Should I change any settings?

LongHaul · Post by **LongHaul** » Thu Apr 29, 2021 7:02 pm

Hi all,

Some background - I've been using a CPAP machine for about 5-6 years now. Recently the effectiveness of the therapy dropped off, so I created an account here and posted some questions in Feb 2021. Strangely, I can now find neither the old post nor the username. So now I've created a new one!

Anyway some updates - I increased the pressure, increased EPAP, removed ramp time and got myself a neck brace. That made a difference, so thanks for that!!

The mask that I was using - full face Comfort Gel - was leaking, so I bought a new F30i.
It feels amazingly comfortable and I felt a bit better on waking up, but I still wasn't back to the 'old days' of waking up 'sharp'. My evenings are also still drowsy and irritable.
I did try a side-sleeping pillow, but it made no difference.

Now for my questions - looking at the charts of the last 2 nights, do you think I should increase the pressure a bit more? The red line seems to be spending too much time near the roof.
Should I increase the EPAP? I feel a bit of resistance when I exhale.
Should I worry about the 'large leaks' on the chart? They don't wake me up like the old mask used to, so I don't even know from where the leak is.

Thanks once again for the previous help and also in advance for now!

LongHaul · Post by **LongHaul** » Sat May 01, 2021 6:04 pm

Hi everyone,
Any opinions?

I've posted last night's chart as well. I'm also wondering why the lines like Tidal Volume, Resp Rate, Minute Vent (second screenshot below) etc. are so spiky with the new mask? Any views on that?

Thanks!

Pugsy · Post by **Pugsy** » Sat May 01, 2021 6:09 pm

Increase your minimum from 11 to 15.
Increase your maximum to 20.

LongHaul · Post by **LongHaul** » Sun May 02, 2021 6:00 pm

Thanks, will try out and update here.

LongHaul · Post by **LongHaul** » Thu May 13, 2021 5:51 pm

Thanks Pugsy. I upped the min and max pressure in stages and now I wake up much more refreshed.

However, by the evenings I'm still a bit fatigued and irritable. On zooming into the Oscar reports, it seems I'm waking up quite a lot, even before an 'event'. Thanks to your suggestions, I know that the machine is doing all it can. Time to follow other leads - like visiting a GP, getting more exercise, etc ...

latest screenshots attached, as promised. Thanks once again!

Miss Emerita · Post by **Miss Emerita** » Fri May 14, 2021 11:36 am

LongHaul, even with your revised settings, you're seeing a fair number of obstructive apnea events, along with a lot of snoring and flow limitations. A couple of questions:

Can you think of something that changed around the time your night-time results changed? Sleep environment (mattress, pillow, light, temperature, etc)? Sleep postures (side, back, stomach)? Weight? Medications?

And do you sleep on your back (whether or not that is a change)?

palerider · Post by **palerider** » Fri May 14, 2021 4:53 pm

Your minimum is actually *12*, since that's what the machine goes to when you're not inhaling. (pressure-EPR).

try setting the pressure to 17 and see how things go,

LongHaul · Post by **LongHaul** » Mon May 17, 2021 5:44 pm

Thanks Palerider. Made the changes and the numbers are a bit improved. Screenshots attached.
I also reduced the EPR to 2. Not entirely sure why I did that though.

Ms Emerita, yes things changed massively in the last one year, as they did for many of us. In the Covid lockdown I was bored and started late night snacking and sleeping at random times. Naturally the AHI shot up so much that I used to feel I was awake all night. Anyway, I cleaned up my act a few months ago - started exercising, no eating after 8 PM, no booze (at all) and sleep for 9 hours.
Thanks to the people on this forum, I upped my pressure settings, removed ramp, went and got a new mask and a neck brace and now things are almost normal again.
Since I started using CPAP (5 years ago), I trained myself to sleep on my side, with my arm below my head. With the new mask and higher pressure, I started sleeping on my back, which is more comfortable for my shoulders. But at some point in the night, I turn onto my side, with my arm below my head. No pillow.

