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+--- Thread: TiredGal's - Therapy Thread (/Thread-TiredGal-s-Therapy-Thread)
TiredGal's - Therapy Thread - TiredGal - 03-03-2023
Hi! VERY new to APAP & sleep apnea and trying to nail down correct pressure settings. My AHI’s are always very low - usu .3 or less. Last night was zero again, but here is the confusing part. Initially, the dr set pressure at 5-12, then dropped it to maximum 9, then 8, then 7, and then when I never had any apneas, I dropped it to 6 and even 5 and the AHI never goes - so I’m never sure where to cap max pressure at. The other strange thing is whatever I put the max pressure at, it goes to that amount most of the night and doesn’t come back down. Seems like if I didn’t need it, it would stay lower since it’s an APAP and I thought it is only supposed to give me what I need? But, IF I need the higher pressure, then why don’t I get any apneas when I lower max pressure all the way down to 5? I’ve used the machine for about 5 weeks, but just found out about this site and Oscar (so I only have 1 night of detailed data & the rest is only the basic My Air ap data). I REALLY struggled with the home sleep test - got claustrophobic or something from the finger piece and how tight it was squeezing/cutting off my circulation so I was constantly trying to move my finger to loosen it and even almost pulled it off at one point and had to try and push my finger back down inside it (ugh!) and hardly slept. I was a back sleeper for the test, but switched immediately to side sleeping after when I learned that’s better for preventing obstructive apneas. Does anyone have any advice or ideas? My EPR is at 3, ramp is off. Thanks! (This site is awesome!)
RE: Newbie looking for some help - upsman - 03-04-2023
Keep in mind, the maximum pressure isn't what treats your apnea. It's more or less just a cap to prevent the machine from runaway high pressure. If your minimum pressure is 5, lowering the max to 5 gives you a straight CPAP treatment rather than APAP. A minimum pressure of 5 cm is very low and may not be giving you the most effective therapy. EPR of 3 cm is also not doing anything for you at that low a minimum pressure.
You're gonna need to post some OSCAR charts to really see what's going on. Take a look at this info on how to set up your charts for analysis.
http://www.apneaboard.com/wiki/index.php?title=OSCAR_Help
RE: Newbie looking for some help - TiredGal - 03-04-2023
Hi! Thank you SO much for the reply. I have only had Oscar for a couple nights, so only have data for 2 nights (Thurs &, now, last night Fri). I wanted to post both nights' data for comparison, because Thurs I had pressure set at 5 to 7 and last night I changed it to 6 min & 9 max. It always goes all the way to the max no matter how high I set it and I never have more than .3 apneas no matter how low I set it either. I did feel like maybe 5 was too low so I increased it to 6 last night. I got your message this morning & I think you agree with that so that's good - I made "some" progress at least! WooHoo! Maybe I should increase it to 7? Try 7 and 9 or 7 and 10? I swallowed a ton of air when I tried 10 initially and had such a sore stomach from that and I don't get any apneas regardless so never sure if I need it that high. Yet the machine always goes as high as I set it, and it's an apap machine, so maybe it "thinks" I do need it??? The machine always wakes me up every 1 to 2 hours so far no matter what the settings and, after 2-4 hours, I try to continue, but typically give up because it's too much. I'm not sure if I just need to "get used to it" or if my settings are still not right. On Thursday I didn't have any OA, UA, H or RE but, after I made changes last night I now have RERA of .33. Can you glean anything from looking at last night's data to help me know what to try next? I attached the Oscar "summary" page so you can see some of Thursday's data there, too, or let me know if I should upload any additional data from Thursday for comparison. This is all pretty confusing to me at this point, so I appreciate everyones' expertise and experience here and know I'll learn a lot as time goes on. The other change I made last night was to sleep with only 1 pillow, as I had started propping myself up on 2 pillows thinking that would be better, but then read on here that can make things worse as it might bend my chin too much. I slept on my side all night both nights. I keep wondering if maybe sleeping on my side would have been enough to control my sleep apnea since I was diagnosed as "mild" and I had slept on my back the entire night of the home study. Plus, I slept very little. I asked the sleep tech if I could be retested with me sleeping on my side, but she said they don't typically retest and that I'm overthinking things and should be happy that my sleep apnea is so well controlled. But I'm not sleeping well at all and I'm not sure if all the numbers/data that Oscar provides are in "good ranges" or not or if maybe I can improve them by making some changes. It's easy for me to see that I don't have any apneas, but not sure if flow rate, insp time/exp time, tidal volume, minute vent, etc are all ok??? Maybe if some of that is off, it explains why I feel so bad. Also, I wear a Polar Ignite Fitness watch and my ANS numbers are horrible when I use the apap machine. Maybe it thinks I'm choking or maybe my body is stressed from having air shoved into me? Thank you, again, for the support, and any advice you may have. Have a good day!
