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Therapy Result Changes - stevesleep - 07-26-2024
Deviated septum and some slight nasal congestion. Possible UARS.
Mode: Vauto
EPAP min 5.0
Max Pressure 14.0
Pressure Support: 4.0
Ti Min 0.3, TiMax 2.4
Cycle Medium
Trigger High
Accessories: Chin Strap + Mouth Tape
P10 Nasal Pillows
This is about my 6th night using a CPAP machine.
I have tested now the above with Pressure Support 4, and High Trigger. Last night was the longest I'd slept with the machine, but I felt quite tired after waking up.
Tests I have conducted and results:
1) Reducing Pressure Support to 3 & Trigger To Medium -> I tried this for a few nights and I couldn't fall asleep for some reason and I'd wake up quickly.
2) Chin Strap + Mouth Tape -> This stops the air leaking out my mouth like crazy so it's good.
Attached is my OSCAR last night, it looks like I'm getting a lot of Clear Airway Events.
Where do I go from here? The machine is subjectively comfortable, I can fall asleep with it now. However wake up feeling not refreshed and get all these events still.
Shall I do any edits and give it more time? Some advice needed please.
RE: Therapy Result Changes - HalfAsleep - 07-26-2024
Settings are not my skill set, but I’m confident someone will be along soon to address those.
However, I can say, it takes a while for your body to adjust to the machine and feel rested. For me, it took at least 6 weeks. I was stuporous at first, falling over tired. And then, I noticed a different kind of brain feeling. I realized it must be my brain on good sleep, and the feeling was very unfamiliar.
You are doing a great job overall.
RE: Therapy Result Changes - stevesleep - 07-27-2024
Do you mean that, even with all the correct settings - it took you around 6 weeks for you to wake up refreshed, without changing any settings or optimising?
If so, why is that? Curious on the thinking behind that.
RE: Therapy Result Changes - sauerkraut - 07-27-2024
stevesleep;
Everyone reacts differently to cpap/apap therapy ..
Everyone has an adjustment period ..
I use a AS 11 Autoset and don't know much about
vpap and the extra adjustments ..
Someone will be along that can help You ..
It takes time to get things right ..
RE: Therapy Result Changes - HalfAsleep - 07-27-2024
@stevesleep. Regarding your question about whether it’s for real I got my numbers to a reasonable range and pretty patterns on my charts, but still didn’t feel rested for 6 weeks. Yep, that’s how long it took for me. It’s still a work in progress, but very noticeable when I get it right.
RE: Therapy Result Changes - PeaceLoveAndPizza - 07-27-2024
Overall things look quite good, but there are a few things to consider tweaking.
First is setting trigger to “very high”. That will clear up the remaining CA’s.
Second is to consider increasing EPAP/IPAP pressure by a bit over a few nights to see if that helps. May be used with or without the above.
Third, You could also try increasing or decreasing PS a bit to try and dial things in.
Try a few of the above and let us know how it goes.
RE: Therapy Result Changes - stevesleep - 07-27-2024
Thanks PeaceLoveAndPizza I will try these optimisations and post the results. I just had a few questions:
1 - For increasing EPAP/IPAP pressure, just for my learning, what is the reason that this may help me in my situation? What would it help with exactly - CA's?
2 - For increasing EPAP/IPAP pressure, I have it at:
EPAP min 5.0
Max Pressure 14.0
Do you have any specific suggestions on how much I should increase it by at a time, to run these tests? (Quite new to all of this, so any concrete specifics would be appreciated).
3 - Could the current CA's also be a case of something I've read called therapy adjustment events? E.g. since I'm new to the machine (6 days in only, and been tweaking settings), you get more events but as your body gets used to it, it goes down... In that case, is there a certain minimum time period one should run tests for, before making changes (to make sure it's not just an adjustment period). Rather than just making a change after 1 night of data for example.
Thank you!
RE: Therapy Result Changes - PeaceLoveAndPizza - 07-27-2024
In order…
1. Based on your complaint of not feeling refreshed in the morning leads me to think your pressure is too low. Whilst one may get a good AHI at low pressure given enough pressure support and trigger sensitivity, it does not mean a good nights rest. Adding a bit of pressure may help reduce the arousals and help with getting more o2 into the blood, both of which should help with getting a better rest.
