Very low pressure range seems to be right for me

[SkySleep]

Some background: I've had my AirSense 11 for only a couple of weeks. I did my home sleep study to try to deal with my snoring, which was so loud that my sleeping partner couldn't sleep at all. The study showed an AHI of 42, which was my first indication that I had sleep apnea. I had been waking up one or two times a night, but was otherwise getting enough hours to have a good night's sleep most every night.

The machine immediately totally stopped the snoring, but I was having a lot of trouble getting to sleep and staying asleep. I couldn't get used to the ResMed F20 at all. The P30i was much more comfortable, but it was making my mouth so dry that parts were sticking together and I had to swallow water to even free them up.

On the advice of people here, not directed specifically at me, I had raised my minimum pressure from 4 to 7 or 8. When I opened my mouth while awake, I could hear the air rushing out.

I decided to change the pressure range to 4 - 6 on the theory that the airflow was causing my mouth to open and drying it out. My take after reading a lot of posts here is that this range is way too low. (Example advice: "They set you up on too low of a min pressure (4cm is for children)-please raise...")

The result: No snoring, no dry mouth, AHI dropped to under 1. Very good night's rest. I woke up a few times as you can see from the attachment because I turned off the machine momentarily, except for one longer interval when I got out of bed to use the bathroom. But I got right back to sleep.

I've attached last night's OSCAR in case some more experienced people here see something that I don't know about. My plan is to leave the pressure at 4-6 and keep with the P30i. I'm disinclined to increase the minimum or maximum pressure, since what I have seems to be working and I don't want to go back to dry mouth.

Thanks!

[G. Szabo]

Would you mind posting a 3-4 minute wide window of your flow rate around 4 am? You might have palatal prolapse between 4:30 am and 3:30.

About the low-pressure range. If you feel better, use this setting. However, you would have fewer pressure adjustments and a more peaceful night at a higher minimum pressure, like 5.6 or even 6. 

It would be best if you also used the EPR 3 setting full-time.

[Sleeprider]

Using EPR (exhale pressure relief) can reduce your flow limitations and pressure fluctuations. Everytime your pressure dros below 5, your flow limitations increase and send pressure back up. You can still have low pressure, but with EPR, stabilize your therapy. For example with EPR on full-time at setting 2, and minimum pressute 6.0, your pressure will be 6.0/4.0 (inhale/exhale). let's increase you minimum pressure to 6.0, maximum to 8.0 and use EPR full-time at setting 2. That will provide a range of 6/4 to 8/6 and should prove effective and more comfortable.

[SkySleep]

Would you mind posting a 3-4 minute wide window of your flow rate around 4 am? You might have palatal prolapse between 4:30 am and 3:30.

About the low-pressure range. If you feel better, use this setting. However, you would have fewer pressure adjustments and a more peaceful night at a higher minimum pressure, like 5.6 or even 6. 

It would be best if you also used the EPR 3 setting full-time.

Posted that window.

In addition to the experiment you suggest, another I'm thinking of running is to set the machine to CPAP and the constant pressure to 4. In theory, this might prevent the machine from dealing with apnea at all, but I think only the OSCAR data can say for sure. If I run this experiment, I'll post the OSCAR.

My reasoning behind CPAP mode with pressure set to 4 is that I was sleeping OK before I ever used the machine, and I think this is as close to having the machine do nothing as it's possible to get. If that prevents snoring AND the AHI is good AND I'm rested in the morning, isn't that all I'm in need of? In effect, I've turned a very sophisticated APAP machine into a snoring suppressor.

(I should add that there's no absolute proof that I even suffer from sleep apnea. All I'm going on is the score of 42 that came from a single home study. Who knows what was going on with me that night, what with the chest sensor, the wrist sensor, and the pulse oximeter all attached and feeing very strange.)

