New user intro, looking for Sleepyhead feedback + Progress!

[Pugsy]

I think that increasing the minimum to 7 would be a good next step. I don't think that you necessarily just have to increase the max but you can if you want to. The machine won't go there unless it needs to and it doesn't really appear to want to or need to all that much.
Unless the higher pressures are causing problems like stomach bloating or centrals (which I don't see happening here yet) then you might try a little more max but I don't see it being an urgent need.

About the higher AHI...a good chunk of that AHI is central/clear airway in several of the recent reports (I only looked at the most recent 3 nights). More pressure isn't going to fix those centrals so you sort of have to mentally remove the CA/central index from the AHI evaluation when thinking pressure changes. Unless those centrals are post arousal centrals caused by and OA/hyyponea arousal...we can't fix them with pressure changes. Now if they are post arousal centrals caused by some sort of apnea event..then better preventing the apnea event (OA/hyponea) could reduce the centrals by reducing the arousals.

How is your sleep quality? Do you find you are waking often during the night for whatever reason?
I see at least one break in therapy line on 2 of the 3 reports I viewed...so we know you woke up at least once and turned the machine off and back on again. Do you have more wake ups where you don't turn the machine off?...if so, about how many?

[kasmca]

Thanks for the quick reply Pugsy.

Honestly since I have started my therapy almost a month ago, I have not really seen much difference. I can't say I'm more or less rested when I wake up. I have noticed that I do get up less. I used to get up for a bathroom break 2-4 times a night. I think because of the mask I have been trying to hold off on those bathroom breaks. I think I have reduced my bathroom breaks from 2-4 a night to 1 every other night. If i do wake up for a bathroom break at night, I do turn off the machine, as the rush of wind would wake my wife. I do wake up periodically and not turn off the machine or get up. Usually it's because of a leak and I quickly readjust and go back to sleep.

I wish I could be one of those folks who miraculously have much more energy and better sleep after starting therapy, but unfortunately I can't see or feel much difference.

Good point on the Centrals.

I will change my prescription to 7-12 next and see how that goes.

[Pugsy]

I wish I could be one of those folks who miraculously have much more energy and better sleep after starting therapy, but unfortunately I can't see or feel much difference.

Don't we all
I was and still am in that same boat. It was several months before I had one of those "AHA" days and unfortunately those days have been few and far between.

I think that often there are other contributing causes to not feeling as good as we would like despite maybe having some awesome sleep report numbers.
Plus there's is a lot of truth to the "give it time" thing...and we might as well do it because we don't really have much to choose from.

I don't remember....are you male and if so, of such and age that the old prostate gland could also be a factor in the middle of the night bathroom breaks?
Nocturia is a common symptom of sleep apnea but it would be impossible for the sleep apnea nocturia to get fixed but still have the nocturia from some other cause to remain.
Sleep apnea isn't the only cause of nocturia.

In my case I still have more wake ups than I would like but they are unrelated to sleep apnea...and thus I would have them even if I didn't have OSA. I know that these wake ups play a big factor in how I feel each day along with just how many hours of sleep I got.

So...you have to "give it time" since it's not like you can do anything else but while giving it time you can try to optimize your therapy as best you can.
At some point once you get the OA/hyponea numbers lower...and if you still feel less than what you want to feel you might consider trying a fixed pressure or a really, really tight apap range on the off chance that the changing pressures are impacting sleep quality.
For some people they find that they feel better on a fixed pressure and it wouldn't be impossible for you to be one of them.
But you have time to try that later...there's still a bit of tweaking needing to be done in terms of pressure right now.

[palerider]

I just wanted post and update and get some feedback on how I can lower my AHI's. I have turned of the ramp since my last update. I have also been using the Airfit P10 since Feb 2. I have changed my pressure from 5-10 to 6-11 cm H2O for 19 days now. I think it is better as my 95% sits near the top. I may need to bump up to 7-12. My AHI's are unfortunately trending worse. Last night was 5.96, last week avg 4.04 and last 30 days was 3.23. Leak rates are also averaging worse.

I'd either raise the minimum to 9, maybe 10, or turn off EPR.you pressure is way too low to stop the obstructives with the epr lowering the base pressure so low.

[kasmca]

So I have raised my pressure to 6.8 - 12 range of cm H2O and have been on this range for the past 28 days. I"ve been using the Airfit P10 all this time as well. Unfortunately my numbers are not getting any better. Not much worse but I'd like to consistently get it under 3.0 if I can. Last week's AHI's averaged 4.57, Last 30 days was 4.27 and since Jan 20 (when I started) was 3.70, so I'm trending in the wrong direction. My leaks are also averaging worse. 2.88 last week, 2.66 last 30 days and 1.89 since Jan 20. The good news is that after raising the max pressure to 12, I don't seem to be spending much time at the maximum. Here are my latest charts:

- Summary chart
- March 15 - AHI: 4.63
- March 14 - AHI: 4.40
- March 13 - AHI: 6.31
- March 12 - AHI: 5.78

Any suggestions on how I can get my AHI down? Thanks

[Pugsy]

Looks like half your AHI is central/clear airway...more pressure can't fix it.

I don't know if turning off EPR will help with the centrals or not but you might try it.
Turning off EPR also effectively raises the overall pressure average since the pressure would no longer be dropping during exhale.

[kasmca]

Thanks, I noticed that on average half of my events are CA's. I thought I read that sometimes too much pressure will increase CA's is this correct? Perhaps I may try to go back to my original prescription of 5-10 CM H2O and disable EPR.

[Pugsy]

I thought I read that sometimes too much pressure will increase CA's is this correct?

It can trigger centrals in some people but usually when it does there's a LOT more centrals than you are seeing.
And you would need to try to figure out of the centrals you are seeing are really true centrals and not just sleep/wake/junk centrals.
If cpap pressure is going to trigger centrals it can happen at any pressure and not "higher" pressures where yours doesn't really qualify as higher anyway. I have seen centrals be triggered with as little as 5 or 6 cm.
I doubt very seriously if yours are related to the pressure at all.

Now there is also a very small subset of cpap users who find that using exhale relief which creates a bilevel pressure situation will have bilevel triggering the centrals. Very small subset of people though...very rare but it wouldn't hurt to try turning off EPR.

Turning off EPR removes that one rare potential central causing issue and will effectively increase the overall average pressure just a little bit which might help reduce the OAs and hyponeas a little.

[palerider]

Thanks, I noticed that on average half of my events are CA's. I thought I read that sometimes too much pressure will increase CA's is this correct? Perhaps I may try to go back to my original prescription of 5-10 CM H2O and disable EPR.

some people can have CAs happen when pressure gets too high.

more people have CAs when they're over ventilated by a difference in inhale and exhale pressures, (which is what we're guessing might be happening with you).

just turn off EPR and don't diddle with anything else, your original prescription is too low.

[kasmca]

Thanks again!

I looked more closely at my stats and did notice that actually my Obstructive Index isn't too bad. My Centrals are the ones that are trending up. See here:


I will try just turning off EPR for a week or two and report back. Thanks for all the support!

[kasmca]

It's been less than a week, but I'm pretty sure turning off EPR has worked. My AHI's have dropped in half since turning EPR off. See "Changes to Prescription Settings" below.



- Stats and Changes to Prescription Settings
- March 17 - AHI=1.48
- March 18 - AHI=2.31
- March 19 - AHI=1.26
- March 20 - AHI=1.67
- March 21 - AHI=1.13

The bad news is that today I woke up with a bad case of Aerophagia (see March 21 image above). Never experienced it before. I can't see from the chart comparisons how last night was any different from previous nights. I'm looking for insight from experienced forum members to see why I may have developed Aerophagia last night.

Aside from that I'm very happy with the results since turning off EPR. Do you think setting EPR to 1 (previously it was set to 2) would be a good balance? What about using the APAP setting for Her? Do you think I need to modify my min / max pressures? From last night's chart, I'm not hitting the maximum.

Thanks for all the support!

[Pugsy]

The bad news is that today I woke up with a bad case of Aerophagia (see March 21 image above). Never experienced it before. I can't see from the chart comparisons how last night was any different from previous nights. I'm looking for insight from experienced forum members to see why I may have developed Aerophagia last night

I don't see anything on the reports that screams out "I caused the aerophagia". Your median pressures and the 95% pressures all have been running pretty close to each other.
This may be one of those situations where we simply can't put a finger on the cause. I have had it happen twice in my coming on 9 years of cpap therapy. In both my situations I made a major change in what I was doing. You haven't made a major change but obviously something changed for it to happen. Now what changed...dunno. I don't see anything standing out on the detailed reports.

Aside from that I'm very happy with the results since turning off EPR. Do you think setting EPR to 1 (previously it was set to 2) would be a good balance? What about using the APAP setting for Her? Do you think I need to modify my min / max pressures? From last night's chart, I'm not hitting the maximum.

In terms of the maximum setting...it's really a moot point if you never get there. Doesn't really matter what it is set to if you never go there. The minimum pressure setting is the most critical setting because that's what holds the airway open in the first place.

I think trying EPR of 1 is a good option. See if it helps prevent any aerophagia issues without allowing too many OAs and hyponeas to slip past the defenses. Sometimes that minimum pressure starting point is at the very bottom of the line where the airway is held open the best and giving the pressure a good enough head start when it needs to go higher.
Adding EPR causes that little drop during exhale which could cause a person to have some OAs try to happen if a person is at the bottom margin. If that happens it's easily fixed with just a little more minimum pressure to offset the drop during exhale and it doesn't always have to be a per cm increase.
I would suggest that you try EPR of 1 and just see what happens to the rest of the report...evaluate and then decide if an adjustment needs to be made to offset the drop during exhale. You may or may not need any adjustment to maintain same results.

As for trying the for Her mode...I don't know enough about that mode to give you any idea as to what to expect.
Worth trying at some point in the future though if for no other reason than curiosity. If you do try it be sure to keep the same settings at least to start with that you end up using in regular apap mode. No rush though. Just something to maybe try later and see if anything really changes.

[Tballinusa]

Do you wake up ever with dry mouth? when I used the Dream Wear, my mouth would open at night and give me dry mouth. I had to use a chin strap but have since went to the ResMed Quattro FX, the lightest smallest full face mask and I trade off with the Phiillips Respiraronics Amara View. Those solve my dry mouth problems.