2. I suggest moving EPAP min to 7 and IPAP max to 12, whilst keeping PS at 4. We may want to consider increasing/decreasing PS depending on how things go.
3. I would make the pressure changes first, then give it a few days to a week before changing anything else. Your CA’s are possibly TECA, but using a high-sensitivity trigger to reduce them does not hurt. I suggest a minimum of two nights for any major changes to give you time to adapt, but if it is totally off-the-rails then I would change the next night. No reason to have multiple poor nights of sleep if something is not working.
RE: Therapy Result Changes - stevesleep - 07-30-2024
@PeaceLoveAndPizza - You Genius!
I slept with the machine for 2 hours (1 sleep cycle I'm assuming), and I had 0 AHI (the one event shown was before I had fallen asleep for sure, and ignore the first 30mins or so as it's as I'm getting comfortable). But more importantly, I woke up not-tired, like I had a refreshing nap. Obviously it's not enough sleep but it's progress. I took the machine off as I felt quite awake and tried to get back to sleep normally, it did take a while but I managed to. I feel the new pressure increase gives a ton of air coming in as well which is good.
This is my best experience using the machine so far, now I just need to do this for 7-8 hours in a night. If I can do that, I can see myself waking up refreshed.
So I think the settings are good to work with for a while now. I'd like some advice on the following problems:
1) Sleep Time With Machine/Waking Up - FYI my sleep hygiene is pretty good, and without CPAP gear, I'll sleep like 9 hours straight and consciously wake up (tired) once maximum or none.
I'm still new to the CPAP gear, I'm using a chin strap and mouth tape too. My body isn't sleeping the whole time I need to with the machine currently (despite good AHI etc).
What's the best practice to do? If I wake up, should I just try to get back to sleep (even if I'm quite awake) with the CPAP gear on again instead of taking it all off? I guess I want to make sure I get some sleep in, versus keep waking up/or maybe I can't fall asleep again with it on.
For some reason I was quite wide awake as well when I woke up after 2hrs with no AHI events. Maybe the body got too good of a rest in that period in that moment lol.
2) Slight Nostril Bone Pain P10 - I use the ResMed P10. I do have a severely deviated septum (but nostril breathing is fine). However on one side, the nasal pillows really puts a lot of pressure onto my nose... I think because of the deviation, it hits the bone a lot. I wake up and feel a bit of pain on it. I also feel with these new changes you made (higher pressure) it's increased the force that it's on my nose... I use the LARGE size. Although other than that, the mask is smooth. Is this something that goes away with time, or should I look into other nasal pillow mask options that don't stuff the inside of the nose but go around the nose? If so any recommendations... And general thoughts on this?
Thank you so much, I appreciate your help!
RE: Therapy Result Changes - HalfAsleep - 07-30-2024
Regarding #1…I’ve handled this a couple of different ways myself. The settings need to be correct, otherwise you might not have a lot of choice. PL&P is guiding you with these, so that aspect is going in the right direction.
If I wake up early in the morning, I will fling off my mask, thinking it must be time to get up. Often, it’s not. I have had to train myself not to do this, since it’s a bad habit. I also notice I feel a lot more rested, with clarity of mind, if I stay masked up for the last hours.
However, on days like this morning, when I had a super rough night (something’s wrong with my settings, I’ll bet), I removed it before I hit snooze on my alarm. I was that desperate for even an hour of sleep.
So, not a definitive answer on that one.
Regarding #2…mask comfort is everything IMO. Plus, the nostrils are sensitive: the trigeminal nerve can come very close there. Your mask might not be so much hitting bone, but hitting a nerve end. If you can, I would try a different mask. Most happy users have to try more than one mask before they get the right thing. You might even have to try 2 different nasal cushion masks to get the right thing.
By personal experience, I have a trigeminal problem, with one hotspot at my nostril. This eliminates alot of masks. I tried a nasal cushion, and just about went through the roof in 30 seconds. I am most comfortable in an FFM with nasal cushion. Go figure. But that’s just me: every face is different. So, yep, trial and error: comfort is everything.
Also, trigeminal nerve issues and the nose are something to ask an ENT.