grizwilson - Therapy Thread

[Sleeprider]

What the redneck said ^^ Set your machine to Autoset mode, minimum pressure 10.0, maximum pressure 10.0, EPR on full-time, Setting 3.

When I use pain relief, it is usually just a NSAID like your Naproxen. I have no access to Oxy or Tramadol, so my experience with opioids is limited to some post surgery and meds received when I had neuro-Lyme's. You seem to be aware of the down-side of frequent use of those, and we frequently see central sleep apnea manifested in members that use opioid based pain relief. Nothing is going to be perfect, but maybe add in 10 to 20 mg of Melatonin with the Naproxen when you can tolerate it. Sleep position can make a big difference in pain, and using a high-quality, adjustable mattress is essential. A firm, conventional mattress is probably the worst. Memory foam comes in many different compositions and feel, and the air-supported beds with memory foam have worked well for some people, but are expensive.

[grizwilson]

The 10/7 are inhale/exhale pressures.   On your model CPAP, setting your pressure to a fixed 10 cm, and setting your EPR to 3 will yield the 7 cm exhale pressure.    The formula for an AirSense CPAP is, Pressure - EPR = Exhale Pressure.   Note, this value will never below 4 cm, the machine's minimum pressure.  Make sure the EPR is set to "Full Time".

Thank You, I think I have it set, will step back and use my Mirage med pillows as that has been the long time standard.  Will give it a go for a few nights and see it things get better.  Tired of being tired.

[SarcasticDave94]

Also setting it to AutoSet with both pressures at 10 with full time EPR 3 should yield the 10/7 pressure.

I've had some pain killers myself, some that were the same it seems. Meloxicam was the last and to me was least sleep robbing. But I am not on PAP therapy while I am trying to get the right machine. I've had oxycodone, Prednisone for anti-inflammatory, maybe tramadol, and there's others I've forgotten. All for extra extreme back pain. The only answer for me was a Spinal Cord Stimulant implant to electrically block pain signals.

To me, the OSCAR charts look pretty good. But this is why it's always necessary to answer "how do you feel?" preferably before looking at the data so it doesn't influence your subjective answer.

[grizwilson]

Also setting it to AutoSet with both pressures at 10 with full time EPR 3 should yield the 10/7 pressure.

I've had some pain killers myself, some that were the same it seems. Meloxicam was the last and to me was least sleep robbing. But I am not on PAP therapy while I am trying to get the right machine. I've had oxycodone, Prednisone for anti-inflammatory, maybe tramadol, and there's others I've forgotten. All for extra extreme back pain. The only answer for me was a Spinal Cord Stimulant implant to electrically block pain signals.

To me, the OSCAR charts look pretty good. But this is why it's always necessary to answer "how do you feel?" preferably before looking at the data so it doesn't influence your subjective answer.

Thank you Sir, think I have everything set for tonight, likely need to quit tweaking on a daily basis, let myself get used to things, will try to wait until next week to look at data if I don't feel too bad.

[grizwilson]

Well I am simply not smart enough to decipher running at a straight 10, my AHI still good, my large leak rate looks good, but chart shows lots of leaks some quite long.  I do not feel that I am sleeping good.  Would appreciate thoughts ideas, advice. Thanks in advance

[Sleeprider]

A CPAP pressure of 10.0 continues to show good efficacy in terms of AHI.  Comparing data from 1/26 to /21 we see a nearly identical AHI. Median leaks are lower but 95% leaks are higher, suggesting that leaks are less frequent, but higher in amplitude when they occur.  Tidal volume and minute vent have dropped a bit but this may be the result of lower average leaks as respiration rate is unchanged.  Probably the most remarkable feature is that we don't see therapy breaks and fluctuating pressure.  The lack of therapy breaks may be one of the bigger improvements. 

I don't see a reason to go back to variable pressure, however if you want to try a lower pressure of 9.0, that might help with leaks and comfort.  Leaks are not a function of pressure so much as fit of your mask, so that remains your biggest challenge.

[grizwilson]

Sleeprider, Thank You.  Not sure I understand all that but will stay at 10 a few more days and try some different mask.  Not sure if the Fisher/Pickal mask Sarcastic Dave has good luck with are available from my provider for a try? I am afraid my restless sleep tossing and turning knock the mask loose is a problem as they all seem to fit well while I am awake and when running mask fit??? Do not feel as rested even though charts look better.

[Sleeprider]

Keep in mind that your fatigue may be unrelated to CPAP therapy which is working well. We can optimize the therapy and minimize sleep disruptions related to pressure changes, and perhaps even control leaks; however if your poor sleep is due to tossing and turning that is a separate problem to take up with your doctor.

[SarcasticDave94]

I'm sure most DME's carry the Fisher and Paykel Vitera full face mask or their other models. I'm not certain which mask you've got now, but pay attention to the cushion size. And if you get it, we can go over strap adjustment and where it needs placed to minimize the nasal bridge leaks. Call you DME's office and ask them about it. This may help eliminate one more sleep disturbance.

[grizwilson]

Thanks Sleeprider and Sarcastic Dave.  My tossing and turning are due to pain, during the day I block out, at night it wakes me when it changes,  thus switch positions about every hour readjust to tolerate. I do not/will not tolerate pain meds of any type well, other than the meloxicam and gabapentin I take daily, the others are only taken if I cannot go to sleep.  They usually cause me to sleep at about half sleep.  I also have chronic thought disorder and think even while sleeping. My three Docs say this is my life.

Mask, currently using the mirage nasal swift pillows medium, the large will not seal on mask check and the small "wheeze" having tried several the dreamwear I really like, tried S, M, L but the MW is the only one that seals well, but my leaks become ugly, have not tried at this new lower steady pressure...... 

In an odd place with DME as was referred to ENT to discuss INSPIRE... so.....