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palerider wrote:and the EPR 3 makes it worse

Yeah, I know and I started to mention the option of turning it off or reducing it but decided to wait before going down that road.
I just didn't want to go there right now. I actually had it typed out but deleted it. If last night wasn't the fluke then that EPR might come in real handy if the pressures need to be in the teens.

Your machine settings have been changed from the default settings? Who changed the settings and when? Clearly, you didn't do it since you don't know how.

The way we sleep each night can also vary widely - especially when first starting therapy. CPAP is complicated as is the way we sleep. It's not just a matter of turning the dial left and right to get the right setting. For some people, it can take a long time to determine the proper settings. Also, your body adjust to the therapy to a degree.

What was your usage pattern before? How long did you use it for and how consistently? How many hours per night? How long did you stop using it for and why? Have there been other changes to health, medication, or sleeping arrangements?

Someone has changed the settings on your machine to limit the amount of therapy it can provide. It would be useful if we knew who did that and why. Do you have the prescription that your doctor wrote for the machine? If not, ask for it - you want to have it in your files. If you do have the prescription, what does it say?

Well started researching what each thing is and started testing. Total failure...
I was told that the mask should be fairly loose, and now wish I never tried.

Did the mask seal test mode and holy hell that was not fun! It put out so much pressure my cheeks puffed out and any attempt to breathe out would result in leak everywhere! Unless I had it tight enough to make my face red and leave indention on my face, it wont seal.
Had to find the nasal pillows. Changed setting and tested again. Seal test worked great.

Unfortunately using it not so great. I would have to take a break cause I was suffocating! I literally had to open my mouth and catch my breath!
Thats when I decided to dig into it.
Found out how to get into the settings menu; which was stupid easy.
Raised max pressure to 14 and minimum, in steps, to 6.6 IIRC.
Also tried EPR disabled.
I could breath a little better, but still found (still breathing through nose) that I could breath phenomenally better without the pillow or machine.
Chest started to hurt and after 3 hours and gave up...

Was wearing mask way too low. Still have a leak into eyes at higher pressure.

Increased minimum to 7 and max to 15.

Ended up taking it off to clean at about an hour after putting it on and fell asleep before getting it back on. Reviewed and still had a 13 AHI
Worrisome after such a short time

Believe it or not, you can get used to the pressure fairly quickly. I have my min set to 13 and my max at 20 and I have to check to see if it's on because I don't even feel it! I'm not joking. As far as I can tell, I breathe the same when I'm on the cpap as I do when I'm not on it. Even when my machine hits 18 or 19, I have no trouble breathing out.

My recommendation is to use your cpap while watching tv or surfing the net - the more distracted you are, the better. You don't need to think about your breathing - just breathe naturally. Don't try to adjust your breathing to the machine, let it adjust to you.

If, when you look at the data, and you see that you keep hitting the max pressure you have set, this usually indicates that you need a higher maximum pressure. Your pressure needs can vary throughout the night. That's why auto machines are so great.

The higher the EPR the less pressure will be felt when exhaling, correct? So while a high number may be more comfortable, it may lead to more events per hour? So ideally, if you can stand it, an EPR of 0 is ideal?

Wonderbrah wrote:The higher the EPR the less pressure will be felt when exhaling, correct? So while a high number may be more comfortable, it may lead to more events per hour? So ideally, if you can stand it, an EPR of 0 is ideal

Some people look at EPR that way but I don't. I look at it like if you can't sleep so great because of problems exhaling then it doesn't really matter what the AHI is if you can't sleep.
The chance of higher AHI if EPR is being used..yeah it might or it might not happen but if it does it's usually something that is easily remedied with just a little more pressure to start with.
It doesn't always mean that using EPR lets apnea events slip past the defenses...it depends on what pressure you are using to start with.
The best AHI in the world is worthless if you can't sleep.

Wonderbrah wrote:The higher the EPR the less pressure will be felt when exhaling, correct? So while a high number may be more comfortable, it may lead to more events per hour? So ideally, if you can stand it, an EPR of 0 is ideal?

if everybody was the same, then your "epr of 0 is ideal" might be accurate, however, it's not.

EPR is a limited bilevel, and there are therapeutic reasons for bilevel as well as comfort reasons.

the problem with epr comes in some edge cases.

for instance, say you need 9cm to keep your airway from closing, so you're happily at 10cm pressure, to give a bit of a safety margin... epr0, then decide you want some exhale relief and change the epr to 3. now, you've reduced your base pressure to 7... well below the 9 you need, and you start having apneas.

the proper method would be to raise the set pressure to 13, and set epr at 3, then you'd have inhale pressure of 13, exhale of 10, and you'd stay over your apnea threshold, plus you'd get a bit of assistance in breathing from the machine due to the differing pressures. with those settings, you'd be the same as a bilevel machine set to 13/10, or epap 10, ps 3.

like most things in cpap therapy, trying to oversimplify the concept leads to problems.

Thanks for all the replies everyone!
I have gained some weight back and I am feeling worse, day to day tasks are harder, focus and critical thinking getting pretty bad; so I think Im going to give this a try once again... again.
Wish my provider, which I pay for some reason not yet known to me, were as half as helpful as you guys!

So what should I try tonight? Settings wise? Nasal or mask? Any thoughts or tips?

So what have you been doing in terms of cpap therapy since last June?

Use the mask that you find the most comfortable and like the best. Start with that.

In terms of settings..
Maybe start in apap mode with 10 minimum and 20 max and EPR at 3 (if you need EPR or you could use less or turn it off even)...and then see what happens by evaluating the detailed reports.

I dont think I have an apap setting.
I have Autoset and CPAP.

Current settings are;
Mode - Autoset
Max Pressure - 20
Min - 10
Mask - Pillows
Ramp Time - off
EPR - on
EPR Type - Full time
EPR level -3
Humidity level - 1
Tube - standard
AB Filter - no
Essentials - on
Smartstart - off

Been doing the same thing since last June with the exception of losing just shy of 50lbs. This helped considerably; certainly better than this machine ever did for me. Anyway, I have since gained a lot of weight back and need the energy the lack of breathing steals from me. In turn, I will be weight lifting every other day and doing (very short) HIIT sessions everyday in the AM.

About to give this a try. Wish me luck!

APAP refers to auto which is your autoset mode. On your settings the only thing I would change is the Essentials from on to Plus. That will give you more data on your on screen report. If you don't have your clinical manual here is a link to one. https://sleep.tnet.com/home/files/resme ... -guide.pdf

Mode ....AutoSet is apap mode.
The other choice is cpap mode.

Lol sorry ladies! I work in IT so I have enough acronyms in my head for a one of aneurysm

Unfortunately I was not able to try last night.
I tried the nasal pillows and they smelled extremely musty; certainly would have made a bad night MUCH worse.
I was unable to find my mask as a backup.

The hoses, nasal pillow, head wrap has all been soaking since last night. Hopefully theyll be good to go tonight.
Wish me luck!!!

If you haven't already....also wash the water chamber and change the filter in the machine for good measure.