---

Using EPR (exhale pressure relief) can reduce your flow limitations and pressure fluctuations.  Everytime your pressure dros below 5, your flow limitations increase and send pressure back up.  You can still have low pressure, but with EPR, stabilize your therapy. For example with EPR on full-time at setting 2, and minimum pressute 6.0, your pressure will be 6.0/4.0 (inhale/exhale).  let's increase you minimum pressure to 6.0, maximum to 8.0 and use EPR full-time at setting 2.  That will provide a range of 6/4 to 8/6 and should prove effective and more comfortable.

Thanks for this suggestion. Please see my reply to G. Szabo. I am thinking of an experiment where I limit the range (CPAP mode), but with a lower pressure than you suggest. It was the higher pressure that I think was causes air to flow into my mouth.

[G. Szabo]

Look at your pressure plot. You needed 6 cm to prevent obstruction. At 4 cm, your obstruction will increase, and your sleep quality will decrease. 

You want to experiment with a CPAP pressure of 4 cm. May I suggest instead using the APAP setting with a minimum pressure of 4 cm and a max pressure of 4 cm? This will give you the same constant pressure as CPAP, but you will also obtain the flow limit figures.

[SkySleep]

Look at your pressure plot. You needed 6 cm to prevent obstruction. At 4 cm, your obstruction will increase, and your sleep quality will decrease. 

You want to experiment with a CPAP pressure of 4 cm. May I suggest instead using the APAP setting with a minimum pressure of 4 cm and a max pressure of 4 cm? This will give you the same constant pressure as CPAP, but you will also obtain the flow limit figures.

Thanks for this clarification. I'll run several experiments: 4-4, 5-5, 6-6. Then maybe even 4-5, 4-6, and 5-6.

But, first, I want to leave everything the way it was last night to see if this good result is repeatable or just a one night happening.

To complicate the experimental plan, I just today got an F40 mask (full-face hybrid), which looks very inviting, and solves the dry mouth problem in a completely different way. Perhaps it gets around the discomfort that I've had with the F20.

[Sleeptechmaster]

With an obstructive AHI of 42 you are likely going to need a maximum pressure of 15 or greater. I would definitely steer clear of the nasal masks but if you like the p30i I would try the F30i.
The machine will supply you the pressure you need so I would set the maximum pressure much higher.

[HalfAsleep]

Hey, @SkySleep, I would recommend following guidance from apneaboard administrators or moderators (and many advisers, but not me) when it comes to settings advice. They’ve been handpicked for reliability, experience, and skill, and are xPAP users themselves. You may be lucky enough to get one of the fellas who wrote the Oscar code to give you advice. (Hint: observe the number of posts in the avatar).

I use an F40 myself and love it. It doesn’t entirely solve my dry mouth problem, but I have heard that some folks use xylimelts to alleviate that, and they say it works very well. I use a loose cervical support collar to keep my mouth from dropping open, and it resolves the dry mouth most of the time.

The other thing…you might never have experienced good sleep. You may be very surprised what it feels like when it comes your way! So, I think a ‘before xPAP” comparison with an “after xPAP” where the former was better than the latter….is not a germane comparison. Get the settings right, a few weeks under your belt, and some less choppy sleep, and you might be very surprised.

[Narcil]

With an obstructive AHI of 42 you are likely going to need a maximum pressure of 15 or greater. I would definitely steer clear of the nasal masks but if you like the p30i I would try the F30i.
The machine will supply you the pressure you need so I would set the maximum pressure much higher.

the dude has 0.8 ahi with 6-8cm and you believe he needs 15 or greater? wtf?

[SevereApnea]

I just want to add a polite comment here, my own Severe Sleep Apnea AHI was > 40

I currently run my VAuto at EPAP 3.4 - 3.6 with IPAP at 6.4 fixed in S-Mode, AHI always < 4, good sleep, often uninterrupted, my leaks are under control, my side effects of PAP are under control, soft cervical collar to the rescue, no mouth tape needed anymore

This Board and my dog Toby taught me all about soft cervical collars, (that's him in his doggy bed, neck extended). Sadly he is no longer with us

Things might not always be as simple as they might appear at first sight

Just sayin', as some would say

Regards

Chris