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+--- Thread: TiredGal's - Therapy Thread (/Thread-TiredGal-s-Therapy-Thread)
RE: TiredGal's - Therapy Thread - TiredGal - 03-11-2023
Oops, our messages crossed.
I’m going to try min 7, max 10, EPR 3 tonight.
I’ve tried that before, but didn’t have Oscar at that time so this will be good to see the data.
When it was too much for me, and I had no events, I dropped down to max 9, then 8, then 7, then 6 and 5 - still no events or very minimal… .2 OA, etc
I have Oscar data for quite a few of those combinations, some were with 2 pillows, though.
I hope if I can find ways to keep my neck straight, maybe I’ll be able to lower the max pressure a little, and that will maybe be the magic combo.
Thanks for guidance and expertise.
RE: TiredGal's - Therapy Thread - TiredGal - 03-11-2023
Hi Llort…
Thanks for the suggestions. I have two neck collars on order to try. Fingers crossed!
Not looking forward to yet another thing to try and get used to when I’m trying to sleep, but it seems like lots of people on this site have had good success with it so it should be worth it.
I like your idea about checking O2 levels, too. I have a finger oximeter next to me in bed and have been checking it as soon as I wake up throughout the night just to even get a very basic idea, but I know waking and moving around increases it so I def want to try and see what’s happening while I’m actually asleep. Sounds like you’ve found a good one so I’ll look it up.
You were right about flow limitations! Others mentioned it, too. Hey, you’re becoming a pro. Good call. (Smile)
I’m still trying to figure it all out.
I’m sorry you’re frustrated. It sounds like so many of us struggle at first, and sometimes for quite a while, from what I’ve been reading. When I first Googled and read about sleep apnea after getting diagnosed, I saw the suggestion of finding a support group and I thought, hmm..wonder why. Well, after starting therapy, now I know!
Great news about the sleep study! What a relief, huh? That should provide some answers.
I sure hope you start getting some relief soon.
RE: TiredGal's - Therapy Thread - TiredGal - 03-12-2023
Interesting....I tried min 7 and max 10 and, finally, the machine didn't try to go up to 10 and just stay there all night now that flow limit was managed. Think that's a step in the right direction, though I still only slept an hour at a time before waking. Not sure why that is. I know it's normal to wake up throughout the night sometimes, but every hour is too much. I can't feel rested with that, so I only end up using the APAP for 3 hours or so total each night and then I sleep propped up in bed. Last night I slept 1 hour, then another hour and then gave up and slept propped up without the APAP, then tried the APAP again, but woke in an hour again.
I started the night with ramp on for 15 or 20 min (can't remember which) and then the second time I put it to 10 min, I think, or maybe I turned it to Auto then. If I didn't turn it to auto that time, I did for sure for the 3rd hour.
1) It looks like increasing the min pressure to 7 is the way to go, as that stopped it from going straight to 10 and staying there all night, correct?
2) What should I do about ramp?
3) It seems like it's better to turn ramp off, but I might need it to fall asleep - at least until I get more used to it. Thoughts?
4) Should I lower max to 9 or just leave it at 10?
5) Any idea why I wake up every hour when I use the APAP machine, but sleep straight through at 3 hour stretches of time without it each night?
I did have an OA, and I usually don't, but it wasn't much and - if I understand the data - it happened during an air leak so maybe the settings are fine as is and I should try these for a week or so and see how it goes? I do know it's normal to have events even when using the machine and this is really minor.
I received the neck collar this morning, so can try it tonight.
Thank you!
RE: TiredGal's - Therapy Thread - Sleeprider - 03-12-2023
Keep your maximum pressure at 10. The minimum pressure of 7.0 was important to allow EPR to be fully expressed, however your pressure remains very low between 7/4 and 10/7 (IPAP/EPAP). Increased EPAP pressure has a a significant impact on flow limitation. as does pressure support or EPR. Based on trends shown in this thread, you have a combination of positional issues and airway obstruction that you're dealing with. Increased minimum pressure, increases minimum EPAP, and if you're not having problems with the pressure of 7 minimum, 10 maximum EPR 3, then I would not be reluctant at all to suggest 8 minimum, 11 maximum and EPR 3 to improve on results. Reducing pressure is the last thing to do at this point, unless you have an amazing reduction of flow limits with the new collar.
You need more hours of sleep and to keep working on flow limits which are disruptive to your sleep by using higher, more effective pressure and continuing progress on positional aids.
