Newbie - Suggest CPAP setting adjustments

My wife has a ResMed Airsense 10 CPAP (yes, the brick). So the best data I think I can get is MyAir (ugh). (Longer term, I am getting an APAP for myself, and will put her on it for a few nights to see what is happening, but would like to make an educated guess on adjustments now.)

Pressure is 9 cm H2O; Ramp is on and initial pressure is 6. EPR is 3. Leak level is 1 to 2 L/min, occasionally higher. Mask is Airtouch F20.

AHI has been running 6 to 9.

She has been using CPAP fewer hours, 6 instead of 8, because it is "uncomfortable" in that it feels like she can't breath.

Any suggestions would be appreciated.

Problems is of course we don't really know for sure what kind of events are getting flagged since the cpap model doesn't distinguish between central apneas and obstructive apneas. I think it does tell you hyponeas though.
So you get some sort of apnea and hyponea breakdown of that AHI.
If you go into the clinical setup menu and change essentials from "On" which is just hours of use to "Plus" you can at least get the apnea hyponea breakdown of the AHI if you scroll down a little deeper into the sleep report on the machine.
Have you done this?
If you don't know what I am talking about this manual explains how to get to the clinical setup menu area where you can change the "Essentials" setting.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

Obviously we also don't know when those whatever events are happening. Like maybe a couple of hours goes by with not much of anything but then a dense cluster happens and the overall AHI might be lower than just for that one time segment because the 2 hours with nothing happening causes the overall average to lower.

At any rate about all you can do is increase the pressure and see if the AHI reduces. I would start with a small 1 cm increase and see what happens. If the events are obstructive they should reduce in number a bit and the average AHI should reduce a little.

I would only make one change at a time...you could also reduce EPR but if it were me I would just increase the pressure from 9 to 10 and see what happens.

Still use the ramp if she needs it but if she is stopping the machine often during the night for some reason and then restarting it then she may be spending a lot of time at the ramp's lower pressure which is probably sub optimal and might be a factor in the airway trying to collapse. Maybe shorten the ramp period if she needs it and the period is prolonged.

Thank you for the suggestions. I just changed Essentials to Plus now, so we'll leave everything else alone for a couple days and see if that tells us anything useful.

BlueDragon wrote: ↑

Wed May 30, 2018 7:19 pm

" in that it feels like she can't breath.

Too much air, or too little air?

They have opposite solutions... too little? turn up the pressure, too much? try EPR.

Wow! I had my wife use my new APAP machine last night and it's clear why my adjusting her CPAP pressure hadn't made any difference.

Mostly she sleeps on her side. Not sure what caused the first pressure increase at 2:45 am unless maybe her head was tilted back more than usual. She was on her back for the big increase at 4:45 am.

Unfortunately, I wasn't expect this extreme and had the machine max set to the 15 that I use. Just to be prepared, what treatment is typical if even 20 cm isn't enough?

Thanks!

The machine increases pressure on flow limitations and snores. If you look at her flow limitations graph you can see how that corresponds to the increases. If it was me I would increase her minimum to 7 and maximum to 20 to see if she can prevent the clusters. If you can better control the obstructions with the minimum pressure it may not go very much higher. These machines respond after events to try and prevent further ones so by getting an optimum minimum it helps to control their beginning.

That ugly cluster when she was on her back might have been prevented if the machine could have gone higher. We don't know until more maximum is tried.
If more maximum doesn't do the trick then more minimum will often do the trick. What happens with more minimum is the airway is held open better all night long and hopefully by doing that the airway collapse in the first place is better prevented.
Often if more minimum is used the machine won't need to go so high.
How much more minimum...don't know for sure but sometimes not all that much more. Example I would see clusters like that when I used 8 cm minimum on my Respironics machine back when I was using that brand (my culprit was REM sleep causing higher pressure needs) and when I used 10 cm minimum I didn't have those clusters. I just opened the max to 20 and let the machine sort it out.

First thing I would try is simply more maximum and if that didn't do the trick more minimum...maybe in 1 cm increments.

Other choice is of course stay off one's back but that's easier said than done and sometimes not possible for various reasons.

If she doesn't have an auto adjusting machine of her own and has to use fixed pressures then she will need more pressure all night probably and while it can be done...not as comfortable as using lower pressures for the bulk of the night and having the machine go up only when needed. That might be a situation where trying extra hard to stay off one's back might be warranted.
Otherwise she's a prime candidate for auto/apap machine.

Pugsy wrote: ↑

Fri Jun 15, 2018 8:29 am

Otherwise she's a prime candidate for auto/apap machine.

We're planning to get the DME provider to swap her CPAP brick for an Autoset. We think her doctor will sign the order when we see him this afternoon. We'll also try her with a nasal mask plus chin strap instead of full face for comfort.

Thanks for all the information you provide!

Second night for my wife on my APAP machine with pressure range set to 7-20. Video clearly shows she rolls over on to her back, can't get air, and disconnects her mask.

However, she does say she is sleeping better with my APAP machine compared to her CPAP machine, which is set to 9.6 cm. (We have submitted paperwork to switch her machine for an APAP.)

She wants to try a nasal mask instead of the full face she has now. I suspect with that mask, when she turns on her back, she'll switch to mouth breathing. Maybe that's better than tearing off the mask?

Mouth breathing better than taking the mask off??? For me it would be. Not all mouth breathing is so bad that a person's therapy going down the toilet. There's degrees of mouth breathing.
She seems to remove the mask when the pressures climb...there's a chance that with a nasal mask the pressure won't climb so much.
Often nasal mask users can get by with a little less pressure than they need with a full face mask.

The AHI is about half CA and half obstructive. I don't know if those CAs are real centrals or not but even if they were we can't do anything about them and there's not enough of them to need to do anything about them anyway.

Make her happy...let her at least try a nasal mask of her choice...one that she likes and wants to try and worry about any mouth breathing if it is proven to be a problem.
Any therapy is better than no therapy with the mask off.

Pugsy wrote: ↑

Sat Jun 16, 2018 10:27 am

Make her happy...let her at least try a nasal mask of her choice...one that she likes and wants to try and worry about any mouth breathing if it is proven to be a problem.
Any therapy is better than no therapy with the mask off.

That's certainly my goal! I try to find options for her, let her decide what she wants to do, then help implement.

If she thinks the ResMed AirFit P10 looks interesting I have a gently used frame and headgear she can just have to try...and some new unused nasal pillows. Just send me a PM.
Free except maybe a little postage reimbursement if you can. I am getting ready to do some major cleaning out of all the donated stuff and mailing costs add up. Maybe $7 or 8 depending on how far you are from me.