APAP experiment without official OSA/UARS

Geer1 wrote: ↑

Thu Nov 14, 2019 9:29 am

. For someone new to CPAP

Someone new to CPAP should NOT be offering *advice". You end up causing more work for people with actual knowledge, who have to spend time correcting your bad ideas.

Geer1 wrote: ↑

Thu Nov 14, 2019 9:29 am

I'm thinking about this from an engineering

Geer1 wrote: ↑

Thu Nov 14, 2019 9:29 am

I could see how people that have been on successful CPAP treatment would feel suffocated at a lower pressure. For someone new to CPAP it seems like even minimal pressure should be helpful but I'm thinking about this from an engineering first basics point of view and may be missing variables like issues with expiration etc.

I don't have any documentation but I will share a little personal experience that I encountered with lower pressures.

I was going to screen my sister using my apap machine to see if she was suspicious for some sort of SDB issue....never been on cpap at all. I really wanted to try the minimum of 4 cm just to get what you are thinking about.
So that's what I had it set for and it took about 10 seconds for her to literally rip the mask off with her telling me I was trying to kill her by suffocation.
I explained it wouldn't suffocate her but she would have no part of such a low setting. It simply wasn't comfortable.
We played with various minimums until she got comfortable with it. I had to start out with a minimum of 6 cm for her to be okay with it.

So don't assume that just because someone has no experience with cpap pressures that they will be okay with the minimum....it's not always the case.

Given what I read about here from so many people and how they don't do well with 4 or 5 cm...and my own experience with my sister....I haven't needed to go looking for documentation. Real life is enough for me.

rosie1231 wrote: ↑

Thu Nov 14, 2019 9:00 am

I'm still so curious about the 0 RERAs scored from my study. As best I can tell, they scored RERAs based on variance in movement of the chest/abdominal bands, if such variance was associated with an arousal. Is it possible to have flow limitations WITHOUT variance in effort? In other words, is it possible to just have low-grade but constant flow limitation? And another question: can micro-arousals cause sleep stage fragmentation?

I'm sure you're thinking "who cares? If APAP makes you feel better, just do it and move on." But I felt so bad for so long that I can't help but want to keep digging...

Ha, I am the same but worse being an engineer who loves to overthink everything...

Any level of arousal causes sleep stage problems as it is your brain switching to being awake (whether momentarily or not). Your sleep study showed 0 RERA's and only 4 arousals from all your leg movements yet you had a significant number of arousals (not sure what is considered abnormal). Maybe this was due to the sleep study, being in a strange place with equipment strapped to you etc considering the amount of time you spent awake? Your doctor did comment on the leg movements kicking you out of sleep stages so that is definitely an issue even if they aren't always causing arousal.

Resmed flow limitations have to be calculated/determined by flow and pressure and tell you nothing about your effort. My understanding is that the effects of flow limitations are not agreed upon which is why they aren't included in sleep apnea diagnosis (unless doing an in clinic study and an arousal is caused hence being scored as a RERA).

If you haven't stumbled on these yet I found them to have a lot of good information for those of us that want to understand the details.

http://freecpapadvice.com/sleepyhead-free-software

http://www.apneaboard.com/wiki/index.ph ... SleepyHead



Palerider, a simple explanation as to why something is a bad idea and maybe a good reference would suffice... My "stupid" comment just made her aware that the same idea she she was having may be a bad idea... Easiest way to stop uninformed opinions is to teach.



Pugsy, thanks for that information. I felt more suffocated at a higher pressure since I haven't got used to CPAP yet. At 6 I feel far more comfortable and could wear mask all day, I never would have though that 4 would cause issues. I'm thinking maybe it has to do with expiration, perhaps low pressures don't provide enough support for the CPAP expiration process? I'll try mask at 4 tonight and see what it feels like.

