cpap has made my situation worse. now what?

[PhotoWolf]

Reviving this thread rather than start a new one...

Fine.
But that's no reason for you to come back with the same settings you had when the thread started.

?? I didn't. I've changed the settings as I was advised to: minimum of 6, maximum of 10. Before it was 4 and 10.

[ozij]

?? I didn't. I've changed the settings as I was advised to: minimum of 6, maximum of 10. Before it was 4 and 10.

You did. I was so impressed by your snoring and flow limitations seeing the machine reporting a minimum of 4 that I only saw that you did nothing with the ramp, despite three people suggesting you do not leave it at 4 for 45 minutes.

In your new settings, you raised the minimum pressure to 6, but by raising EPR from 2 to 3 you caused you exhale pressure to be lower. In other words, even when your inhale pressure goes up to 7, you drop to 4 when you exhale. And 4 is too low and seems to have exacerbated both the snoring and the flow limitations. The machine isn't responding quickly enough when your breathing switches from exhaling to inhaling.

Yes, it was a respected forum member who recommended raising your EPR from 2 to 3. I'd say your trial shows that doesn't work in your case. First thing I'd do if this was my data is take EPR to 2, so that your exhale pressure isn't that much lower that your inhale pressure.

[lynninnj]

Reviving this thread rather than start a new one...

Fine.
But that's no reason for you to come back with the same settings you had when the thread started.

?? I didn't. I've changed the settings as I was advised to: minimum of 6, maximum of 10. Before it was 4 and 10.

I noticed too that settings were same.

I prefer a short five minute ramp as it gives me a few to settle in and then it goes right to treatment.

One other thing I noticed was your comment about congestion. Does a hot shower clear you out a bit? Just asking because I see you have humidity set at 4 I think but can’t tell if you have a heated hose to carry the moisture to your nose. I wager this would help you TREMENDOUSLY. I keep mine (just as reference point) humidity 3 temp 78.

Getting heated tube would probably help with flow limits caused by mucous esp if you live where trees are dropping pollen like crazy!

hth and hope you will keep us posted.

[lynninnj]

Reviving this thread rather than start a new one...

I didn't even try to use the cpap for most of March -- cataract surgery on both eyes, two weeks apart, was so high stress that also trying to use the machine was out of the question. I have been trying to use it for the last couple of weeks, but without much better results. Some nights I manage three or four hours with the mask on, other nights I can't get to sleep with it at all. The night recorded here is more or less typical of the first type: https://sleephq.com/public/8e1a58f1-8fc ... c5336570e5

All I can tell from that is that I'm still apparently having apneic events. Increasing the maximum pressure might help, but on the other hand I know I can't tolerate much more. I got to 15cm the night of the sleep study, and it was like having a ten or twelve-knot wind blowing down my throat nonstop. Even if I can fall asleep like that, choking on my own breath while I'm asleep does not sound like fun. The machine is stupid enough to read that as an apneic event and increase the pressure even more, and then where will I be?

BTW you should have the SMART START turned on! maybe that’s why you aren’t getting air!

[PhotoWolf]

?? I didn't. I've changed the settings as I was advised to: minimum of 6, maximum of 10. Before it was 4 and 10.

You did. I was so impressed by your snoring and flow limitations seeing the machine reporting a minimum of 4 that I only saw that you did nothing with the ramp, despite three people suggesting you do not leave it at 4 for 45 minutes.

When I am experimenting, I try to change only one parameter at a time. Since I posted that, I have tried changing the ramp setting. I spent several nights with it on Auto, and then last night I turned it off completely. Neither change made any difference. I still wake up about two hours after falling asleep, with the pressure at 10 and feeling like I just swam forty or fifty yards underwater. I have to take off the mask and blast the air out of my lungs the way you do when you've been holding your breath, just to get rid of the stale air and breathe in fresh air. I can't imagine that higher pressure is going to do me any good; higher continuous pressure will only make it even harder to breathe out.

[robysue1]

When I am experimenting, I try to change only one parameter at a time. Since I posted that, I have tried changing the ramp setting. I spent several nights with it on Auto, and then last night I turned it off completely. Neither change made any difference. I still wake up about two hours after falling asleep, with the pressure at 10 and feeling like I just swam forty or fifty yards underwater. I have to take off the mask and blast the air out of my lungs the way you do when you've been holding your breath, just to get rid of the stale air and breathe in fresh air. I can't imagine that higher pressure is going to do me any good; higher continuous pressure will only make it even harder to breathe out.

Your comment that it feels like you have to "blast the air out of your lungs" makes it sound like you've got the problem of feeling like the machine is forcing so much air down your throat that you can't get a good, satisfying exhalation until after you take the mask off. And you're right: A higher continuous pressure may very well make that problem worse.

Given that and some of the things you said earlier in this thread, I think that it may be time to focus on learning how to sleep with the machine, or more accurately learning how to get back to sleep with the machine once you wake up. Since you're experiencing problems with being able to get good satisfying exhalations, I think you are right: Increasing the pressure (to address the snoring and flow limitations) may be counterproductive since it could make in even harder to breathe out, and that would leave you feeling even more frustrated with the feeling that you have to "blast the air out of your lungs" when you wake up.

So it may be time to just not worry about less than optimal therapy in terms of the AHI and the amount of snoring and the amount of flow limitations. Rather, start focusing on what increases the comfort of breathing when you wake up a couple of hours after falling asleep. Have you tried setting the max pressure lower than 10cm? And are you still using EPR? If so, is EPR set to 2 or 3? (Also, since you earlier commented about feeling like sleeping in a swamp, have you turned the humidifier down?)

So it may be worth your while to try the following settings for a few days:

No ramp
MIN pressure 5 or 6 cm (if you are comfortable breathing at 6cm, use that for your min pressure)
MAX pressure 9 cm
EPR = 3. (Or keep EPR = 2 if you want)

Try using these settings for several nights and see what happens, both in terms of how you feel when you wake up after a couple of hours sleeping with the machine and in terms of the data.

And when looking at your data, focus more on whether you're seeing reasonably long stretches of decent quality sleep breathing at least once or twice during the night rather than just looking at the AHI, snoring, and flow limitations. (And remember: Given your chronic sinus issues, some of your "flow limitations" might not even be indicative of an upper airway threatening to collapse---they may just indicate that your nasal congestion is bad enough to trigger sniffing that winds up resembling flow limited breathing.)