supercharge2 (Therapy Thread)

[supercharge2]

Hi All,

First, I really appreciate all the users on this forum.  I was diagnosed in Feb of this year and got my ResMed Airsense 11 about a month later.  Since then I have been reviewing threads on this forum, tweaking settings, trying different masks as many here have done.  I finally have had a couple nights of "Success" and would appreciate any analysis of my data.  My only issue right now is waking up a lot still through the night but super excited my AHI is finally down and getting some sleep.  My current setup:

Tap Pap (minimal on face, doesn't leak or care how much I move around, great addition)
Chin Strap (This turned out to be key, as soon as I introduced this things changed for the better regardless of the mask)
Mouth Tape (Even with the chin I was letting out some leakage)

Well met all and thank you for any analysis!

[fishfinderG]

Your pressure is maxing out almost immediately and you are having a consistent flow limitation that is significant enough that it could be impacting your sleep. I'm far from the most knowledgeable person here but I would try raising your max pressure to 9 or 10 and seeing what a few nights look like. That'll make it clear if you need higher pressure, or if pressure support via EPR might make sense for you.

[pholynyk]

With flow limitations coming in at 0.20, I would suggest using EPR full time at 3. This may reduce the pressure swing, but I would also suggest raising your maximum to 10, although the EPR should be your first change.

[supercharge2]

Great feedback, thank you all for the insight!  I will make some adjustments and see how it goes.

[supercharge2]

Hi everyone,

After learning some hard lessons around making too many changes at once and not giving time for adjusting, I employed patience and have made progress.  I wanted to post this update to get advice on next steps.  Progress includes:

• Finding my max pressure, 14
  
• Working from EPR 0 to EPR 2
  
• Body has adjusted to EPR and Clear Airway Events are good
  
• Increasing min pressure to 9
  
• Improving AHI
  
• Partially bringing down flow limits
  
• Using the ResMed auto ramp to get to sleep faster initially, not running long, as soon as I fall asleep its doing a good job of detecting and kicking in treatment
  

My goal is to improve flow limits in hopes of sleeping more through the night, still wake up a lot/toss turn.  I am feeling better, but still having a hard time staying awake in the evenings but overall improving.  Right now my focus is on getting to EPR 3 full time to hopefully bring my flow limits down to a reasonable level.  My question for the board is what would be the next best setting based on my current results?  Does it look like I am ready for EPR 3?  Should I move my min pressure up some more, won't I have to do this for EPR 3 anyways?  I would like to keep to the 1 setting change at a time rule, this has been a big help.

As always I appreciate the help and advice, reading through these forums has been a game changer.  If I had to rely on my every 3 month visit to the sleep doctor I would be struggling for years not months/weeks.

[supercharge2]

Hi all,

Out of know where, I have had 2 bad nights in a row.  I was doing great for a week and starting to feel better, I posted on another thread my good progress, but now I seem to be having issues.  I still wake up a lot which is why I have been trying to progress towards EPR 3, to get my flow limitations down.  I have been doing just fine at EPR 2.  Last night and tonight though when I wake up I find the faster paced EPR 2 breathing pattern hard to follow.  Its like I am hyper focused on breathing and I am trying to match the pattern, then I want to slow the breathing down but the machine won't match my breathing so I am breathing off pattern and I know I am doing this.  Not sure if this makes any sense but I seem hyper focused on my breathing instead of just breathing naturally.  You will see in the charts these new Cheyne Strokes Resperations that I have never had before but now have had 2 nights in a row.  I know I was awake because I spot checked the time as I just knew this  was going to show up because I was awake and trying to get a comfortable breathing pattern.  I also haven't been having nearly any clear airway events over the last week and these seem to have shown up again.  Feels like I need to go back EPR to 1, I have never liked EPR but I was doing it to improve flow limites and cut back on swallowing air.  Any advice would be appreciated, feeling very defeated because I was finally making real progress and know it feels like I am going to be starting over again.

Thank you

[Psychotech]

yes your epr at 3 triggering your central apnea i would suggest turn epr 1-2, it also may be triggering your csr too

[OpalRose]

supercharge2,
I have merged your two threads and changed your thread title. This will enable anyone offering advice to see your therapy changes in one place.

It would be helpful if you could keep your questions and graphs to this thread. Thanks!

[supercharge2]

Hi all,

Can someone look at my inspiratory time vs expiration time.  Why is insp high and expr low?  From looking over others data it seems insp is high, if so any steps needed to address this?  I look back through all my data and this is the case no matter what settings I have tried over time.

I backed off EPR 2 to 1 for now and the CSRS cleared up.  CA's only seem to be an issue when I am trying to fall back to sleep, otherwise negligable.  Obstructives are very little if any even with the lower max pressure.  Still looking to work back to higher EPR for flow limit issues.  I also lowered my max pressure since it didn't seem to make a difference and less pressure to deal with when I wake up during the night.

Thank you