Need Feedback on my CPAP Pressure

[Hexus]

Hello all! I have been on CPAP therapy for almost a year now. It has been going great. Much better than pre CPAP therapy but I still wake up tired, groggy many times and get aerophagia bad when I up my pressure the higher above 10 cm. If anyone can give me some feedback on my sleepyhead reports that would be much appreciated.

I have been running very consistently at 8-10cm pressure range for a bit now but I tried to up the higher pressure to 12 cm last night. I looked at my report and saw an AHI value around 1.0 which is lower than what I usually get of 2.5-4.0 AHI. It might be a coincidence. Might not. So I have posted the reports for you all to analyze.

THANKS!

[katestyles]

Wiser heads than mine will be along to respond, but I think you have already begun to answer your own question. Higher pressure will help reduce the number of OA events.

[Hexus]

Yes, that is what it seems to be. The problem is the more I go above 10cm in pressure the aerophagia gets worse. I woke up today with a bloated stomach and incessant and strong enough farts and burps to rip through the fabric of the space-time continuum and of course the fabric of my bed sheets.

I wonder if I need a different type of machine?

[palerider]

Yes, that is what it seems to be. The problem is the more I go above 10cm in pressure the aerophagia gets worse. I woke up today with a bloated stomach and incessant and strong enough farts and burps to rip through the fabric of the space-time continuum and of course the fabric of my bed sheets.

I wonder if I need a different type of machine?

Clearly, you need more pressure to alleviate the breathing events, but, aerophagia... so you have to do a balancing act.

A different type of machine *may* help, so let's try, you don't have any pressure relief set up...

Pressure relief drops the pressure when you exhale, which may help with the bloating... however, since you're right on the edge of having too little pressure at 12... we don't want to drop it much, without raising your max pressure.

How about setting EPR to 2, and max pressure to 13? (that'll give you an effective pressure of 11 when not inhaling).

[Hexus]

Yes, that is what it seems to be. The problem is the more I go above 10cm in pressure the aerophagia gets worse. I woke up today with a bloated stomach and incessant and strong enough farts and burps to rip through the fabric of the space-time continuum and of course the fabric of my bed sheets.

I wonder if I need a different type of machine?

Clearly, you need more pressure to alleviate the breathing events, but, aerophagia... so you have to do a balancing act.

A different type of machine *may* help, so let's try, you don't have any pressure relief set up...

Pressure relief drops the pressure when you exhale, which may help with the bloating... however, since you're right on the edge of having too little pressure at 12... we don't want to drop it much, without raising your max pressure.

How about setting EPR to 2, and max pressure to 13? (that'll give you an effective pressure of 11 when not inhaling).

This sounds great! I will try that max pressure with EPR set to 2.

Some questions: I was diagnosed with mild UARS and very mild to mild obstructive sleep apnea. Why is it that sleepyhead is registering central events when my sleep study said I had zero?

Also, upping the pressure to 12 cm from 10 cm eliminated a lot of central events. Is that coincidence or does greater pressure alleviate central events? I believe I have noticed my centrals decrease with a higher pressure.

[palerider]

Some questions: I was diagnosed with mild UARS and very mild to mild obstructive sleep apnea. Why is it that sleepyhead is registering central events when my sleep study said I had zero?

sleep studies aren't perfect, sleep varies from night to night, and that's not even getting into the question of whether they're actual central sleep apneas, or central post-arousal apneas (which would be ignored on a sleep study score).

Also, upping the pressure to 12 cm from 10 cm eliminated a lot of central events. Is that coincidence or does greater pressure alleviate central events? I believe I have noticed my centrals decrease with a higher pressure.

I wouldn't call it 'coincidence', more a 'side effect'... the pressure doesn't alleviate centrals, but the extra pressure can keep you from waking up as much from the obstructive events, which would result in better sleep, which should result in fewer post arousal centrals.

a post arousal central is where something *else* disturbs your sleep... and you may take a couple deep breaths, or turn over, and in doing so, you just don't breathe for a bit... and if that 'little bit' hits 10 seconds, you get a central scored, the machine doesn't know you were roused by something, it just knows you stopped breathing.

[Hexus]

Thanks Palerider!

Here are my results from last night. I had a grouping of centrals in the latter part most of them around 14-20 seconds long. My sleep was not good last night as you can see. I have trigger finger and soreness all over my body from manual labor. My body was not made for hard manual labor much to my chagrin.

[palerider]

Thanks Palerider!

Here are my results from last night. I had a grouping of centrals in the latter part most of them around 14-20 seconds long. My sleep was not good last night as you can see. I have trigger finger and soreness all over my body from manual labor. My body was not made for hard manual labor much to my chagrin.

How was the aerophagia? Your AHI wasn't great, but it wasn't bad. With the manual labor factored in, we can't read a lot into the sleep data because of it.

I do like the fact that you weren't pegged at the max pressure all night long.

[Hexus]

How was the aerophagia? Your AHI wasn't great, but it wasn't bad. With the manual labor factored in, we can't read a lot into the sleep data because of it.

