1 Month on APAP - Very Confused

[jeb1980]

Hi Everyone,

I have been using my APAP machine for a little over a month now. I have a Resmed Airsense 10. It is set to a pressure range of 4-15, EPR 1 full-time, humidity 5. So far, I feel like the treatment has gone pretty well. My AHI when diagnosed was 24, and has been 0.65 over the last 30 days. My average pressure is around 10. I have noticed a significant improvement in how I'm feeling.

My main issue is that I still feel like I wake up quite a bit. One thing I have suspected is that I may be getting congested and waking up when my mouth opens, and air is pushed out. So, I bought a chin strap, and tried that for the first-time last night.

I am super confused by what happened. From the charts (attached), it looks like my pressure went up to the max and just kind of stayed there all night. I also had more RERAs than I've ever had.

I am trying to figure out what this means for my treatment. I had been thinking my minimum pressure needed to be raised, but am concerned there are other issues that I am not seeing. Is it as simple as stop wearing the chin strap? Why would having the chin strap make my charts looks so much different and make my pressure so much higher throughout the night? I also attached a graph from a previous night with no chin strap and would be happy to provide more or zoomed in images if necessary.

My doctor was supposed to call after 2 weeks to talk about fine tuning the pressure settings but has not called themselves or returned my calls. Any and all help is appreciated.

Chart with chin strap: https://imgur.com/a/AvVfupT
Chart without: https://imgur.com/a/ZIelN4F

[Tricky Wash]

Bump

I haven't been here since my time off work at Christmas. Hope everyone is doing well.

[Julie]

You couldn't do your own post for that and not barge into the OP's notes?

[Okie bipap]

Chin straps often push the jaw backwards slightly. I tried several different ones and could never find one I liked. Like a lot of the people here, I use a firm, foam cervical collar to hold my mouth closed. This has the added advantage of keeping my chin up which helps to hold my air passage open.

[Miss Emerita]

In so many ways you're doing great -- congratulations!

Your pressure and RERAs went way up because your flow limitations went way up with the chin strap. That's probably because the strap moved your jaw as Okie bipap has described, which caused your airway to narrow a bit, making you move vulnerable to FLs.

On neither night did you have any leaks at all, which is pretty amazing. You could try a soft cervical collar, or you could just not worry about leaks unless you become convinced they're messing with your sleep.

How would you feel about experimenting with your settings? Given your FLs, I'd be curious how you'd do if you increased your EPR to 2 and your minimum pressure to 6.

[jeb1980]

Thank you so much for your reply. My chart from last night, without the chin strap, is below. Much better, although I still feel a little tired. That could be because I only slept 6hrs tho.

You mentioned my flow limitation, and I am wondering how to gauge that stat. From what I've read, it seems like the lower the flow limitation is the better. But which stat would I use (the med, 95%, or 99.5%) to understand how I'm doing? And my understanding is that when you suggest raising the EPR, that is what helps with flow limitations? And raising the pressure will help with the apneas?

I feel fine experimenting with the settings, I've had treatment resistant hypertension for a minute, so I'm really trying to understand how I can get the most out of the therapy. I have held back from changing them because my respiratory tech basically read me the riot act about touching the clinical menu. They also told me I could *only* install a resmed SD card and I didn't exactly listen to that tho...


https://imgur.com/a/WB8ZeCh

[Pugsy]

Are you experiencing any nasal congestion during the night at all? If you are then the increased activity we see on the FL graph could be from nasal congestion and pressure changes won't help with nasal congestion related FLs. You have to treat the nasal congestion in the more traditional ways we treat nasal congestion.

Now if you aren't experiencing any nasal congestion that we could maybe blame the FLs on then we start looking at little tweaks with the settings to see if the FLs reduce any.

Now...are those FLs bad enough that something SHOULD be done??? Dunno at this point but it is possible that the FLs are disturbing sleep and in that case we could want to try to reduce them but more out of the disturbing sleep thing than anything else. If you were sleeping great and feeling great then not so much of an urgency to go killing FLs....so up to you.
I would increase EPR as my first thought to try to reduce FLs though if it were me.

it seems like the lower the flow limitation is the better. But which stat would I use (the med, 95%, or 99.5%) to understand how I'm doing?

