CPAPtalk.com

Thank you for your review and comments.
I have now more knowledge (let’s say key words like APAP, back sleep, REM worsening OSA)
That I can put in discussion with the SL doc.
I will put it back to 12cm get two more bad days of data
and show the results to the doc on Monday.
13cm was already not nice.
So probably I will go for the backpack option

The backpack option won't help if REM sleep is a potential culprit but worth trying to see if it helps or not.
I had a friend with really bad OSA when on her back and she decided to try the backpack trick...and filled it with probably 15 tennis balls...woke up in the morning flat on her back and from the looks of the report she was on her back the bulk of the night.
Staying off one's back is easier said than done.

If you do need substantially higher pressures and those pressures are really uncomfortable to deal with then you may need a bilevel pressure machine.

Pugsy wrote: ↑

Sat Nov 17, 2018 9:16 am

A common complaint with higher pressures....aerophagia...air in the gut...belly pain...lots of burping and farting.
If this happens...even more reason to use the auto adjusting model to limit the time at the higher pressures as much as possible.

just curious....does a plain cpap machine have any exhale relief settings?

zonker wrote: ↑

Sat Nov 17, 2018 2:22 pm

Pugsy wrote: ↑

Sat Nov 17, 2018 9:16 am

A common complaint with higher pressures....aerophagia...air in the gut...belly pain...lots of burping and farting.
If this happens...even more reason to use the auto adjusting model to limit the time at the higher pressures as much as possible.

just curious....does a plain cpap machine have any exhale relief settings?

Most do.

zonker wrote: ↑

Sat Nov 17, 2018 2:22 pm

just curious....does a plain cpap machine have any exhale relief settings?

Respironics and ResMed for sure have exhale relief even on the bricks.
The other brands usually also have some sort of relief also. Might be in a little different form but usually something.

In this thread with this OP...he's already using EPR of 3 which is the max and if he needs higher pressures and maybe needs even more exhale relief either for comfort or aerophagia issues...he will need a different machine. One of the bilevel machines that offer more exhale relief than he can get with this model.

Sorry, for the break, I will follow up now.
I will post the last days experiments post by post now to show what happened so far.
Just for information my apnea was diagnosed as "REM worsened".

So, the last screenshot I posted above was from 11/16/18 and had AHI 14.02.
As settings I had 13mBar with EPR-2.

11/17/18 I will skip because of non-valid data. (Beer manipulated data )

On 11/19/18 I got back to 12mBar and disabled EPR and got AHI 6.78

On 11/20/18 I introduced the ClimateLineAir tube with Heating because of cold sleeping room. (I had water in the mask/nose that started to itch)

I used 12cmH20 and EPR-3.

From 11/21/18 its getting interesting.

12cmH20, EPR-3 and I was wearing a backpack t-shirt for avoiding sleeping on my back.
AHI 5.34

11/22/18 12cmH20, EPR-2 and backpack T-shirt.
AHI -> 1.16

11/23/18 -> EPR-1 and Backpack T-shirt
AHI 3.31
I had a apnea cluster in the morning, where I was somehow positioning myself on back position although there was a backpack T-Shirt.
To be said, I can't sleep the whole night with that Backpack T-Shirt. I get backpain around 4:30am usually and then start forcing lying on that backpack balloon.

11/24/18 EPR-2, increasing pressure to 14cmH20. Backpack T-Shirt.
AHI 4.63.
With 14cmH20 I remember that the Mask starting to leak sometimes. Not sure
if I need to tie it further or if this is normal at such high pressure.
Again I have two blocks of apneas whereas I am possible was lying half on my back.
For sure for the block in the morning I can remember that I was on my back.
The second ramp you see is because i had to remove the T-shirt because of backpain forcing me into another position.
I wouldn't say that this was a recovery sleep.

Ok, now I don't know what to try next.

Ideally you need a machine that will auto adjust to higher pressures only when needed...REM or supine or both.
I have REM worsened OSA myself. You can't do anything about REM so might as well just accept it and the supine sleeping and use the pressures that will take care of both and sleep in any position you need.

If ideal isn't possible then you can either accept some clustering of events during REM or when supine (obviously not ideal) or use a higher pressure all night long than you are using...with or without EPR being in the mix.
Obviously when using higher pressures then adding EPR makes it easier but that's a two sided sword...the reduction that makes EPR so helpful also lowers the overall average pressure a bit and lets the airway try to close up.
All that said...I still think that using 15 with EPR of 3 is an easier chore to manage than 12 or 13 without EPR...but that's me.

If it were me...and with my REM dependent OSA...I would say screw the Tshirt backpack thing and work on figuring out pressures that deal with everything because you can't control REM anyway.

I don't know what that final pressure is going to be...and you are likely fast approaching pressures where the bilevel machine might be definitely and easier road for you.....and preferably a bilevel that will auto adjust.

Thanks, It sounds like I will try 15cmH20 with EPR-3 and no Backpack T-Shirt today.
I am still in data collection phase to slap it later into the doctors face.
I have no idea what they measured in the SL to come up with the 12cmH20 and EPR-3.

Ok I am back now.
I had the doctors appointment and they agreed that I didn't slept much in back position during the hospital nights. But before they can change anything they said I have to follow the Health Insurance Rules/Procedures and this took so long until now.

While I was waiting (having always 13/EPR-2 not using the backsleep avoiding t-shirt ) for an appointment with the hospital I tried to improve my "other" Health Parameter.
I put myself on a Plant-based Diet, Fixed my Vitamin D deficiency, my cholesterol levels are awesome now, started muscle training, added more cardio and so I lost around 7kg Fat (its also noticeable that my double chin got smaller). Also my blood pressure lowered significantly I was able to reduce my BloodPressure Medicine from 5mg Ramipril+12.5mg HCT to 2.5mg Ramipril only.
Also I got some hose support and special pillow to not disturb the mask placement when I am changing sleep position.

Interestingly my AHI Levels dropped day after day. I am attaching a typical result that I usually get.
What do you think, should I still try to pursue for an APAP machine or should I just go on ? Just asking because today I have the doctors appointment and I am not quite sure what I should ask for.

Still saying that 13 is ok pressure wise, with more pressure I think the nights are more "bad" (feeling wise).
But I haven't tried e.g. 13.6 for one week. I did 13.6 for one night - felt bad and went back to 13.

Is it generally solved/acceptable for me ? I would say no, I am still not really recovered in the morning, but much better then last year. Are values below "5" ok ? SH says "technically treated". But for me as an engineer with perfection in mind I would like to approach <1 if we speak technically. But maybe I am shooting for too much there.

Not sure how to continue (except for improving further all health parameters)