RE: Newbie looking for some help - upsman - 03-04-2023
Swallowing air is aerophagia. You need to try and find some way to keep your mouth closed while sleeping. Two ways are a chinstrap or mouth tape. These seem to work for most people.
I'm no expert at analyzing charts, but I can see your pressure is trying to go to your max of 9 cm most of the short time you were asleep. This usually indicates the machine is trying to go higher to treat your flow limitations. Try setting the max pressure to 12 cm and see if it continues to go that high. You may want to cap it there.
The main question is how are you feeling? The flow limitations and RERA are types of arousals but not enough to flag an event. This could lead to fragmented sleep.
Your sleep session is really short, so whatever is causing that might be a good place to start. Good sleep hygiene is very important...especially in the beginning.
Hang on until some of the experts come along. The main thing is to be consistent with your therapy and use it every night.
RE: Newbie looking for some help - TiredGal - 03-05-2023
Hello, again! I increased maximum pressure last night to 10 to see if that would help with Flow Limitations, but it made it worse (RERA went from .33, with no other AHI's to .57 but still, fortunately, no other AHI's). I didn't increase minimum pressure to 7 yet, as I understand if I change more than one thing at a time, we won't know what made the change either better or worse. I can increase minimum pressure tonight to 7, but am not sure I should leave maximum a 10, as it was a lot of pressure and doesn't seem like it helped with anything. It didn't help me stay asleep longer, that's for sure, as I still woke up every hour or hour and a half. Then I couldn't take it anymore, so I slept propped up in bed for a while and then tried using the APAP again - of course, it woke me right away again after about 45 min. My questions are: 1) what should I use for min and maximum pressure, 2) should I sleep on 1 pillow - more flat or use 2 pillows so I'm propped up a little more and 3) maybe I should sleep on 2 pillows, but use a neck collar? I think when I sleep on my side I hardly have any AHI's - even with pressures set as low as 5 (for both min and max) or 5 and 7; 6 and 8; 6 and 9, 6 and 10, etc. Before I started using Oscar I tried 7 and 12, then 7 and 10 and still never many apneas - usually .2 or .3, never 1 or higher. But maybe my problem is more about just a narrow airway resulting in RERA's, that don't get so far as to register as apneas or hypopneas usually. I read about Inspiratory Flow Limitation and how having that means your apap will go right up to maximum pressure right away and just stay there all night because it senses you always have a narrow airway, but that it won't necessarily go to apneas. It says with this you tend to have insomnia - trouble falling asleep, versus some with sleep apnea saying they sleep at night, but just don't feel rested. I don't ever get more than 2 hours sleep with APAP since I started using it. It does also say that CPAP/APAP is still a form of treatment for IFL, but that sometimes positional therapy (side sleeping), with a neck collar might be enough. That said, I don't mind trying the APAP more, but really would like to get the settings dialed in a little better for me so I don't wake up every 60 to 90 minutes all night. I attached Oscar data from last night (Sat night). I couldn't fit all the info into the attachments, but I think I added what the site said are the main pages from Oscar. If other data is helpful, please let me know. I appreciate any help or advice. I think UPSMAN (thanks for replying to my post, btw, I really appreciate it!) said that maximum pressure isn't what controls apneas so can you explain what does? Thanks for listening to my "troubles" (smile). This is quite a journey! And not a fun one. Argh!