RE: TiredGal's - Therapy Thread - TiredGal - 03-12-2023
Hi Sleeprider…
Any thoughts on Ramp for me?
I’ll increase min pressure to 8 tonight and max 11, but is it ok to use ramp to help me fall asleep?
1) I can try to do it a very short time - 10 min maybe?
2). Or do you think auto ramp is better?
3) or no ramp is best?
Giving me hope that we will be able to tweak this to get me some sleep - Thx!
My sleep center isn’t concerned when I tell them I am not sleeping. They only ever say my “sleep apnea is well controlled and that’s the goal”. But I say I’m not gonna be healthy if I never sleep, either, so it should be a 2-prong approach…control apneas, but also help tweak settings for better sleep.
RE: TiredGal's - Therapy Thread - Sleeprider - 03-12-2023
Use ramp at 10 minutes or Auto. If you can tolerate the minimum ramp pressure at 6.0 that will give you some EPR to start. I can't make the comfort decision for you, but I think you used a ramp pressure at 6 last night.
RE: TiredGal's - Therapy Thread - TiredGal - 03-13-2023
Hmm, well, last night's experiment didn't go so well. I set min pressure at 8, max pressure at 11, ramp to auto, starting pressure 6.
The max pressure is too high for me for now, I think, as I swallowed air and my stomach got sore. I also felt like I had to belch, but couldn't because I had the mask on, so had to take it off to do it. I think I tolerated the min pressure of 8 ok, though I still do struggle some with getting the "rhythm" to breathing with the machine. Takes time, I suppose.
But, again, no problems with apneas or events of any kind so if I could just figure out a pressure range that lets me sleep, the AHI's would prob be fine no matter what the settings were.
I can sleep for longer stretches of time when I'm not using the machine so it isn't a different sleep issue like Restless Leg Syndrome or anything. So I'm not sure why I don't sleep very long when I'm using the APAP machine, other than I keep telling myself it must take time. ???
Hopefully, last night's data helps zero in on what to try. Fingers crossed.
I was reading an article on this site called "Optimizing Therapy" and it said I should look at my median pressure and set min pressure 2-cm below that, but I've tried some pretty narrow ranges - like even 5 & 5 before - so the numbers are maybe kinda skewed so don't know if that will work to at least try and narrow down the min pressure and continue trying to figure out max pressure.
I've tried..
4 & 5
5 & 5
5 & 6
5 & 8
6 & 6
6 & 7
6 & 8
6 & 9
6 & 10
6 & 11
7 & 7
7 & 9
7 & 10
7 & 12
8 & 11
The reason many of the ranges are so close together, is I had read before to keep lowering the range if you don't get any events, as you want to use the lowest pressures, which still controlling the apneas. I've stayed at some for a little longer to see if that helps, but I still wake up every 40 min to an hour and I never have any events at any pressure level (so that's good), so it comes down to trying to find the right combo to let me stay asleep longer than an hour at a time. I guess that's where the flow limit discussion comes into play that we've been trying to figure out recently by increasing min and max limits.
Early on I didn't know that the minimums were too low, I just was following what I had read about keep reducing pressure until you start getting events and that'll help zero in on what pressures to use. When nothing happened when I kept lowering the max pressure, I started lowering the min pressure.
Thankfully, then I found this site and now I have some support from people with expertise!
Any thoughts? Tired Gal is really tired.
Thx!
RE: TiredGal's - Therapy Thread - Sleeprider - 03-13-2023
At this point, let's leave the minimum at 8.0, but cut back on the maximum pressure. In fact, let's set the maximum to 8.0 and pressure will be fixed. You have used this pressure without complaining of aerophagia, and it appears it will prevent the events while not making aerophagia intolerable.
RE: TiredGal's - Therapy Thread - TiredGal - 03-13-2023
Oops, I attached Saturday, 3/11 data, to my post above instead of last night (Sunday 3/12) data. Ugh, remember I said I was tired. Argh! I'm sorry for any confusion.
I've attached the correct data now in case it helps decipher anything new.
If not, I'll go with 8 min, 8 max, ramp off, starting pressure at 6 - please let me know if you think anything different after seeing last night's data and, as always, thank you for hanging in there with me.
RE: TiredGal's - Therapy Thread - Sleeprider - 03-13-2023
No change to my suggestion to fix pressure at 8 with EPR 3. Your pressure rises to the maximum due to flow limits, and exceeds your tolerance. There is no clear advantage to the higher pressure.
We only need the first chart with events, flow, pressure, leaks and flow limits. Don't use up your attachment space with the others unless we need to see them.