressure is not high enough (1) the air we are exhaling may not get flushed out completely through the mask vent holes, so we may re-breathe some air which was not vented, and, (2) we may need to work a little harder during inhale, which can cause Respiratory Effort Related Arousals (RERAs). The usual solution for RERAs would be to increase Pressure Support (or EPR), except EPR has no effect on the difference between inhale and exhale pressures whenever the pressure happens to be already at the minimum pressure (and, in your case, increasing EPR may worsen your central events).

In your case, an ASV machine may work better for you, except with your "great" numbers for AHI, there is no way insurance would cover it, and, besides, as others have commented, your sleep quality may improve on its own within a few weeks or months even if you change no settings.

Personally, I think increasing the minimum pressure to 5 or 6 may be more comfortable (may make it easier for you to breathe, lowering respiratory effort, improving your sleep quality) without significantly worsening your centrals.

I suggest doing only one thing at a time. I would suggest raising the minimum pressure to 6 (and back it down to 5 after a week or two if the higher minimum pressure hasn't helped), and, after that change has played out, I would turn off EPR to see if that helps.

Your pressure is raising periodically to 11 or 12. This may be when you are in REM sleep stage, or, perhaps more likely, may be when you are sleeping on your back. The old tennis ball trick (in a pocket sewn right between the shoulder blades of a snug teeshirt) may help avoid obstructive events which can cause arousals which may be fragmenting your sleep, preventing you from reaching deep restorative sleep.

Take care,
--- Vaughn

[Paptillian]

There could be some mouth leaks, you guys are right about that. I'll also try not to sleep in too much and the idea of reducing EPR is interesting. I'll ask the doc about raising the min. pressure when I see him in Sept. Should be alright I think... I don't see the harm in it.

Vaughn, just one question- you said my pressure is raising periodically to 11 or 12 (unless you were talking to Sleepster?). I'm not sure where you saw that in my data. My pressure is limited at 10.

[vsheline]

Vaughn, just one question- you said my pressure is raising periodically to 11 or 12 (unless you were talking to Sleepster?). I'm not sure where you saw that in my data. My pressure is limited at 10.

Oops - I was writing from memory and misremembered the scaling on your pressure plot. I meant:

Your pressure is raising periodically to 9 or 10. This may be when you are in REM sleep stage, or, perhaps more likely, may be when you are sleeping on your back. The old tennis ball trick (in a pocket sewn right between the shoulder blades of a snug teeshirt) may help avoid obstructive events which can cause arousals which may be fragmenting your sleep, preventing you from reaching deep restorative sleep.

[Paptillian]

Wow... what a mistake.

I tried to use a chin strap last night to see if I could cut down on mouth leaks (wife says I do the "lip flutter" thing at night). Didn't get much sleep at all and developed a WICKED headache that only calmed down after Ibuprofen. For about an hour the pressure graph had spiked up to 10 (my max) and plateaued there. I've never seen that before.