RE: Newbie looking for some help (something SleepRider said) - TiredGal - 03-05-2023
Also, one more thing....I was reading another post where SleepRider commented about UARS (upper airways resistance syndrome), that I think I probably have and I believe he said if there is a residual flow limitation in the 95th percentile that raising pressure can help reduce that so perhaps I do need to go even higher than 10 on my max pressure. But over the last 3 nights, it looked like this: Hmmm....
Pressure - at 95% and 99.5%
5-8 was .16 & .32
6-9 was .16 & .43
6-10 was .19 & .36
Any suggestions? Maybe SleepRider can chime in if he sees this post, too? Or someone else that may understand how this part works....because I sure don't. (smile)
Thanks very, very much!
Please help explain attached Oscar Data - TiredGal - 03-08-2023
Hi! I was diagnosed about 6 weeks ago with mild sleep apnea (14 AHI back sleeper 100% of the time). I decided to try sleeping only on my side and I always have zero to .2 AHI's that way, but now I don't know if it's the machine that is correcting things or if sleeping on my side fixed it and I don't need the machine.
I've tried the following pressure combinations:
5 and 5
5 and 8
6 and 8
6 and 9
6 and 10
6 and 11
7 and 10
7 and 12
I've tried ramp on - 25 min and ramp off. I've stayed with ramp off now.
I've tried EPR off and immediately went back to EPR at 3. I like that better. I've stayed with EPR at 3 now.
Very quickly after turning the machine on, the pressure goes all the way up to the maximum pressure and stays there - it never comes back down.
I am short and have a small face so I'm wondering if maybe the machine is sensing a narrow airway right off the bat so the pressure goes high and stays high to avoid any apneas happening? Because even though it's an APAP, it never fluctuates.
When I use the machine, I wake up every 60 to 90 minutes so I only make it about 3 or 3.5 hours a night using it and then I give up and just try to sleep propped up. Then I sleep solid for 3 to 4 hours without it.
Can anyone tell me if you have seen a situation like mine before and have any advice on what pressure settings to try? I'd like a new sleep test to see if I have any apneas now that I sleep only on my side, but my dr doesn't want to do another test yet.
I'm so tired, confused, and frustrated. I'm really hoping someone here has some advice or suggestions for me.
I haven't had Oscar for very long, but attached the few nights I do have. I'm hoping someone here can help, because drs seem to leave us all on our own.
Thank you!
RE: Please help explain attached Oscar Data - OpalRose - 03-09-2023
What's happening is that the Flow Limitation is high. This is what's driving your pressure up. We use EPR to treat FL, and you are already using the maximum setting of EPR 3.
You show a 95% FL of .16 - .18. We like to see it down to .10, preferably lower.
I recommend that you change minimum pressure to 7cm. The reasoning is to get the full benefit of EPR right from the start. Keep EPR set at 3.
The other change I think you should make is the Mode. You are using the "For Her" mode. I haven't yet seen this to be all that helpful with some that use it.
Change the mode to the Auto setting. If your machine has a Soft Mode, try that.
Hopefully, these changes will help will a less disruptive night.
RE: Please help explain attached Oscar Data - TiredGal - 03-09-2023
THANK YOU, Opal!
I was so excited to see a response to my post, as I really appreciate the advice and support!
Last night I tried min 6 pressure and max 7. Now that I've read your post this morning, I see that flow limit was .18 so that's not good. I've attached the Oscar data for last night.
I'll try min pressure 7 tonight. Thoughts on what maximum pressure to try? Maybe 7 min and 8 max? Or 7 and 7 (like a CPAP)?
I've tried min pressure at 7 before and it was a little tough for me, so I had switched back to lower. But I had Ramp OFF, so I could turn ramp on for maybe 20 min to give myself time to fall asleep and that should help.
I VERY much appreciate your input as I know you all have helped so many people on this site - it gives me hope.
I'll check the For Her settings and see if there is a "soft" setting.
Thank you, again!
RE: Please help explain attached Oscar Data - OpalRose - 03-09-2023
Yes, you can use the Auto Mode with a min/max pressure of 7 - 7. If you can't tolerate 7, then try 6- 6. EPR 2 or 3.
Your AHI is low, so what we're attempting to go for is comfort and less awakenings.