Weekly Status

[MyIdaho]

For the last 73 days I've used apap mode with a 15 to 18 range. If I tried cpap, what pressure would you recommend, use 17 (median) or even go up to 18? Leaks are well controlled and I actually spend alot of night very close to 18 already..

Are you still using EPR set at 2? If so, that is allowing whatever pressure is being delivered at the time to drop by 2 cm and it may be quite enough to not do such a great job at preventing the flow limitations. The flow limitations may or may not be the reason for sometimes not feeling so great but it sure wouldn't hurt anything to try to reduce them to see if it helps or not.
Using a higher pressure in cpap mode (near your 95% pressure) and EPR of 2 would allow for a little more higher and consistent pressure overall in hopes of maybe preventing those flow limitations a little better.
Either that or use APAP mode with minimum a little higher and maximum a little higher since your 95% pressure is pretty much right at your maximum and that means you are very likely spending quite a bit of time at the maximum or very near it.

Some people happen to have their pressure set so close to what is needed full time that the reduction in pressure that EPR affords drops the pressure enough to allow FLs to happen and/or apnea events.
Sometimes we suggest to people that they turn off EPR and see what happens but I wouldn't want to do that if it were me and I was looking at 17 or 18 cm pressure...talk about a hurricane.

So yeah, either straight cpap mode at 17 cm with EPR of 2 or 3 or apap mode with an increase in minimum to say 16.5 or 17 and maximum of 20 and keeping EPR at 2 or 3...might as well open it up to 20 and see what happens if you aren't having any problems with the higher pressures if they happen.
Sometimes if the minimum pressure does a more effective job the maximum doesn't fluctuate quite so much.

Flow limitations are something the machine when in APAP mode will normally try to "fix" with more pressure.
If you look at your graphs you may see a correlation between times of those really high FLs and pressure increases.

I haven't made any changes yet as it is still a few hours till my usual bedtime... I had been debating whether to return to cpap mode at a higher pressure or adjust the upper limit in apap mode. I think I'll start by opening it up to 20 cmH20 for a couple nights and see what happens. I'll post results in a new thread later this week. Thanks!

[Pugsy]

I think I'll start by opening it up to 20 cmH20 for a couple nights and see what happens. I'll post results in a new thread later this week. Thanks!

I don't think you will see much of a reduction in the FLs with just the increase in the maximum but you might.
I think that the minimum pressure is likely the critical setting in this situation.

[MyIdaho]

I think I'll start by opening it up to 20 cmH20 for a couple nights and see what happens. I'll post results in a new thread later this week. Thanks!

I don't think you will see much of a reduction in the FLs with just the increase in the maximum but you might.
I think that the minimum pressure is likely the critical setting in this situation.

Okay, I'll use a minimum of 17 (which is slightly above median pressure now) and set max at 20 cm. That'll do it. Thanks Pugsy!

[sleepstar]

I think I'll start by opening it up to 20 cmH20 for a couple nights and see what happens. I'll post results in a new thread later this week. Thanks!

I don't think you will see much of a reduction in the FLs with just the increase in the maximum but you might.
I think that the minimum pressure is likely the critical setting in this situation.

I agree. I think it's the minimum pressure you might want to try tackling.

[khauser]

I've posted the flow limitation graphs from the last few nights. I have not seen anyone else's FL graphs and was wondering how ours compare.

Here is an example of what my FL graph looks like from my S9 VPAP. This is the way mine look 99.9% of the time.

Hmmm, yours are much nicer than mine.... Wanna trade? Sorry. My pressure range is set between 15 and 18 cmH2O. The median is usually 16.5 to 17.2 and 95% is 17.9 cmH2O. Should I consider increasing the pressure? I never have any reported centrals on Rescan and my AHI is usually between 0.5 and 1.5 events/hr. I generally sleep pretty well with 50 to 60% of my sleep time as deep sleep (as measured with Motion X sleep, app uses the accelerometer in my Gen 5 Ipod). I do still have days where I get tired in the morning even though I get 7.5 to 8 hrs of sleep during the work week. Thanks for any advice Dr Pugsy!

Your AHI is great.
If you're still a bit tired though, have you ever set your machine in fixed pressure mode?
I find it can sometimes be more effective than auto set. Especially on high pressures.

I'm not sure if you're addressing this to me or MyIdaho. I do have some snow detection but it's heading in the right direction. I'm edging up the minimum pressure gradually. At the rate I'm going it will be CPAP only unless I get me one of those fancy bipap machines, because I'm darn close to the machine's max.

[khauser]

I haven't posted graphs for the last two weeks, and probably won't post any more, BUT:

Since bringing the bottom pressure up close to my 90% pressure and opening the top to 20, I've had reduced AHI, and more importantly ZERO snoring. Haven't seen VS or VS2 events for over a week now.

I am sleeping heavier ... WAY heavier, and though I am finding it hard to wake up, I feel very refreshed once I do. I am hopeful that the difficulty waking up will resolve with time, and that maybe I'll need less sleep (I still seem to need over 9 hours).

Very pleased with my progress!!

Oh, and I ordered two new masks yesterday: Sleepweaver Elan and Tap Pap. Soon it will be time to PLAY! LOL

[Pugsy]

Since bringing the bottom pressure up close to my 90% pressure and opening the top to 20, I've had reduced AHI, and more importantly ZERO snoring. Haven't seen VS or VS2 events for over a week now.

I suspect the snores were a mild disruption to your overall sleep quality. They probably causes some little mini low level arousals that you probably didn't realize they were happening. Not enough of a reduction in flow to warrant the other event category classifications but enough to impact sleep quality. That's why we like to limit the numbers of snores even if the AHI itself is already within acceptable limits...just in case those snores are a potential cause of some little mini arousals.

FWIW...I still have a bit of a difficulty "waking up" in the sense that my eyes pop open and I am immediately ready to face the world. It just doesn't happen for me...actually never has. Not even back when I didn't have OSA.
Some of it may be related to what sleep stage we arouse from. It's really hard to regulate that aspect of sleep and waking.
Like waking up during the deeper stages of sleep vs waking up in the lighter stages of sleep.
This little possible wrinkle in things is likely going to be more of an issue when we take any type of meds for pain control.
Even something as simple as Tylenol PM...and the PM part being a drug that can make us drowsy and give us a bit of that morning hangover thing.

So some of my "morning hangover" is likely due to the meds I take but it isn't all related to them. I have never ever been a morning person and it is doubtful I ever will.
I am not one of those people who is likely to have had OSA all their life. I am pretty sure mine started around 2005 or 2006 along with menopause rearing its ugly head a couple of years earlier. Hubby says I never snored or stopped breathing in my sleep till around 2005/06 and that is when he started ragging my butt about getting something done about it. He is a truck driver and even back then it was discussed a lot by truck drivers.