I actually just use my eyeballs to evaluate FLs....more activity isn't good and less activity is better....assuming not related to nasal congestion of course. I don't like to use 90/95% numbers much at all because they are easily skewed and IF (big if) I wanted to be using any sort of statistical number it would be the median/average number. 90/95% number often make things out to be worse than they really are and it's not just FL numbers but leak and pressure numbers as well.

Your FL graph isn't horrible but it is a bit active.
Here below is one of my FL graphs...boring...not much going on but then I have never had FL issues either with or without nasal congestion being involved.



And here is probably one of the worst FL graphs I have ever seen. This person had a lot of nasal congestion going on...allergy season I believe it was.

[jeb1980]

Thank you! That is super helpful, and the examples make it pretty clear to me what I need to be looking out for. I do experience nasal congestion, especially when I am lying down. I may try sleeping on more of an incline, as that has helped in the past.

[Miss Emerita]

As Pugsy says, if the FLs come from your nose, then EPR isn't going to help. Have you tried Flonase? Nasal rinses, like NeilMed? They can help. (Flonase can take a week or two to kick in.)

It's also true that FLs just don't bother some people. For other people, they contribute to daytime sleepiness. When FLs originate further down the airway than the nose, EPR can help. FLs slightly restrict your airway as you inhale. EPR drops pressure a little when you exhale; by the same token, it increases pressure when you inhale, which gives your inhalation a little boost.

I'm still curious how you'd do with EPR of 2 and a min of 6. (Raising the min to 6 compensates for the EPR drop so you don't get more obstructive events when you exhale.) But it's your call whether you want to try it. I would suggest one experiment at a time, so if you're going to try raising the head of your bed, or taking other steps to clear your nose, I'd say do that first and see how it goes. But if you prefer, you could flip things around and try changing your settings first, while leaving the other variables untouched.

[jeb1980]

Thanks! I'm inclined to try the settings changes first as I've never felt my congestion is too bad.

This may not be something anyone on this forum can answer, but can making changes without going through the doctor lead to issues with my compliance as far as my insurance is concerned? My respiratory tech gave me a long talk about the settings and not touching them. When I reached out to the respiratory tech to talk about raising the pressure they said the doctor has to write a new prescription to change any settings....I only care in so far as I don't want my insurance to consider me non complaint.

[ChicagoGranny]

but can making changes without going through the doctor lead to issues with my compliance as far as my insurance is concerned?

No. All they care about is the hours used. They wouldn't know a setting from a hole in the ground.

[chunkyfrog]

Your equipment line at the bottom says you have an Airstart.
I also have an airsense 10, no longer available on the menu.
You need to put your machine in the comment line,
so it will show the correct machine.

[Pugsy]

The ResMed AirSense 10 AutoSet is still a working choice in the equipment section of the user profile.

You just have to scroll down the list of the machines to the "R" section and you will find it there. The list is in alphabetical order.

You don't have the ResMed AirStart 10 which is totally different from the AirSense 10 model.
You might want to correct your equipment profile to avoid confusion later.

[Tricky Wash]

You couldn't do your own post for that and not barge into the OP's notes?

My dear, the OP had been up for 29 hours without a single reply. It was about to slip to the second index page. I bumped it, and almost immediately he received good help.

[jeb1980]

I think I've fixed the machine in my profile, thanks for the heads up.

I did try the settings recommended last night, and my chart (to me) looks pretty similar to other nights. My average pressure is a little higher, but not much. I am going to keep these settings for a bit just to see if they take some time to show any changes. If my charts continue to look the same, should I consider raising the minimum pressure some more? Or maybe focus my attention on addressing nasal congestion?

One quick note, my original post had said the minimum pressure was 4, but it was actually 5. That's why I raised the minimum to 7 instead of 6.

Thanks!

Last night: https://imgur.com/a/eYrNzpx