I do like the fact that you weren't pegged at the max pressure all night long.

My aerophagia was much much better! Minor symptoms of aerophagia but nothing too bad

I do notice that my pressure was not maxed like it was for the past month+ at 8-10 cm pressure. I am going to do another run with the same settings tonight. Btw the centrals are nothing new if I did not clarify. Last night they were 10-20 seconds and sometimes I have had centrals up to 30-35 seconds. So what I am trying to say is the increase pressure and EPR mode seemingly did not make centrals worse in quantity or duration. Which is a good sign. It is only one data point so I need to do the same test run again tonight.

Thanks again.

[palerider]

How was the aerophagia? Your AHI wasn't great, but it wasn't bad. With the manual labor factored in, we can't read a lot into the sleep data because of it.

I do like the fact that you weren't pegged at the max pressure all night long.

My aerophagia was much much better! Minor symptoms of aerophagia but nothing too bad

I do notice that my pressure was not maxed like it was for the past month+ at 8-10 cm pressure. I am going to do another run with the same settings tonight. Btw the centrals are nothing new if I did not clarify. Last night they were 10-20 seconds and sometimes I have had centrals up to 30-35 seconds. So what I am trying to say is the increase pressure and EPR mode seemingly did not make centrals worse in quantity or duration. Which is a good sign. It is only one data point so I need to do the same test run again tonight.

Thanks again.

Centrals are unfairly vilified.. a few of them here and there are completely insignificant, the only time they're an issue is when they start happening in large numbers or a lot of them in clusters... common theme, "a lot". Add to that the fact that many centrals the machine flags may not be legitimate sleep centrals, pausing your breathing when your sleep is disturbed, or transitioning in and out of wakefulness is common, and normal, and would not be counted as a sleep central on a test... so, I ignore small numbers of centrals.... they're not stressful to your body like fighting to breathe is.

I'm torn between saying "keep things like they are for a few nights" and "let's try an EPR of 3, and a max pressure of 14" ... the 'instant gratification' part of me wants that EPR of 3, but I also know you shouldn't base any changes on a single nights sleep, since sleep varies so much based on so many other factors.

I'd say, let's see what tonight and maybe tomorrow night bring, and then maybe bump up the EPR.

In case I didn't explain earlier, the EPR can help with aerophagia, since you've got lower pressure at times, instead of that constant all the time trying to force air in thing... Yeah, someone else can probably explain it better

[Hexus]

I'm torn between saying "keep things like they are for a few nights" and "let's try an EPR of 3, and a max pressure of 14" ... the 'instant gratification' part of me wants that EPR of 3, but I also know you shouldn't base any changes on a single nights sleep, since sleep varies so much based on so many other factors.

I'd say, let's see what tonight and maybe tomorrow night bring, and then maybe bump up the EPR.

This sounds just like me! I also want that instant gratification by setting EPR to 3 and max pressure to 14 cm h2o. I do have a feeling that in the end I may end up there. Alas, I will see how everything goes tonight and maybe (if I can handle not changing around my settings in hopes of instant gratification) a 3rd day at these settings.

Other than that, I been around reddit a lot perusing the subreddit for sleep apnea and this genius dude Diamaunt on the forums there along with some others explained those other things concerning EPR and centrals. So thank you for the explanations anyways. I'm sure someone else will be benefited!

[palerider]

Other than that, I been around reddit a lot perusing the subreddit for sleep apnea and this genius dude Diamaunt

Only low grade genius, barely qualified for mensa...

on the forums there along with some others explained those other things concerning EPR and centrals. So thank you for the explanations anyways. I'm sure someone else will be benefited!

Well, I hope so, I don't type all that stuff just to get exercise for my fingers

[Hexus]

Only low grade genius, barely qualified for mensa...

I got into mensa...in a dream

Well, I hope so, I don't type all that stuff just to get exercise for my fingers

Oh I must have been doing it wrong this whole time then. It is helping my trigger finger injury by moving it around though!

Other than that, I have my second day's results using the same pressure and epr setting. I woke up again with minor aerophagia and a bit groggy and tired. I am not sure if the grogginess is just due to fragmented sleep or what. All the "centrals" you see are all 10-16 seconds in length. I also am not toplined the whole night at max pressure.

What say you at this point?

[palerider]

What say you at this point?

The centrals are likely 'post arousal' since your sleep wasn't great... they're low enough to ignore, and your obstructives are pretty good. See how things go tonight.

[Hexus]

I am not saying I am going to change the settings tonight but when I do are there any significant drawbacks on tweaking my range settings to 10-14 cm h20 and set EPR mode to 3? Obviously I may or may not have worsened aerophagia, increased centrals (according to some epr mode may increase centrals), etc. Other than that though am I missing anything by upping my settings?

I REALLY want to kick morning grogginess and tiredness out of my life. I do believe it is sleep related too because my nutrition, weight and blood work is fine. I also went gluten free because gluten was messing me up. I apologize if it is TMI. I'm just trying to provide some ideas to see if my morning tiredness is due to my sleep in some way or another.