Newbie to Forum Long Time CPAP user Looking to Improve Therapy

[Frank Drebin]

I've been using CPAP since 2012, but stumbled upon this forum maybe a year ago and this is my first time posting. Earlier this year I underwent a titration in order to get a new machine through my insurance. My pressure went up from 10 to 12 and I received a ResMed Air Sense 10 machine set to CPAP mode with a constant pressure of 12. I've been having trouble getting used to the new pressure and although I've been sleeping ok, I notice my AHI averages between 3-4 and in the morning I feel bloated and have quite a bit of gas. I don't really have a sleep doctor that I work regularly with, I did my sleep study through the local hospital and they sent me to their medical supply department to get the machine. Since this forum seems to be a lot more accessible for information to obtain optimal therapy, now that i have a machine that can record data for Sleepyhead I thought I'd post a chart and see if anyone has any input on how to improve my therapy.

screenshot-20190916-210827.png (124.34 KiB) Viewed 6667 times

I hope I formatted the chart correctly. I generally average around 6.5 hours of sleep per night, but that varies depending on how well my little ones sleep through the night. Most mornings, aside from the bloating, I'm tired, but can normally function ok at work and aren't falling asleep at my desk or anything.

I guess I’m wondering if there is anything I can adjust to lower my AHI and if my pressure is causing the bloating in the morning? Any thoughts or input is greatly appreciated! Thank you.

[Miss Emerita]

Hello, Frank! I’m sure the experts here can help you with some fine tuning. A couple of quick questions: do you know why they gave you a fixed pressure and no EPR? And do you happen to have a copy of your most recent sleep study report that you could post? If yes to that, be sure to blank out any identifying information before you post it.

[palerider]

I guess I’m wondering if there is anything I can adjust to lower my AHI and if my pressure is causing the bloating in the morning? Any thoughts or input is greatly appreciated! Thank you.

You came very close on the formatting, we'd prefer to see 'pressure' not 'mask pressure'. You don't need to pin all the graphs, you can just drag and drop them when they're not pinned. wiki/index.php/Sleepyhead:Organize

As to making your therapy better, you've got an auto machine, Autoset, great machine, it's currently in stupid mode, where it doesn't respond to your changing needs at all.

I'd suggest changing it to Autoset mode, min pressure 12, max 20, and let's see what it does for a night or two.... post a pic after sleeping with it for one night at the new settings.

[Frank Drebin]

Hello, Frank! I’m sure the experts here can help you with some fine tuning. A couple of quick questions: do you know why they gave you a fixed pressure and no EPR? And do you happen to have a copy of your most recent sleep study report that you could post? If yes to that, be sure to blank out any identifying information before you post it.

I’m not sure why I’ve been prescribed the fixed pressure. I asked about it after my titration and the tech could only tell me “that’s what the doc wanted.” I don’t have copies of either my original study or titration. In hindsight I guess I should have asked for them.

[Frank Drebin]

I guess I’m wondering if there is anything I can adjust to lower my AHI and if my pressure is causing the bloating in the morning? Any thoughts or input is greatly appreciated! Thank you.

You came very close on the formatting, we'd prefer to see 'pressure' not 'mask pressure'. You don't need to pin all the graphs, you can just drag and drop them when they're not pinned. wiki/index.php/Sleepyhead:Organize

As to making your therapy better, you've got an auto machine, Autoset, great machine, it's currently in stupid mode, where it doesn't respond to your changing needs at all.

I'd suggest changing it to Autoset mode, min pressure 12, max 20, and let's see what it does for a night or two.... post a pic after sleeping with it for one night at the new settings.

Thanks, I will try those settings. Last night I turned EPR on and woke up with less bloat. Should I keep the EPR on while changing to the auto settings?

[Pugsy]

I would continue to use EPR to help prevent the bloat at the new settings and then evaluate things after you change the settings and see what happens. Using EPR reduces the pressure a bit during exhale and sometimes people need to compensate for that reduction with more pressure but I wouldn't do it until the need is proven in your situation.
Increasing the pressure will just make the bloat worse and no since in going down that road unless you just have to.

[kteague]

I’m not sure why I’ve been prescribed the fixed pressure. I asked about it after my titration and the tech could only tell me “that’s what the doc wanted.” I don’t have copies of either my original study or titration. In hindsight I guess I should have asked for them.

In general, a routine titration is designed to determine an effective fixed pressure. In years past, the auto titrating machines were not routinely dispensed, and were not deemed necessary if one had a properly titrated effective pressure. Thinking on this is evolving. I have used both CPAP and APAP successfully. I'm all for options.

