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Required pressure has increased over last month or two - wickedsleepy - 11-01-2023
Hi everyone,
I've been using CPAP since August 1st of this year, and it's taken a lot of getting used to. I'm still having trouble finding a good mask and managing leaks. But something what has been making it more difficult to manage leaks is how, over the month of October, the autopressure the machine goes to has gone up I think significantly. I have no idea why. I'm maybe 4lbs heavier than I was, and maybe its slightly colder, but I have no idea other than that. Has anyone seen the required pressure climb significantly after using the CPAP for a few months. I'm talking about seeing pressures in 12, 13, 14 range, back in August and September, to waking up with pressures in the 17, 18, 19 range regularly. One night, with my FFM, it topped out at 20 and it wasn't handling my apneas well. Any idea what's going on?
I realize the first thing people are going to ask is for the OSCAR chart, which I don't currently have a way to obtain. I'm working on it. In the meantime, I'm trying to understand if this is normal.
To me, this seems like a dramatic increase in overall pressure. I asked my sleep doc about this, and he shrugged it off as perhaps being because I am sleeping on my back more, but that's not the case. I wake up on my side, sometimes, seeing pressures of 17.9 or 17.1 or over 18. Sure, I could have just rolled over, but I don't think he's right. Is it normal to increase after a month or two of use?
Has anyone else seen this? I have noticed this both with my nasal pillow mask and my FFM. I understand that FFM can require more pressure than nasal or nasal pillow masks, but it just seems weird that overall, regardless of mask, there's been a 30% or higher increase in the pressure the machine goes to across the board over the past month.
RE: Required pressure has increased over last month or two - staceyburke - 11-01-2023
Put up a nightly set of charts from Oscar and we may be able to tell you why you have an increase.
RE: Required pressure has increased over last month or two - Sleeprider - 11-01-2023
The main problem is that your pressure is set to a default 5-20 and you may be experiencing flow limitations which drive pressure higher on a Resmed. You probably need to narrow your range of pressure and add in EPR (exhale pressure relief). This is normal optimization, and you need more detailed information to do it. Download the free OSCAR program, post some charts and we'll get you dialed right in.
RE: Required pressure has increased over last month or two - wickedsleepy - 11-01-2023
@Sleepyrider
Interesting. I had the range topped at 14 for a while and only upped it because a)I started using FFM and noticed 14 wasn’t high enough and b) left it there because it started going up to 16 and 17 with nasal pillow, which hadn’t happened before. So maybe bringing the top back down is the answer?
So what’s the issue with the Resmed machine and flow limitation? What’s the short summary? Also, I don’t use the EPR because I was having central apneas at first with it on.
RE: Required pressure has increased over last month or two - Sleeprider - 11-01-2023
Flow limitation drives pressure to the maximum setting. Flow limitation may or may not be an obstructive apnea precursor, and if not, then it is pointless to let the pressure rise above the level where OA are controlled. EPR directly treats flow limitation, which is a resistance in the upper airway to normal peak flow. It appears as a flattened or downward sloping inspiratory peak on the respiration flow rate graph. With EPR, more pressure is applied as inspiration progresses offsetting the airway resistance with mechanical pressure support, rather than physical respiratory effort. So EPR treats RERA (respiratory effort related arousal) as well as hypopnea, provided minimum pressure is adequate. In some individuals, especially new users of CPAP, EPR may increase central events by reducing the CO2 that drives respiration. Personally, I find the CA events less disruptive than the obstructive flow limits and RERA. If you haven't tried EPR in a while, it might be worth revisiting. Anyway, I don't know how you make any decisions based on MyAir. Here are some basics on flow limits https://www.apneaboard.com/wiki/index.php?title=Flow_limitation
Article on using bilevel pressure (EPR or pressure support) to resolve upper airway resistance (UARS) which is analogous to flow limitaiton. https://www.apneaboard.com/wiki/index.php?title=Flow_Limitation/UARS_and_BiPAP
RE: Required pressure has increased over last month or two - wickedsleepy - 11-02-2023
@sleeprider
Thanks for all of this. Just to test this theory for my situation, I set my ceiling to 17 instead of 20 and turned back in EPR to 1. I was able to tolerate the EPR just fine, this time around, and I’m happy to say that even with my FFM the higher pressures didn’t exceed past 13’s and low 14’s. The mask still leaks and so that woke me up a bunch, but otherwise it was a much more comfortable night and the “events per hour” was 2.3 (around 2 is about standard when I use FFM over pillows). So thank you for this suggestion!
various breathing issues - oscar report finally included - wickedsleepy - 11-17-2023
Hi everyone
I've written in here before about different kinds of strange breathing issues I've experienced using FFM and my Airsense 10. Before, I mentioned that I wake up in the middle of the night with rapid shallow breathing and also experiencing massive spikes in the pressure, which someone suggested was due to flow limitation. As someone suggested, I put EPR back on (at 1) and it seemed to help... at least to my awareness.
My wife still tells me, however, that I have weird breathing issues at night because it wakes her up. Apart from loud leaks (last night I tried a new FFM but it leaked quite a bit), my wife says it sounds like my breathing is staggering... I think it's my inhalation. Like one long inhalation happens across many short staggered inhalations, like climbing stairs. Has anyone experienced this? I included the OSCAR charts from the last two nights. Anything look weird?
RE: various breathing issues - oscar report finally included - cdplatt - 11-17-2023
Your report for the 15th looks pretty good. It appears there is some rapid/deep breathing at the beginning of the therapy and towards the end. You may have been awake or waking and responding to changes in the mask pressure and/or leaks. It may be a matter of getting used to the FFM and your breathing will settle into a more normal pattern when you do. Practicing breathing normally/calmly with shallower breaths during naps may help. Why did you switch to a FFM?
RE: various breathing issues - oscar report finally included - Sleeprider - 11-17-2023
Please use the screenshot organization discussed in the Organizing Your Oscar Charts (link in my signature). It provides charts and statistics much more useful for our analysis than the report function. Meanwhile, increase EPR setting to 3 to reduce flow limitation. That may resolve the issue and should improve how you feel
RE: various breathing issues - oscar report finally included - wickedsleepy - 11-18-2023
[attachment=56253][attachment=56254]
Thanks, Sleeprider
I changed EPR to 3 last night. I don't remember having the same breathing issues, but I had a different one -I woke up two or three times feeling like I couldn't catch my breath/couldn't breathe. Today, I feel pretty foggy in the brain, kinda not with it. I've attached last night's charts. Is there a way to zoom out to show more charts in one screenshot? I had to attach two because of my daughter's laptop screen resolution (which can't be set any higher). Anyway, I can't exactly say I feel better using EPR of 3. I feel more dazed and like I can't think straight ha.
@cdplatt, I was using the P10 for a bit. It was by far the easiest to sleep with and most comfortable... EXCEPT for the massive mouth leaks. I tried chin strips, training my tongue, and mouth taping with cover roll, but couldn't get used to the feeling of having tape over my mouth that I couldn't remove easily if I needed to. It was like CPAP roulette each night, seeing if I could control the mouth leaks. So eventually I gave up on that, determined to get used to the FFM. I started with F30, but it leaks a lot and took some getting used to. My supplier is going to fit me to try something else next week or the week after, so in the meantime I bought the FFM cushion and headgear for the Dreamwear. At least I could cross that off, since I already had the main frame from the nasal mask I was given to start. That's been leaky, too, requiring the straps to be fairly tight. So far my best nights with FFM have been with the F30 and with a thin chipstrap to keep my jaw from being pushed open by the F30 mask's lower straps pushing the cushion against my face.