Now it's just the fatigue that I feel around 5 PM that's baffling me. Does anyone else experience the same? AHI is reasonably low, feel fine the whole day, but in the evening, suddenly I feel like I can't take this anymore.
When I went to the Resmed center to buy a new mask, the sales person there suggested that if the numbers are good, then I should get my vitamin A & D tested. So maybe thats my next step.

LongHaul · Post by **LongHaul** » Tue May 18, 2021 5:19 pm

Before bed last night, I spent a few minutes trying to 'fine tune' the mask fit. Looks like I messed something up big time

Will try again this evening.
Otherwise the graph pattern looks similar to the last couple of days.

Miss Emerita · Post by **Miss Emerita** » Tue May 18, 2021 8:13 pm

Congratulations on changing your habits—that’s hard!

I lean toward advising you to raise your minimum by 1 and increase your EPR to 3. I’m curious whether that might help with the flow limitations and give you more restful sleep.

Do you think your jaw is dropping and contributing to the snores?

Sleeping on your back may be contributing to the snores and FLs. Can you correlate the times with lots of both with the back-sleeping?

Do you think either a lo-cal snack in the late afternoon or a walk might help you have a better evening? At any rate, a talk with your doctor would make sense.

LongHaul · Post by **LongHaul** » Wed May 19, 2021 6:56 pm

Thanks - I made the changes. Results attached. The overall flow limit looks lower.
How do I feel? Amazing actually! I haven't woken up this happy in a long, long time

Let's see how the rest of the day goes haha!

Yes, it's always been hard to sleep on my back, which is why I trained myself to sleep on my side after i started using CPAP. However, with the new higher pressures and this new mask, I was emboldened to try sleeping on my back. It's more relaxing for my shoulders.
With regard to your question on whether I can tell if the events are happening when I'm on my side or back, here's the problem - I start sleeping supine. Then when i wake up and check Oscar, I can't tell whether I was still on my back or turned on my side when the first events happened. I also tried a trick that Pugsy (i think?) mentioned in another thread - switch the machine on and off just before you change position and then look for the small 'break' in the Oscar charts. Same problem - was I still on my back or on my side when the next events kicked in? I can't tell.
I even considered getting a camera with a time stamp to record myself, but none of them were cheap. It also seemed a bit, well, kinky

Anyway, for the sake of certainty, I think I'll go back to side-sleeping.

With regard to my lower jaw - when I'm asleep and exhale, the air somehow causes my mouth to balloon and then open up to sort of 'deflate'. I've seen the same thing with all the men in my family. It almost feels like air can push past the top of my throat. And that's only when exhaling. Which is why I use a full-face mask. Do you think this causes a flow limit? I did borrow some tape from a friend once and used it, but I didn't notice any difference. To be fair, I used it for only half the night and ripped it off because I needed a drink of water

Regarding the evening fatigue, yes I do snack on nuts and fruit. Thanks for the suggestion though!

Long rambling post, but it's helping me clear my head. So thanks for the suggestions and for reading through!

LongHaul · Post by **LongHaul** » Tue May 25, 2021 8:36 pm

Hi all,

Some updates and my next question

All medical tests were reported normal! But the evening fatigue continues, so I went and borrowed a camera to record my sleep.
Here's the recurring pattern that I see - I'm fast asleep on my side, then for some reason, my breathing gets restricted. This causes me to twitch, half-wake-up and roll over onto my back. This causes further restriction, ragged breathing, snores that I can hear, AHI events and eventually I wake up. At this point, I go back on my side, but it takes forever to fall asleep. As a result, even though my average AHI has gone down over the night, I'm awake for long periods. I'm guessing my evening fatigue is related to this.

From the video recording, it’s difficult to tell if my jaw is dropping because the mask is covering the face pretty tight.
The flow limit seems to go DOWN during the restriction, which I think is even more strange.

So my question and request for help - can you look at the zoomed-in graph and guess what might be causing these initial awakenings?
I've also uploaded the full night's graph.

I feel I’ve come so far, this is the final hurdle and if I reduce these awakenings, then I can go back to restful sleep.
Thanks in advance!

Should I change any settings?

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