As to copies of your diagnostic and titration studies, I would suggest going ahead and getting those copies. As you go on in your treatment it's not unusual for questions to pop up, and having the reports at hand may get you to a quicker answer. Plus, there's all kinds of fascinating (well, interesting) tidbits in them. Now this is just an example and may not apply to you, but it's not unusual to find out things like a person's events are significantly worse with back sleeping. If that person has trouble such as mask leaks or air in the belly at the higher pressures needed to accomodate back sleeping, they can then decide if taking steps to prevent back sleeping is a worthwhile effort. Without the study reports, it's more of a guessing game. Good luck going forward.

[palerider]

I guess I’m wondering if there is anything I can adjust to lower my AHI and if my pressure is causing the bloating in the morning? Any thoughts or input is greatly appreciated! Thank you.

You came very close on the formatting, we'd prefer to see 'pressure' not 'mask pressure'. You don't need to pin all the graphs, you can just drag and drop them when they're not pinned. wiki/index.php/Sleepyhead:Organize

As to making your therapy better, you've got an auto machine, Autoset, great machine, it's currently in stupid mode, where it doesn't respond to your changing needs at all.

I'd suggest changing it to Autoset mode, min pressure 12, max 20, and let's see what it does for a night or two.... post a pic after sleeping with it for one night at the new settings.

Thanks, I will try those settings. Last night I turned EPR on and woke up with less bloat. Should I keep the EPR on while changing to the auto settings?

Yes, that's fine.

[chunkyfrog]

Some doctors prefer single pressure because thinking is HARD.

[Frank Drebin]

I’m not sure why I’ve been prescribed the fixed pressure. I asked about it after my titration and the tech could only tell me “that’s what the doc wanted.” I don’t have copies of either my original study or titration. In hindsight I guess I should have asked for them.

In general, a routine titration is designed to determine an effective fixed pressure. In years past, the auto titrating machines were not routinely dispensed, and were not deemed necessary if one had a properly titrated effective pressure. Thinking on this is evolving. I have used both CPAP and APAP successfully. I'm all for options.

As to copies of your diagnostic and titration studies, I would suggest going ahead and getting those copies. As you go on in your treatment it's not unusual for questions to pop up, and having the reports at hand may get you to a quicker answer. Plus, there's all kinds of fascinating (well, interesting) tidbits in them. Now this is just an example and may not apply to you, but it's not unusual to find out things like a person's events are significantly worse with back sleeping. If that person has trouble such as mask leaks or air in the belly at the higher pressures needed to accomodate back sleeping, they can then decide if taking steps to prevent back sleeping is a worthwhile effort. Without the study reports, it's more of a guessing game. Good luck going forward.

Thank you. I've requested copies of both studies.

[Frank Drebin]

Here is my chart for my first night on the APAP settings. I watched the videos on how to interpret flow rate when the machine flags an OA and, unless I'm interpreting the flow rate wrong, it looks like each OA is a true event and it caused my machine increased pressure to around 14. It flagged quite a few CAs which I'm not sure what that means, but on the flow rate chart, look similar to an OA.

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Here is a zoom from a flagged OA.

screenshot-20190918-213456.png (88.87 KiB) Viewed 6519 times

[Miss Emerita]

These are improved results! I’d be curious to see your flow limitation graph (you could leave out the mask pressure graph). The reason I’m curious is that the numbers on the left suggest that your new settings are reducing flow limitations as well as events, which would be good.

That CA event actually looks like sleep/wake junk to me, because you have some arousal-type breathing right before it. And the breathing between the two events isn’t nice and even, so I even wonder whether you were kind of awake starting right after the OA. I’m not an expert of any kind, though, so I’ll be curious what other people think.

[Frank Drebin]

Here are my charts from the last two nights:

screenshot-20190921-202500.png (118.75 KiB) Viewed 6466 times

screenshot-20190921-202442.png (117.51 KiB) Viewed 6466 times

Still can't seem to get below two although Friday morning I felt pretty good. Last night was a bit rough and I woke up at 4am with lots of bloating and gas and wasn't able to go back to sleep. I wondered if I had an event that woke me up and it doesn't appear to be the case, but I'm thinking it was anxiety.

In any event, I'm wondering if maybe I need to try some new pillows or something to adjust my position that may help decrease my AHI. Thank you to everyone who has provided feedback/input so far!

[palerider]

I suggest bumping min pressure to 13... we're narrowing things down, getting closer.

[Miss Emerita]

Given the bloat, you could consider getting up to the minimum of 13 somewhat gradually, so that your body can adjust to the increases.

If you were REALLY awake from 4 on, then you can discount the events flagged after that time.

Nice to see that the reductions in flow limitation are continuing.