Geer1 wrote: ↑

Thu Nov 14, 2019 10:24 am

Pugsy, thanks for that information. I felt more suffocated at a higher pressure since I haven't got used to CPAP yet. At 6 I feel far more comfortable and could wear mask all day, I never would have though that 4 would cause issues. I'm thinking maybe it has to do with expiration, perhaps low pressures don't provide enough support for the CPAP expiration process? I'll try mask at 4 tonight and see what it feels like.

I am not much into overthinking stuff now. Maybe its my 10 years on cpap and realization that sometimes we don't get the answers to the "why" questions. I have had a bunch of "whys" over the years that I never could figure out an answer to.
It is what it is and I learned to put forth effort in questions that I might stand a chance of getting an answer to. I only have so much time and energy to devote to all this stuff.
Since so much of this stuff boils down to the old YMMV sticker and there's not a lot we can do about it anyway....shrug my shoulders and move on.

Comfort is paramount to decent sleep quality. All aspects of comfort....let's face it...if we aren't comfortable we aren't going to be able to fall asleep easily or stay asleep and without sleep none of this stuff matters.
If a lower starting pressure causes a comfort problem...then don't use a lower pressure.
If a higher starting point causes a comfort problem...then figure out what can be done about it so it is no longer a problem.
So I prefer to just fix the problem instead of worrying about why it's a problem. Even if you figure out why....you still need to fix it.

I will say this...from my 10 years here and drawing on what I have read as to people's experiences.....most newbies will complain of being air starved at the lower pressures than those that complain about it being difficult to deal with.

I really get annoyed when people say something is "only a comfort feature and not integral to therapy itself" because without comfort there would be no sleep and thus no therapy IMHO. I think comfort is critical to effective therapy....just as important as optimizing the pressure settings.

If I don't sleep for whatever reason....doesn't matter much what my AHI is or leak is or pressures used.

Geer1 wrote: ↑

Thu Nov 14, 2019 9:29 am

I could see how people that have been on successful CPAP treatment would feel suffocated at a lower pressure. For someone new to CPAP it seems like even minimal pressure should be helpful but I'm thinking about this from an engineering first basics point of view and may be missing variables like issues with expiration etc.

When I started in 2012, my pressure was 11-17 with ramp starting at 4 and set for 45 minutes. The second day, I reduced ramp to 20 minutes., The 3rd day, I turned it off. I was way more comfortable letting it go straight to 11 before I got into bed. I have never tried it at less than 11 since.

Awhile back, I had a bad cough. I would go to bed, have a bad coughing spasm, then rip off the mask because I was gasping for air. I realized it was just like a new person starting at a pressure of 4. There just wasn't enough air movement when I was coughing like that. I bumped my minimum to 13, and I was able to make it through the coughing spasms without feeling suffocated. I could keep the mask on, the coughing would stop, and I could sleep. Much better than going with cpap because of the cough.

If somebody is fine at 4, that's great. But if they are struggling, my first suggestion is to raise the minimum to at least 6. Too many doctors send people home with machines set for 4-20 or 5-20, and then they wonder why so many people quit. They are doomed to fail.

I appreciate your replies, thanks all. I experimented with raising pressure and found that pressure over 10 and/or high swings in pressure tended to wake me up. Not sure if that's because I'm new to PAP or because my brain is extra sensitive to pressure. Anyway, I've been comfortable at min 7.0, max 9.2, and EPR 3 for a while. I tend to have some active flow limitation during the first half of the night, and a half dozen or so OA events during the second half of the night. I know (think?) my event/flow limitation charts look pretty darn good, but I suspect I would benefit from trying to raise pressure a bit. If so, which should I raise first - min or max? Thanks for any opinions.

rosie1231 wrote: ↑

Sat Dec 07, 2019 6:50 am

I appreciate your replies, thanks all. I experimented with raising pressure and found that pressure over 10 and/or high swings in pressure tended to wake me up. Not sure if that's because I'm new to PAP or because my brain is extra sensitive to pressure. Anyway, I've been comfortable at min 7.0, max 9.2, and EPR 3 for a while. I tend to have some active flow limitation during the first half of the night, and a half dozen or so OA events during the second half of the night. I know (think?) my event/flow limitation charts look pretty darn good, but I suspect I would benefit from trying to raise pressure a bit. If so, which should I raise first - min or max? Thanks for any opinions.

