Newbie to Forum Long Time CPAP user Looking to Improve Therapy

[Frank Drebin]

Why don't you experiment for a night or two with EPR at 2 or 1 - it's really about how you feel and our guesses can't gauge that.

Thanks. I’m thinking I need to keep a written journal of how I feel during the day so I can look for trends.

[Julie]

Good idea!

[zonker]

Why don't you experiment for a night or two with EPR at 2 or 1 - it's really about how you feel and our guesses can't gauge that.

Thanks. I’m thinking I need to keep a written journal of how I feel during the day so I can look for trends.

spot on! it's very hard to make guesses based on something that happened 2 or 3 nights ago. a journal will tell you.

btw, you won't necessarily have aerophagia forever. it may sort itself out eventually.

or you can experiment by raising your minimum the slightest amount and seeing how it goes. if it's bad, dial it back down and try again another night.

good luck!

[Frank Drebin]

Hello. Back again spinning my wheels trying to optimize my therapy. I've been trying to hone in a fixed pressure and have been struggling with being able to keep my flow limits down and using less vs more pressure doesn't seem to be helping. I tried a fixed pressure of 13 w/EPR at 2 for three nights and while that seemed to do the best with my flow limits (still not great but lower) I felt absolutely terrible and didn't get the amount of time in REM and Deep Sleep I usually get (track by Apple Watch).

I'm having trouble trying to figure out if my flow limits are due to a collapsing airway or intolerance to pressure. I tried reducing my pressure to 12.4 for three nights and while my flow limits and AHI went up, I generally felt better than I did when my fixed pressure was at 13 and my time in REM and Deep sleep also increased. I have tried ranges on APAP with setting my minimum at 12 and having it go up to 15, I've noticed that my flow limits will go up when the machine increases the pressure and the flow limit will get better as the machine brings the pressure back down.

I'm trying to decide where to go from here and I'm thinking I should try increasing EPR to three, but I'm not sure where to set my fixed pressure or if I should try an APAP range again. Here are some of my SleepHQ charts for reference:

Third night of fixed pressure at 12.4: https://sleephq.com/public/a274c02e-c15 ... 86b4de0de6

Third night of fixed pressure at 13.0: https://sleephq.com/public/628350e9-04a ... e8e6eae708

Example of night on APAP range of 12-15: https://sleephq.com/public/67c2a2f8-b11 ... ccf059c05b

Thank you for any help or suggestions anyone may have.

[Pugsy]

I've noticed that my flow limits will go up when the machine increases the pressure and the flow limit will get better as the machine brings the pressure back down.

You are mistaken on why the pressure and flow limitations go up and down.

The machine's auto adjusting pressure algorithm is designed to increase the pressure in response to snores, flow limitations, obstructive apneas and hyponeas.

So the machine's increase in the pressure isn't the cause of the flow limitations.....the flow limitations come first and they are causing the machine to increase the pressure.
When you see the pressure reduce then it is because the flow limitations have reduced and higher pressures are no longer needed.

Now as to why or what is causing the flow limitations...dunno exactly but are you having any nasal congestion at all?
Nasal congestion will sometimes show up on the FL graph and the machine will try to kill it with more pressure but if nasal congestion is the culprit more pressure won't help. Nasal congestion needs to be dealt with by using the more traditional nasal congestion relief methods.

[Frank Drebin]

I've noticed that my flow limits will go up when the machine increases the pressure and the flow limit will get better as the machine brings the pressure back down.

You are mistaken on why the pressure and flow limitations go up and down.

The machine's auto adjusting pressure algorithm is designed to increase the pressure in response to snores, flow limitations, obstructive apneas and hyponeas.

So the machine's increase in the pressure isn't the cause of the flow limitations.....the flow limitations come first and they are causing the machine to increase the pressure.
When you see the pressure reduce then it is because the flow limitations have reduced and higher pressures are no longer needed.

Now as to why or what is causing the flow limitations...dunno exactly but are you having any nasal congestion at all?
Nasal congestion will sometimes show up on the FL graph and the machine will try to kill it with more pressure but if nasal congestion is the culprit more pressure won't help. Nasal congestion needs to be dealt with by using the more traditional nasal congestion relief methods.

I am struggling with nasal congestion. I use a neti pot, breathe right strip, and Flonase before bed each night. I am working with an E.N.T. and getting immunotherapy for allergies which I’m hoping will help. Issue is the doc told me it will like be about a year before the immunotherapy starts showing improvements with my allergies.

Congestion makes sense why the machine wants to increase the pressure. Problem is finding where the pressure gets too high for me.

[Pugsy]

You can't fix nasal congestion with more pressure. Just not going to happen.

What is it you are wanting to do?
Just get prettier graphs and numbers or sleep better and feel better?
Do you feel the need to improve on sleep quality or how you feel during the day?

What happens when the "pressure gets too high"?

[Frank Drebin]

You can't fix nasal congestion with more pressure. Just not going to happen.

What is it you are wanting to do?
Just get prettier graphs and numbers or sleep better and feel better?
Do you feel the need to improve on sleep quality or how you feel during the day?

What happens when the "pressure gets too high"?

I would like to try and improve my sleep quality. I’m not concerned about pretty graphs and my AHI, I just want to get the best quality sleep I can. Too high seems to be somewhere between 13-14 for me as that when I tend to get some aerophagia. I’ve been using my Apple Watch to gauge my sleep stages. When I get into the 13s my rem sleep seems to go down as does my deep.

[Pugsy]

Too high seems to be somewhere between 13-14 for me as that when I tend to get some aerophagia.

You might consider trying fixed 13 or 14 with EPR set to 3 and see how that does both with sleep quality and the flow limitation situation. Flow limitations could potentially be impacting sleep quality and while we might want to blame nasal congestion for the FLs. They may or may not be totally related to the nasal congestion and EPR at 3 might help a little bit and it shouldn't cause a lot of aerophagia if you use EPR at 3 because upon exhale the pressure gets reduced by 3 cm.

Something to try just to see if it helps or hurts the situation.

When asking for ideas or advice....always mention that you get aerophagia at higher pressures. Otherwise you are going to get all sorts of advice to use auto adjusting mode and let the machine fight what it wants to fight but in your situation the "fighting" could open the door for the aerophagia monster to come for a visit.

[Frank Drebin]

Too high seems to be somewhere between 13-14 for me as that when I tend to get some aerophagia.

You might consider trying fixed 13 or 14 with EPR set to 3 and see how that does both with sleep quality and the flow limitation situation. Flow limitations could potentially be impacting sleep quality and while we might want to blame nasal congestion for the FLs. They may or may not be totally related to the nasal congestion and EPR at 3 might help a little bit and it shouldn't cause a lot of aerophagia if you use EPR at 3 because upon exhale the pressure gets reduced by 3 cm.

Something to try just to see if it helps or hurts the situation.

When asking for ideas or advice....always mention that you get aerophagia at higher pressures. Otherwise you are going to get all sorts of advice to use auto adjusting mode and let the machine fight what it wants to fight but in your situation the "fighting" could open the door for the aerophagia monster to come for a visit.

Thank you. I will give 13 a try on epr 3 to see how it goes.