Newb - Upper Pressure forcing me awake

Hi,

Apologies if this is answered/advised elsewhere but I cannot find/know the right terminology.

I had a number of sleep studies at home (failed) and at the clinic. The ones at the clinic had been stressful, I snore (loudly, forced me out of my wife bed!!), I am overweight, but I have never had trouble falling or staying asleep if I can get into my "position". Side sleeper. The study itself forced me out of my natural position and placed probes up my nose so I felt like I was not comfortable. Either way, I was diagnosed with a 17ahi?

I obtained a CPAP machine, I did some googles prior to picking it up and went for the Philips Respironics DreamWear Full Face CPAP Mask with Headgear as I read it supported side sleeper and I liked the idea of the top head connector so I can turn left to right if need be, and to be honest I am a bit of a mouth breather (small nostrils)

I have had the unit just over a week now, I think I put the mask on too tight a few times, but overall, everything seems to be going well, I can fall asleep fine. My AHI is 0? My throat and chest are a little sore but I chalked that up to adjusting.

Sounds great huh ? So my question resolves around waking up, unless I needed to urinate, I would sleep through the night, now I am waking up 4-5 times a night due to "Pressure" overload it feels like, my mask cushions sounds like its flapping about, my cheeks/mouth are puffing out, I have difficulty exhaling. When I look at the machine it says usually 11+-15 pressure.

I have prescribed 4-15 pressure, I investigated and was wondering would setting EPR or possibly reducing the upper value of pressure? I have read a number of people saying a 4 is too low. But I also read that 0 AHI is rare, and I seem to be hitting it off the bat, so was wondering is it illogical to set the pressure to say like 6-12 and EPR to 2 ? I appreciate I am just pulling numbers outta the air so to speak, I just want to avoid that shock of waking up multiple times.

This is (I see anyway) the only thing that's gonna cause an issue for me. This is the only information I could get from the machine, it didn't have a card so I had to go buy one.

If you start off at the machine's default low pressure of 4 (can't go lower) and ramp at 2, what is the point? There is nothing to ramp from to go to 4, so you might as well turn it off as most of us do quite early in using Cpap. Until you use a min. pressure of e.g. 10 or more, there's little need for the ramp.

Pugsy wrote: ↑

Tue Aug 18, 2020 3:25 pm

viewtopic/t158560/How-to-post-images-for-review.html

Unfortunately that's all the data the application gave me, said summary mode only, I put a card in today

Julie wrote: ↑

Tue Aug 18, 2020 4:48 pm

If you start off at the machine's default low pressure of 4 (can't go lower) and ramp at 2, what is the point? There is nothing to ramp from to go to 4, so you might as well turn it off as most of us do quite early in using Cpap. Until you use a min. pressure of e.g. 10 or more, there's little need for the ramp.

I am a little confused, If you are talking about ERP I though they just lowered pressure for exhaling. As for the 4 - 15 pressure, that is what the system was programmed, as well as ramp settings. I have not programmed the unit at all

GrooveVandal wrote: ↑

Tue Aug 18, 2020 5:10 pm

I am a little confused, If you are talking about ERP I though they just lowered pressure for exhaling. As for the 4 - 15 pressure, that is what the system was programmed, as well as ramp settings. I have not programmed the unit at all

welcome to the zoo! of course you're confused; it's a confusing world and now you have to get used to this new contraption. but we can help.

every regular on this forum have (has?) taken control of their own therapy. the sleep doctor prescribes the widest range for your cpap. that is usually the default of a min of 4 and a max of 20. but every now and then, an "adventurous" doc will even go as high as 5. (gasp!).

this minimum pressure makes it hard for most of us to breathe. and it's the #1 reason, in my opinion, why newbies fail at any chance of wearing the machine long enough to actually get therapy.

as i said, we take control of our own therapy. and if you want to, you can too. you can actually change your settings so that they are more effective for you. you'll get all kinds of help in that regard.

but first, we need to see that data. see what your sd card has captured for you in the morning. then post it here, right HERE, in this thread.

once the experts can catch a glimpse, you'll get some advice, believe me.

you can do this.

we can help.

good luck!

Ahhh....summary only data because the SD card wasn't in the machine during the night.
The SD card must be in the machine during the night to get the detailed information.
You will have more information tomorrow.

Hey Folks,

Thanks for your patience,

Here is my last night's data. Just as an FYI, the first time I woke up, the pressure felt high, my nose was hurting and my mouth was open (dog head out of a window...). The second time I woke up, the pressure was the same I think but didn't have the same feeling but the mouth was not open. I had reset my mask to apply less pressure to my nose the first time. Its hard to find a balance with the mask, sometimes it feels comfortable but it sounds like air is rushing out and sometimes it tight but I don't hear any air escaping.

GrooveVandal wrote: ↑

Wed Aug 19, 2020 6:16 am

Hey Folks,

Thanks for your patience,

Here is my last night's data. Just as an FYI, the first time I woke up, the pressure felt high, my nose was hurting and my mouth was open (dog head out of a window...). The second time I woke up, the pressure was the same I think but didn't have the same feeling but the mouth was not open. I had reset my mask to apply less pressure to my nose the first time. Its hard to find a balance with the mask, sometimes it feels comfortable but it sounds like air is rushing out and sometimes it tight but I don't hear any air escaping.

wel, first off, your numbers are freakin' amazing! but, we don't go by merely numbers around here. how you slept and how you feel are really more important.

your first post says-

"...now I am waking up 4-5 times a night..."

currently, it looks like you woke up 2x? do i have that right?

it takes a bit of time to get used to all of this. and that mask (neigh, ANY mask!) is the hardest thing to get used to, in my opinion. and people endup changing out masks. some go through a ridiculous number of masks. i got very lucky in that i found MY mask on my fourth try.

now, let's see what the experts have to say.

