yadoog [Therapy Thread]

[yadoog]

I'm seriously struggling, I've had cpap/apap for around 4 days and I have no idea what's going on.

I feel like I only sleep in 2-3 hour bursts when I can and I don't feel much better at all, my AHI before was 8.3, it's now dropped
to around 2-4 but I don't feel any different...

I've added 2 screenshots of my OSCAR, I'm not sure which pressure to stick with either, I am a healthy weight and never snore.
Also, I didn't get my machine set up by a doctors as I bought it second hand (I didn't have much choice as another waiting list would have 
ended my will to live lmao) If anyone can  help me decide the right settings it would be greatly appreciated. I'm very new to all of this.

[Ratchick]

Do you have a copy of your original sleep study? That would really help us to help you.

For future reference, it helps to minimise the calendar and use the F12 button to take a screenshot but there's enough info here for now.

First off, almost all of your events are CAs. Did you have any central events during your sleep study or purely obstructive? This is a point where it's definitely helpful for us to see the paperwork if you have it.

You do have some flow limits and hypopneas, and normally I would suggest that you turn on EPR full time for that - however, that may increase your centrals. It depends if those are mostly happening around the times you wake up or otherwise get disturbed, roll over etc. Can you zoom in onto some of the CAs and give us 2-3 minutes and maybe 10 minutes of them and the breathing either side?

Your pressures of 8-14 look fine. You're not really topping over 10 and that leaves plenty of space for the machine to do its thing, and 8 is a good starting point.

It looks like you're also having a lot of leaks, too. Those could be disturbing your sleep as well, so we need to figure out if they're from your mask itself or maybe mouth leaks.

Four days is SO early - and I feel you, I was crying after four days because I was so exhausted and my ribs ached and my ears hurt and I was utterly miserable. It will get easier, when we figure out what's going on and how best to keep you from waking - and if that's just from the use of the machine, that will hopefully improve over time.

[Sleeprider]

It appears you are using ramp and are intolerant of pressures above 6 or 7 cm and repeatedly discontinue therapy. We want to get you more comfortable, and your pressure is rising due to flow limitations. The Resmed Autoset is very sensitive to flow limits and interprets them as obstructive, so it automatically increases pressure when they are detected. I think we can help by turning on EPR (exhale pressure relief) and setting a lower maximum pressure. Here are setting I will suggest to try:
Mode: Autoset Soft
Minimum Pressure: 5.0
Maximum Pressure: 8.0
EPR: On full-time
EPR Setting: 1
Ramp: Off

This will stabilize your pressure and give you a more comfortable feel as the pressure will relax during exhale. There is no need for ramp as you seem not to have a very long ramp period selected, and you will be starting near the minimum pressure of the machine anyway. As Ratchick notes, it is very early in your therapy experience, so we are going to mostly focus on comfort and getting more therapy time, then we can address the events as you tolerance increases.

[yadoog]

Hi all, I have attached a picture of my OSCAR readings for last night. I still only manage to sleep in 2-3 hour bursts before waking up and/or realising
I've pulled my mask off. (I usually don't pull my mask off though last night was an exception). 

Somebody hear suggested I change my pressure to 5-8, but nothing seems to have changed.
My overall AHI has gone down from 8.3 to around 3/4, so that's good at least, but I don't feel much different :/

Any advice / tips at all would be greatly appreciated, many thanks,

Sam.

[desaturator]

What happened in the period between 2.45 and 4.30. Did you switch the machine off, thinking you would not be able to sleep?

I suspect that somebody suggested you lower the maximum pressure to 8cm, on the basis that you were finding the pressure hard to tolerate, or it was waking you up. It seems to me, from the latest graph, that the machine would set the pressure higher if it could. At the same time, you seem to have a number of central apnea events, that probably won't be improved by increasing pressure.

There seem to be a number of problems here, but my impression is that the largest and most immediate is that you can't tolerate the mask, and sometimes it leaks. Was your sleep fragmented like this before you started using CPAP? Or is this a new thing? Do you know what it is about the mask/pressure that you can't tolerate? Is the mask itself uncomfortable (mine still is :/) ? Is the airstream too cold? Too dry? Have you tried any other type of mask?

Can you tolerate the machine/mask when you're awake? I believe the some people have to acclimatize themselves to the machine by using it whilst they're watching Netflix or something like that.

There are people who use this forum who are far more expert than me; but I understand the problems you have, because I've had them myself (and, to some extent, still do).

Best wishes, DS

[SarcasticDave94]

You've yet to mention or show what your sleep study results were in either thread. For myself with these CA I would like to see events and count on the sleep study.

Best to keep therapy in one place. The 2 you have are a continuation of the other.

[yadoog]

Hi all,

I'm quite new to apap and OSCAR in general, but I have attached my OSCAR readings
and it seems that most of my central apneas happen when my pressure is raised. 

I think my current pressure is 5-8, should I lower it to 5-7 or 5-6 and see if that improves?

Regards

Sam

[OpalRose]

yadoog,
You had a previous therapy thread set up for you, so I've merged this new thread you started with the previous thread. This keeps your history in one place.

I've noticed that you were asked to post a copy of your sleep study.
It's important to know if you had Centrals showing up on a sleep study.
That would determine what advice might be given on your current chart.

[yadoog]

I was never given the exact details but my study said it was looking for obstructive apnea and came up with a score of 8.3 AHI

[SarcasticDave94]

It would be helpful to ask the medical team to get the report so we can determine the Central Apnea/CA flavor you're dealing with. If it's treatment emergent, you'll expect these CA to diminish within 3 months. For most users that have these TECA that is. If it's the other CA like mine, pre-dominant, you're best served on the ResMed AirCurve 10 ASV, in your area it's a version of ResMed PaceWave. The ASV is specifically programmed to combat CA.

Not using the same AutoSet but for a single day, I've forgotten the setting options, but you may want to get an even more narrow pressure around 8, or static 8. EPR may need to go off.

No matter what, CPAP therapy in any form most likely takes more that a week to help with getting you the well rested feeling. Just don't quit, and try to get the report details.