Waking up every hour

[Hauko]

hey,

I recorded the last nights and I have to say I sleep way better not only has my insomnia gotten way better but I think I sleep better with the current machine settings.
Do you think I need to up the pressure even more? (Kinda scared because higher pressure drys out my nose und I mouth breathe even more I think)

[PeaceLoveAndPizza]

I am very happy that you are feeling better with those settings and that we were able to help.

I do think you need to increase your pressure. If you want to be brave, try the following:

Mode APAP
Min pressure 9
Max pressure 14
EPR 3 full-time
No ramp

I think that will smooth out the flow rate a bit and help resolve the remaining events.

If that feels like too much increase it slowly, something like 0.2 or 0.4 cmH2O every other night or so to allow you to get used to the pressure.

[Hauko]

just for better understanding why do I need more pressure if my ahi is so low?

[PeaceLoveAndPizza]

AHI is a directional indicator, not the goal. The goal is high-quality sleep.

Your breathing looks very ragged with many inhalation and exhalation spikes. What we want to see is a nice and smooth flow-rate. As all we have to work with on your machine is pressure, we have to find what works best. 

You are also maxing out your pressure at 10, which tells me you need more pressure. 

Look at your 09.06.2024 chart. Your inhalations at 00:00, 02:40, and 05:40 are nice and smooth. Your exhalation spiking is lining up with your flow limitations. Both of which imply to me you need more pressure, or at least more pressure support. You are already at EPR=3, so no room left there. The best we can do now is increase pressure.

Note that it is all a trade-off. We try to balance pressure, pressure support, flow limitations, arousal breathing, and more, to get you a good nights rest. 

For now you are getting good results with your current machine. Depending on how things go you may want to consider a bilevel at some point, but I do not think you are there as yet.

[Hauko]

Thank you very much your comments and insight have really helped me a lot on my journey sadly my sleep clinic seems to be not the best.
I have been there recently and they wanted to turn off my epr and reduce my pressure to 5-9 
They just seem to look after ahi and not how the patient feels.

I will up the pressure now a bit each weak till I will reach 8-12