Thank you.. I would claim i intended it, but well..

Last night I actually turned on EPR (after reading about exhaling) so I had only one direct situation I would say where I feel "overwhelmed" by the situation, the second time the mask actually woke me up as it sounded like the cushion was pushing away from my face as I was exhaling and "flapping in the wind". But last night was the least interruptions since I started, 3-5 every night. And I don't mind waking up, its the manner, blast of air.. etc..

Like I said before, I could sleep through the night the majority of the time so it has taken me aback that I feel generally, more lethagic during the day now, obviously I am irritable because of the wake ups.

One thing that confuses me, I woke up the first time, I think the pressure was around 11.8 and I watched it for a good 60 seconds, shouldn't it adjust down ?

I am hoping I can just reduce the upper so it can not directly impact me. I think I am used to the mask, the hose tho.. damn thing..

GrooveVandal wrote: ↑

Wed Aug 19, 2020 12:45 pm

One thing that confuses me, I woke up the first time, I think the pressure was around 11.8 and I watched it for a good 60 seconds, shouldn't it adjust down ?

It will adjust down but it takes maybe 5 to 10 minutes of very gradual reductions. It doesn't go upwards in terms of pressure in the blink of an eye and it doesn't go downwards in the blink of an eye either.
If people go look at the actual zoomed in pressure changes they will see gradual changes and not rapid changes.
I know they look rapid on the detailed reports but that is because of the scale and everything being squished together.

If you wake up and don't like the higher pressure...just push the on/off button and restart the machine at your lower pressure.
If you don't you have to wait many minutes for the machine to gradually reduce the pressure while awake.

Great job with Oscar, GV! And those numbers are freakin' amazing!

It looks to me as though the changes in pressure are mostly responses to your flow limitations (FLs). FLs reflect a partial limitation within your airway, most often when the tissues lining the airway relax during sleep.

If you zoomed in on your flow rate, you can look at the traces about the zero line. These are your inhalations. You will probably see these exhibiting dents, peaks, or flattened tops, instead of the nice smooth curve that would be normal.

These anomalies in your inhalation reflect your doing extra work as you encounter then overcome the limitations. That adds up to a lot of extra work during the night, and it can be tiring and disruptive. It'd be nice to reduce the FLs.

The first thing to do is to set your EPR to 3. Expiratory pressure relief on your machine creates a differential between your pressure when you inhale and your pressure when you exhale. The maximum of 3 will give you your best shot at easing the FLs.

The second thing to do is to raise your minimum pressure to 7 so you can get the full benefit of the EPR throughout the night. (The machine can't go lower than 4; 7 minus EPR of 3 = 4.) I wouldn't be surprised if you find this more comfortable than 4, which leaves many people feeling air-starved.

The third thing to do is to reduce your ramp time or turn the ramp off completely. If you just reduce it, be sure you have ramp EPR at 3.

To change your settings, enter the clinician menu on your machine by holding down the round dial and the home button simultaneously until the new option appears. When you change a setting, be sure to lock it in by pressing the round dial as needed. Let us know if you have any trouble with this stuff.

Thank you for the response and information.

So I went ahead and set EPR to 3 and minimum to 7. I did not change RAMP and that was due to fear more so than anything else ? I wasn't 100% sure what EPR RAMP meant, and I set EPR to be always, I figured I can do small steps ?

Anyway, I had napped much earlier yesterday afternoon with the machine which made me feel utter crap if I was honest, my head was so so foggy and heavy.

I read your post and made the changes. I also adjusted my sleep situation so the hose itself was supported as opposed to hanging off my head to the machine.

I had no wake up events due to airflow, I do not believe. I had an issue with what seemed like a noisey leak, watching TV initially, and adjusting to the initial incoming pressure, so wasnt really sleeping 23:00-23:50. But when I fell asleep (00:30?) there no interruptions.

When you use ramp you can't get or feel the what EPR does until the ramp pressure starts up past the starting point of 4 cm.
EPR drops the pressure during exhale and ramp starts at 4 cm and there is no where for it to drop to until the machine gradually increases the pressure above 4 cm. The machine simply can't go lower than 4 cm no matter what the EPR setting is.

So until ramp time is used up you aren't getting full EPR benefit.

Example if you set EPR to 3 that means a 3 cm drop during exhale BUT until your pressure is 7 cm you won't get that full drop because the machine can't go below 4 cm.
When you use ramp and it starts at 4...there is no drop...when the machine has reached 5 during ramp you get a 1 cm drop and when it reaches 6 cm you get a 2 cm drop.

Try 7 minimum with ramp off and EPR set to 3 full time....while awake. It is actually much easier to breathe with using that setting than starting out with ramp on and doing the 4 cm thing right off the bat. Using it this way.....7 inhale and 4 exhale is actually more comfortable and more natural feeling than dealing with 4 cm all by itself. Try it while awake...see what it feels like.
You need that much pressure anyway. See how the pressure graph goes up and pretty much stays up??? You might even need more than 7 cm minimum.