From this night, it looks like if you raised min pressure to 9 you would end up with pretty stable pressure.

Rather than lower the ceiling of max pressure, in other words, raise the floor.

Keep in mind that you may end up needing a bilevel; as in, pressure support that your machine cannot provide with EPR. LSAT has a VAuto for sale right now, so if you can swing it, you might just bite the bullet now.

Also, do you really need ramp?

slowriter wrote: ↑

Sat Dec 07, 2019 7:33 am

From this night, it looks like if you raised min pressure to 9 you would end up with pretty stable pressure.

Rather than lower the ceiling of max pressure, in other words, raise the floor.

Keep in mind that you may end up needing a bilevel; as in, pressure support that your machine cannot provide with EPR. LSAT has a VAuto for sale right now, so if you can swing it, you might just bite the bullet now.

Thanks. I'll bump the min up by increments of 0.2 every few nights. Unfortunately I do seem to need autoramp - pressure values of 8-10 feel too low when I wake up in the middle of the night but also feel too strong to allow me to fall asleep.

I'm actually in the market for a new machine...I'm currently borrowing one from my non-compliant longtime OSA husband, and I'm already so happy and energetic from sleeping better on APAP that he wants his machine back to try again I was wondering which feature would be most useful for me in a new machine - the Autoset "for her" algorithm or the extra PS from the Aircurve Vauto. Sounds like the Aircurve might be the ticket.

The VAuto without any doubt.

slowriter wrote: ↑

Sat Dec 07, 2019 10:44 am

The VAuto without any doubt.

Yup

rosie1231 wrote: ↑

Sat Dec 07, 2019 9:12 am

.... the Autoset "for her" algorithm or the extra PS from the Aircurve Vauto.

Just to clarify, beyond the additional pressure support, there are two other benefits to the VAuto:

1. EPR can only be set at integers (1, 2, 3); PS on the VAuto can be set more precisely (like, 3.4)
2. The VAuto has a variety of other breathing-related settings that be used to fine-tune your therapy

Chiming in: VAuto. Getting the pressure support values higher than 3 has dramatically reduced my FLs and has noticeably improved the quality of my sleep. I've been inching up very slowly, .02 at a time, to manage aerophagia, and am now at PS 4.4. I am noticing that my sleep cycles are longer (they were very short) and REM lasts longer. I feel better during the day.

I'm very sensitive to pressure changes, and obstructive events are well treated with low pressures, so I don't set a range. I use EPAP fixed at 5 and PS fixed at (now) 4.4. Just a thought in case you'd like to experiment with a fixed regimen.

palerider wrote: ↑

Sat Dec 07, 2019 10:53 am

slowriter wrote: ↑

Sat Dec 07, 2019 10:44 am

The VAuto without any doubt.

Yup

And another "yup" added.

Coming from someone who currently owns both the AirSense 10 AutoSet for Her and the AirCurve 10 VAuto.

Miss Emerita wrote: ↑

Sat Dec 07, 2019 11:25 am

I'm very sensitive to pressure changes, and obstructive events are well treated with low pressures, so I don't set a range. I use EPAP fixed at 5 and PS fixed at (now) 4.4. Just a thought in case you'd like to experiment with a fixed regimen.

The one downside of this is that I'm pretty sure the vauto won't track FL in the fixed mode.

I thus always use it in vauto mode, even if I'm setting max IPAP such that it is basically fixed, or close to it.

These days my max IPAP is 15, which is just one above the min IPAP. So my pressure doesn't change much at night, and it rarely hits max, but the FL data and the pressure graph gives me some insight into how the therapy is going.

Example: