Hi there

[Guitarist]

Usually 2 cups a coffee a day. 1 in the the morning and 1 at 3pm-ish

If it were me, that second cup would be eliminated. It's sometimes surprising how long caffeine has an effect.

If you decide to eliminate it, you might want to go for a few days at one-half cup and then drop it altogether - some get headaches if they don't taper down.

Been thinking of that also. It’s kinda hard when your a medical person. It’s a ritual we all do. When I was younger I’d have ten cups a day. You visit a floor and a pretty Nurse has the coffee pot going and your gonna stop and have a cup and chat ... lol


Also needed to turn off the smart phone a couple hours before I sleep ugh

[Miss Emerita]

Yeah, those kinds of habit changes are tough, though they may pay off big-time. On coffee, if you can get a cup that is half caffeinated and half decaf, then gradually change the proportions over time, that can be a gentle way to get where you want to go.

[Guitarist]

Yeah, those kinds of habit changes are tough, though they may pay off big-time. On coffee, if you can get a cup that is half caffeinated and half decaf, then gradually change the proportions over time, that can be a gentle way to get where you want to go.

Yeah I'm gonna get rid off that 2nd cup today and see how it goes

[Guitarist]

I know it sounds weird but starting at 6 cm and adding 2 cm drop for exhale relief (so 6 inhale and 4 exhale) is actually easier to do than just start 4 cm without the drop for exhale.

So I set my machine to 6cm last night but I just want to make sure I did this right because there's NO exhale setting that I can adjust to 4cm so to speak of on the machine.


What I did was:


1.Set the range to 6-20 cm h20
2. Set the START Pressure to 6 cm h20
3 Set the EPR level to 2

I'm thinking the EPR level to 2 is the "4 exhale" your talking about right ?

6-2 = 4


I took some pics just to show how I set it.







So did I do it right ???



Anywho, I will say that it was much easier to breathe set to 6 like like that and the EPR at 2 so BIG THANK YOU for that.
I don't have any Sleepyhead/ Oscar data to look at from last night because I got up and went to work. Stupid Job. UGH

Wish I had a Clinical manual on this machine. The stuff they give you is kinda basic.


Thanks in advance

[Pugsy]

Here's the online clinical/provider manual.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

Yes, you set it the way I was talking about. Using EPR drops the pressure upon exhale 1 cm per setting...so the setting of 2 is a 2 cm drop....setting of 3 would be a 3 cm drop except it can't drop below 4....so 6 with EPR of 3 still gives you 4 exhale. Now during the night if the pressure moves from 6 to 7 or above then there would be a 3 cm drop upon exhale.

The inhale pressure is called IPAP....exhale pressure called EPAP....and when you use EPR to create the 2 distinct pressures you have created a bilevel or dual pressure function. Most people find that having 2 different pressure for inhale and exhale is simply more comfortable...more natural feeling. A few people don't care for it for whatever reason and don't use any exhale relief and that's fine too. You already have found out that pretty much everything related to cpap comes with a big YMMV sticker.
The only thing that is important is how you feel about something and does it work well for you. If you like it...use it.

I have owned real bilevel machines in the past and I have found that I really like that drop during exhale. Just feels more like natural breathing without fighting against the exhale and it's something I just like. There are some other benefits to a bilevel situation too but the main thing is to get someone comfortable with the breathing so they can fall asleep easily and stay asleep. Limit the wake ups whenever we can because anything that causes wake ups is unwanted.

If you want to see what 3cm drop feels like you would need to set the minimum to 7 and the setting to 3. You may or may not like it but it's something to check out at sometime in the future.

Real bilevel machines will offer more than a 3 cm drop....the difference between IPAP and EPAP is called PS or pressure support.
Using EPR creates PS. So that's why we often say that using EPR creates a poor man's bilevel.

[Guitarist]

Here's the online clinical/provider manual.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

Yes, you set it the way I was talking about. Using EPR drops the pressure upon exhale 1 cm per setting...so the setting of 2 is a 2 cm drop....setting of 3 would be a 3 cm drop except it can't drop below 4....so 6 with EPR of 3 still gives you 4 exhale. Now during the night if the pressure moves from 6 to 7 or above then there would be a 3 cm drop upon exhale.

The inhale pressure is called IPAP....exhale pressure called EPAP....and when you use EPR to create the 2 distinct pressures you have created a bilevel or dual pressure function. Most people find that having 2 different pressure for inhale and exhale is simply more comfortable...more natural feeling. A few people don't care for it for whatever reason and don't use any exhale relief and that's fine too. You already have found out that pretty much everything related to cpap comes with a big YMMV sticker.
The only thing that is important is how you feel about something and does it work well for you. If you like it...use it.

I have owned real bilevel machines in the past and I have found that I really like that drop during exhale. Just feels more like natural breathing without fighting against the exhale and it's something I just like. There are some other benefits to a bilevel situation too but the main thing is to get someone comfortable with the breathing so they can fall asleep easily and stay asleep. Limit the wake ups whenever we can because anything that causes wake ups is unwanted.

If you want to see what 3cm drop feels like you would need to set the minimum to 7 and the setting to 3. You may or may not like it but it's something to check out at sometime in the future.

Real bilevel machines will offer more than a 3 cm drop....the difference between IPAP and EPAP is called PS or pressure support.
Using EPR creates PS. So that's why we often say that using EPR creates a poor man's bilevel.

Cool and thanks for the response.

Interesting that if I set the EPR to 3 I'll only get 2 relief if I'm cruising at 6cm h20 because the machines minimum is 4.
If my pressure goes to say ...10 I'll get a 3 relief

Did I get that right ?



I forgot to mention that the 2 pressures remind me of BiPAP machines that we set at work. IPAP to 15 and EPAP 5 for example. I'm familiar with it but as a Respiratory guy we don't get into it all as detailed as you guys do and I'm thankful for your knowledge.

We usually get a Sleep study report , look at the AHI and the MD recommends the settings and then we set it and bam on to the next thing. Different machines for different people. Some have Respiratory rates , some have pressure support , some are CPAP with just one pressure and some are Bipap's.

Interesting enough that there are so many different type machines that when I have to set them, I almost always have NO manual or paperwork and I have to google it all. 90% of the time I end out in a CPAP forum like this to find out how to do it. It's a crazy world out there ...lol



Big thank you for the clinical manual THANK YOU !!!!

and for looking at how I set it of course

[Guitarist]

and FWIW. I don't have the Sleepy time/ Oscar report to look at YET from last night with the increase to 6cm because I'm at work but .....

I just checked the MYAir app and my AHI was .9

It's normally pretty low @ a 1.5 to 2.0 range and I'm glad about that but that's the 1st time I've ever had it that low

[palerider]

and FWIW. I don't have the Sleepy time/ Oscar report to look at YET from last night with the increase to 6cm because I'm at work but .....

I just checked the MYAir app and my AHI was .9

It's normally pretty low @ a 1.5 to 2.0 range and I'm glad about that but that's the 1st time I've ever had it that low

It's a more effective use of everyone's time, including your own, if you post data first.

[Guitarist]

and FWIW. I don't have the Sleepy time/ Oscar report to look at YET from last night with the increase to 6cm because I'm at work but .....

I just checked the MYAir app and my AHI was .9

It's normally pretty low @ a 1.5 to 2.0 range and I'm glad about that but that's the 1st time I've ever had it that low

It's a more effective use of everyone's time, including your own, if you post data first.

I’m at work so No Can Do posting data. I flew out the door in a hurry this morning and didn’t have the time to get the data


But I’m glad I set the machine right and it was a effective use of my time.

[Guitarist]

Okay Co-Zombies let's see if I did this graph right ?

and thanks in advance for looking !!!

Last nights attempt @ Sleep. The struggle is real


Thoughts ?

[Pugsy]

So why the wake ups? Any special reason? Did you have this fractured sleep prior to starting cpap?

[Guitarist]

So why the wake ups? Any special reason? Did you have this fractured sleep prior to starting cpap?

Yes

I went on Night shift from around 2015-2018. I went back to days about a year and a half ago. Night shift messed me all up.
I never sleep more than 3 hours roughly and its usually 2-3.

FWIW I was having 2 cups coffee a day. For a week now it's 1 cup in the morning.
I'm on NO meds thankfully and otherwise pretty healthy. It's just that dang sleep issue.

[Pugsy]

Ah....I understand better now.

You know that this isn't going to be an easy fix. I was wondering if it was related to your mask or something like that where we could maybe alter things but when the body sleep cycle is messed up....old habits are really hard to break.
It's actually a form of sleep maintenance insomnia but not from the usual culprits.
Have you thought about some form of CBT stuff to see if you can get the old circadian rhythm back to more normal?
Maybe talk to your doctor about the pros and cons of sleep aids to get you better regulated??? OTC or RX maybe?
You already know about taking a hard look at your sleep hygiene to see if there is anything there that needs work.

I doubt seriously if there is anything you can do with the machine settings that might improve things but you could try using more minimum pressure in an effort to stabilize the pressure changes somewhat just in case those wide changes are a factor.
Might be worth trying.
Your flow limitation graph isn't horribly horrible but it is fairly active and assuming you aren't having nasal congestion (which can cause increased flow limitations) more minimum pressure is what we use to deal with FLs.

It is what I would at least try....more minimum...maybe around 8 or 9 and just see if sleep improves any. You don't really need it from the AHI perspective but it might help reduce the FLs and it wouldn't be totally impossible for the FLs to be a factor in the sleep quality issues. It's a long shot but worth trying IMHO.

[Pugsy]

To give you a perspective for FL graphs.
Here's mine from a night last week.
Again...I am not certain that your FLs are a factor in your problem but it wouldn't be totally impossible and thus it is something at least worth trying.

flowlimits.JPG

[Guitarist]

Ah....I understand better now.

1. You know that this isn't going to be an easy fix.



2. I doubt seriously if there is anything you can do with the machine settings that might improve things but you could try using more minimum pressure in an effort to stabilize the pressure changes somewhat just in case those wide changes are a factor.
Might be worth trying.
Your flow limitation graph isn't horribly horrible but it is fairly active and assuming you aren't having nasal congestion (which can cause increased flow limitations) more minimum pressure is what we use to deal with FLs.

It is what I would at least try....more minimum...maybe around 8 or 9 and just see if sleep improves any. You don't really need it from the AHI perspective but it might help reduce the FLs and it wouldn't be totally impossible for the FLs to be a factor in the sleep quality issues. It's a long shot but worth trying IMHO.

Thanks for taking a look

1. Yeah It's a battle but I'm gonna fix it. I'm better than I was a month ago.
No more waking up with headaches that last a hour or 3 is cool
The struggle is real


2. You know, I was thinking the same thing about the pressure.

I will add this:
On this study my Max pressure peaked at 15.54 and it normally is 11-13 range when reviewing 3 weeks of data.
Could be just a 1 night thing ?


So being a newbie at using one of these, if I set it to 8Cm should I leave the EPR at 2 or set it to 3 ?
I know I can always try and see myself but why not ask use guys.

Also, I've gotta gig tonight so I won't be home till 3 am so I'll experiment another night