Data review for any Concerns

[SlingerOfZa]

Hello, I've been a big lurker on this board for a bit now and have made an account finally. I have been using CPAP since 2013. I started with a full face mask, then switched to a nasal mask but that really cut my bridge of my nose up, and have just recently as of 10/9/2019 switched to the P30i Nasal Pillow. I really love this thing. 3 days in and my face is no longer BRIGHT red and dry from the silicone. I have data from my past 3 nights and was hoping if any of you veteran board members notice anything out of the ordinary or cause for concern. I haven't had any complaints about sleep quality, as I haven't been bobbing off during work hours since I started on CPAP some years ago. I am no expert on this and I enjoy seeing data, so I figured maybe some others can take a look. Thanks for reading and looking and a big thanks to all you on this board for the all the knowledge.

If you all need more data or anything let me know. I'm just putting this out here to make sure there isn't something concerning showing up.
Machine: ResMed AirSense 10 AutoSet (37028)
Mask: AirFit P30i Nasal Pillow (Standard Headgear/Medium Size Nasal Pillow)

Please note the nights of 10/9 and 10/10 my MIN Pressure was set to 4.00

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10-10-2019.png (93.64 KiB) Viewed 1614 times

After reading this board, Upped MIN Pressure to 8.00 for data below

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[Dog Slobber]

Your minimum pressure is WAY to low as is your maximum pressure.

Your machine almost immediate moves from 5 cm to 8, then then 14 (the max) and stays there for a good portion of the night. Moving to 8 didn't really change much because your spending the night well above 8 anyway. The machine wants to go higher but can't because you've limited it. Your Flow Limitation graph is very active.

I would set the minimum pressure to 12, maybe 13, whatever you're comfortable with and the maximum to 20. You've been on CPAP for for a while and used to the pressure so a few more cm of pressure shouldn't be an issue. If it is, move up gradually.

After a few days of the new pressures, post more graphs and see how you're doing.

[slowriter]

I also wonder: might be helpful to turn on EPR and set it to 3?

[SlingerOfZa]

Your minimum pressure is WAY to low as is your maximum pressure.

Interesting. The RX for my Study in 2018 had set to 14. This was recently confirmed when I went to a fitting about 30 days ago by the DME.

So if I make sense of this the pressure of 14 is not enough to prevent events?

[Pugsy]

We don't sleep the same each night. Some parts of the night you don't need 14 and some parts of the night you need more than 14.
Probably related to sleeping position.....you were probably on your back when you needed more pressure.
Might also be REM related....both REM stage sleep and supine sleeping are well known to worsen OSA and cause the need for more pressure.

If you don't want to increase the maximum at this time....at least increase the minimum. Often when the minimum pressure is more optimal the machine won't need to go to the higher pressures so much.

I am thinking minimum of at least 10...most likely 11 or 12 even.

If you do end up adding in EPR...you will likely need even more minimum because of the drop during exhale.
The minimum pressure is going to be your most critical setting. It has to be high enough to hold the airway open the bulk of the time and close enough to quickly get to what might be needed for special circumstances.
Using EPR drops that minimum during exhale so you might need to compensate for that drop with more minimum.

[SlingerOfZa]

Thanks for everyone for reading and replying. I have done two nights with MIN pressure at 10.0 and MAX at 20.0. Interesting things I've noticed on the graph is 10.0 is still probably too low for my MIN. Feel free to take a look and give me your thoughts. I'm not sure if an average of 2-3 AHI is the going rate for most people on CPAP. Attached are two images. Thank you.

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[Okie bipap]

I would suggest 12 or 13. I keep my minimum high enough to control the flow limits and hypopneas. I seldom go much more than 1 cm over my minimum pressure.

[slowriter]

I would suggest 12 or 13. I keep my minimum high enough to control the flow limits and hypopneas. I seldom go much more than 1 cm over my minimum pressure.

So if OP were to turn EPR on and set it to 3, then min pressure would be 15 or 16.

[Pugsy]

I would suggest 12 or 13. I keep my minimum high enough to control the flow limits and hypopneas. I seldom go much more than 1 cm over my minimum pressure.

So if OP were to turn EPR on and set it to 3, then min pressure would be 15 or 16.

Huh?

No, it doesn't work that way on the AutoSet/Elite models which use EPR.
When EPR is used the drop comes off the minimum pressure setting...doesn't get added to it. EPR gets subtracted from IPAP.

EPR and PS perform essentially the same function but one gets subtracted from IPAP and one gets added to EPAP.

[slowriter]

Right; get temporarily confused between CPAP settings details and bilevel.

Was just wanting to help the OP out if they wanted to try EPR.

[SlingerOfZa]

Hello Everyone. I am once again checking for any feedback you might have regarding the graphs I've attached. More and more recently I seem to be falling asleep about 2-3 hours after after I wake up. I am dozing off during working hours and sometimes in the afternoon. Some mornings my mouth is extremely dry. I do use a chinstrap. From what I've read it seems possible that I am opening my mouth as I have been a mouth breather for as long as I remember. I am thinking about trying the F30i Full Face Mask since I currently have the P30i and it has been the most comfortable mask I've used. If anyone takes a quick and sees anything alarming please feel free to suggest improvements. thank you!

Due to the Limit of 3 attachments, I've created an imgur album with a full 7 days of data: https://imgur.com/a/h5GIoVm

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4-21-2020.png (139.03 KiB) Viewed 1360 times

4-22-2020.png (94.28 KiB) Viewed 1360 times

[Pugsy]

The bulk of your AHI when it is elevated is central apneas or CAs.

Go here and learn how to figure out if those centrals are real or not.
http://freecpapadvice.com/sleepyhead-free-software

How is your sleep quality in general? Waking often or sleeping soundly for the most part?

Do you take any medications? If so, what?

[SlingerOfZa]

The sleep is sound. Only wake up to use the bathroom. I usually sleep through my girlfriend getting up around 5:30 am.

I am on bupropion and Sertraline. I will take a look At that link you posted. Thank you

[Pugsy]

Read up on the side effects of your meds. While maybe not 100% to blame ....they might be playing a part.

https://www.drugs.com/sertraline.html

in part

Common sertraline side effects may include:

drowsiness or tiredness;

insomnia or agitation;

indigestion, nausea, diarrhea, loss of appetite;

sweating;

tremors or shaking;

sleep problems (insomnia); or

decreased sex drive, impotence, or difficulty having an orgasm.

https://www.healthline.com/health/bupropion-oral-tablet

Bupropion is well known to not only cause drowsiness but it messes with sleep quality in general and messes with the sleep stages.


The bulk of your AHI is CA/central....I am betting there is evidence of arousal/awake false positive central flagging going on because you aren't sleeping as soundly as you think. We don't always remember arousals.
We can't fix centrals with the kind of machine you are using even if they were real asleep centrals but I am betting that your meds are a factor. They both are well known to mess with sleep architecture and have some rather nasty daytime symptoms which ends up with us having fatigue issues and/or excessive sleepiness issues. The AHI is a symptom of poor sleep instead being the cause of poor sleep.

[SlingerOfZa]

I will discuss the medications this week as I do have an appointment this week. I will have to see what options are out there. The Meds do make sense, as I take them when I wake up and about that 2-3 hour mark it hits me with the drowsiness.

thanks for the help.