Advice requested, is my pressure too low?

[lilasmom]

I'm adding my screen shots for advice please. I'm not feeling better yet and am concerned my pressure is set too low. I wear my mask for awhile before falling asleep and think my AHI number isn't really accurate. What can you infer from my last two nights of sleep? Thank you!

[Pugsy]

You've done a lot of work posting graphs that we don't really need and omitted some graphs we need and it helps if we have just the graphs we like to see in one image.

See this thread for examples of which graphs...
viewtopic/t103468/Need-help-with-screen-shots.html
I like these on the right (along with what you have included on the left)
Events
Flow rate
Leak
Flow limitation

In your case we don't really need the pressure graph because you are using the Elite which only offers fixed pressure and your pressure isn't going to vary so no real need to see it.
You can turn off the unneeded graphs like the AHI and mask pressure graphs by clicking on the little green block in the lower right corner of your daily page...it will expand so that you can change from green to red those unneeded graphs and allow Events...flow rate...leak and flow limitation to easily show in one screen shot.

Looks like you are using 12 cm pressure with EPR set to 3 which means a reduction during exhale to 9 cm.
It's possible that during that reduction the airway is trying to collapse a little and that is why your hyponea count is a bit high.
Your flow limitation and snore graphs show a lot of activity.

So yes...you likely need a little more pressure...how much we don't know but you have 2 ways to get more pressure....either reduce EPR or just set the pressure setting from 12 to maybe 13 and leave EPR alone.

I normally would suggest a small increment change but from the looks of your snore graph and flow limitation graphs I think 1 cm (maybe more) is going to be needed.

Oh...one other hint...when posting images on imgur if you will follow these steps the image will be smaller with a clickable link for us to enlarge it if we need to and won't be so huge that we have to "view image" to see the right side.

Upload your image and before copying the address line
1..click on the "large thumbnail" thing at the bottom of the address box
2..then copy the LAST line in the box with all the addresses on it
3..then paste that copied address into the body of your text here.

Once you do that the end result is an image that is smaller but can be clicked on to enlarge if we need to enlarge it but often we can see what we need to see without having to click on it.
Doing it this way makes it easy to review while composing.

[lilasmom]

Thanks! I'm learning... How about these? Same two days, added two more.

[Pugsy]

Thank you, that makes for quick easy evaluation.
My thoughts still stand. More pressure to better hold the airway open and prevent the airway from collapsing or trying to collapse.

Looks like your sleep is still fragmented...do you wake often during the night? If so, any idea why?
When I see some breaks in therapy where we know a person turns the machine off and then back on I can't help but wonder how many other awakenings might be happening where the machine doesn't get turned off.

I also don't know all your history or why you are looking at your reports but I assume that you aren't feeling as good as you would like to feel.
While this AHI isn't horribly horrible...it is a bit higher than we would like to see and if we add in the known awake times where the machine was turned off...and the snore and FL graph...all that points to perhaps not feeling so good or sleeping so good and while I don't know if improving the AHI and snores and FLs will guarantee feeling better or sleeping better....it is a place to start because it could stand for some improvement.

Worth trying anyway...might help.

[lilasmom]

Thank you. Yes, I'm not feeling better after 16 straight nights of cpap use, I'm feeling worse. This feeling is why I normally quit my cpap. Let's face it, if your untreated you're very tired and to then get treatment and feel worse, it's too much. But, I'm back on it and more than likely going to have nasal surgery next month to help me. I'm going to have a Septoplasty, turbinate reduction and a nasal aral suspension. I hope that allows me to use a nasal mask or at least help me with my face mask. I'm claustrophobic and tend to take my mask off during the night. I wake up later, realize it's off and put it back on trying to get to at least 5 hours a night. I'm also awakened and go to the restroom probably three times a night. At first I was turning off my machine during these breaks, but now I just take off my mask, come back and put it back on. My sleep therapist told me I would feel worse for awhile, that I need to rebuild my REM. I'm concerned now that though if I'm wearing my mask for an hour, awake watching tv trying to get comfortable in it and my AHI is 4 or 6, I think it's much higher really and my levels aren't correct. I'm going to go up to 13 tonight and see if that helps. Thank you so much!

[Pugsy]

Some of your snores or FLs could be related to nasal issues....I don't know if more pressure will fix those issues if they are related to structural problems in the nose but if they are related to airway (just down below the nasal passageway) trying to collapse then more pressure should help.
Worth trying for sure.

Did you try a nasal interface mask (pillows or cushion) and change to FFM because of a lot of mouth breathing due to nasal congestion issues?

[Pugsy]

IMHO...looking at your snore and FL graphs...you see the first part of the night with not much going on and then later things get really ugly. I think that when things are ugly you are asleep and that points to the issue being more in the airway and not in just the nose...if the snores and FLs seemed to be from nasal issues then I would think you would see them all night long and not for just part of the night.

Part of it may be sleeping position...part of it might be related to REM sleep or maybe a little of both.
It's common for OSA to be worse or need more pressure in either situation.

[lilasmom]

Yes, I tried nasal during my appointment and couldn't breathe well enough. I'm optimistic about surgery, even if I can't get off the full face mask I'm sure it will help me breathe better, even when awake!

[Lucyhere]

Yes, I'm not feeling better after 16 straight nights of cpap use, I'm feeling worse. This feeling is why I normally quit my cpap. Let's face it, if your untreated you're very tired and to then get treatment and feel worse, it's too much. But, I'm back on it and more than likely going to have nasal surgery next month to help me. I'm going to have a Septoplasty, turbinate reduction and a nasal aral suspension.

Just wanted to say that the surgery you are considering doesn't seem to be the be all, end all for many people. I hope you are getting a few opinions, and doing a search here may be of some help. Good luck with whatever you decide is right for you.

[lilasmom]

Lucyhere, thanks. My expectations aren't that I'll be off cpap. But, I believe that breathing better through my nose will help my claustrophobia issues. I think my answer will come together in pieces, the right pressure- the best mask/nasal for me. I'm just going to keep trying until I can't anymore or it doesn't feel like trying. Thank you everyone, I really appreciate all your help.

[Wulfman...]

Lucyhere, thanks. My expectations aren't that I'll be off cpap. But, I believe that breathing better through my nose will help my claustrophobia issues. I think my answer will come together in pieces, the right pressure- the best mask/nasal for me. I'm just going to keep trying until I can't anymore or it doesn't feel like trying. Thank you everyone, I really appreciate all your help.

Having been a mouth-breather all my life, it wasn't until I got into my CPAP therapy that I finally managed to breathe consistently through my nose. Even though I've never been to an ENT, I've had suspicions that I had enlarged turbinates, deviated septum and maybe some mild allergies. What I did was to turn off my heated humidity, using (cool) "passover" and came up with a nasal cleansing routine that has helped keep my nasal passages open and really helped my therapy and avoid surgery.


Den

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