Need Help Adjusting CPAP Settings

KKWinOK · Post by **KKWinOK** » Tue Dec 24, 2019 6:34 pm

palerider wrote: ↑
Tue Dec 24, 2019 6:30 pm

KKWinOK wrote: ↑
Tue Dec 24, 2019 5:53 pm

palerider wrote: ↑
Tue Dec 24, 2019 5:11 pm

KKWinOK wrote: ↑
Tue Dec 24, 2019 4:33 pm
Hi, I'm new to CPAP and I would like some pointers on adjustments to make to my CPAP machine. I had an in-home study in November during a weekend. One report showed 1 obstructive, 1 central, 13 hypopneas and an AHI of 3.7. A different night had 3 obstructive, 4 central, 28 hypopneas, and an AHI of 7.9. I've been dealing with sleep apnea for some time and I suspect it's been going on for around 5 years, maybe a little longer. I started CPAP on 12-10-19 and the sleep clinic has made several adjustments to my machine already. The changes were primarily centered around trying to lower the AHI and addressing aerophagia. It was on auto from about 5 to 15, then changed to CPAP of 7 and now 8. The current settings are CPAP of 8cm, ramping up from 4cm and EPR now at 1 (EPR was turned on to 3 due to aerophagia and is now at 1). It did help but my AHI increased from roughly around 5 to 7 to as high as 14.55 and now down to about 9. I'm wondering if the increase in central events was due to EPR. What changes do you suggest to lower AHI while also decreasing aerophagia? (The aerophagia wakes me up because I need to burp which causes broken sleep)

Thanks!
OSCAR - 12-23-19.png
It's quite possible that the EPR is driving up your centrals, can you try turning it off?
palerider, I plan to tonight. But turning it down to 1 increased aerophagia to the point that it was waking me up. Do you have any suggestions to minimize it?
Try dropping the pressure to 7

palerider, I was actually thinking of doing that. Should I leave it in CPAP mode or change it to APAP with a min/max?

palerider · Post by **palerider** » Tue Dec 24, 2019 6:37 pm

KKWinOK wrote: ↑
Tue Dec 24, 2019 6:34 pm

palerider wrote: ↑
Tue Dec 24, 2019 6:30 pm

KKWinOK wrote: ↑
Tue Dec 24, 2019 5:53 pm

palerider wrote: ↑
Tue Dec 24, 2019 5:11 pm

KKWinOK wrote: ↑
Tue Dec 24, 2019 4:33 pm
Hi, I'm new to CPAP and I would like some pointers on adjustments to make to my CPAP machine. I had an in-home study in November during a weekend. One report showed 1 obstructive, 1 central, 13 hypopneas and an AHI of 3.7. A different night had 3 obstructive, 4 central, 28 hypopneas, and an AHI of 7.9. I've been dealing with sleep apnea for some time and I suspect it's been going on for around 5 years, maybe a little longer. I started CPAP on 12-10-19 and the sleep clinic has made several adjustments to my machine already. The changes were primarily centered around trying to lower the AHI and addressing aerophagia. It was on auto from about 5 to 15, then changed to CPAP of 7 and now 8. The current settings are CPAP of 8cm, ramping up from 4cm and EPR now at 1 (EPR was turned on to 3 due to aerophagia and is now at 1). It did help but my AHI increased from roughly around 5 to 7 to as high as 14.55 and now down to about 9. I'm wondering if the increase in central events was due to EPR. What changes do you suggest to lower AHI while also decreasing aerophagia? (The aerophagia wakes me up because I need to burp which causes broken sleep)

Thanks!
OSCAR - 12-23-19.png
It's quite possible that the EPR is driving up your centrals, can you try turning it off?
palerider, I plan to tonight. But turning it down to 1 increased aerophagia to the point that it was waking me up. Do you have any suggestions to minimize it?
Try dropping the pressure to 7
palerider, I was actually thinking of doing that. Should I leave it in CPAP mode or change it to APAP with a min/max?

For now, leave it like it is and let's see what happens with that one change (removing the extra ventilation)

zonker · Post by **zonker** » Tue Dec 24, 2019 7:17 pm

KKWinOK wrote: ↑
Tue Dec 24, 2019 6:33 pm

zonker, I can certainly do some trial and error and I plan on looking through your post. Thank you for sharing!

hat-tip.gif

please update me on this, even if it doesn't work.

it may inspire you look at some other way.

KKWinOK · Post by **KKWinOK** » Wed Dec 25, 2019 10:23 am

palerider wrote: ↑
Tue Dec 24, 2019 6:37 pm

KKWinOK wrote: ↑
Tue Dec 24, 2019 6:34 pm

palerider wrote: ↑
Tue Dec 24, 2019 6:30 pm

KKWinOK wrote: ↑
Tue Dec 24, 2019 5:53 pm

palerider wrote: ↑
Tue Dec 24, 2019 5:11 pm

It's quite possible that the EPR is driving up your centrals, can you try turning it off?
palerider, I plan to tonight. But turning it down to 1 increased aerophagia to the point that it was waking me up. Do you have any suggestions to minimize it?
Try dropping the pressure to 7
palerider, I was actually thinking of doing that. Should I leave it in CPAP mode or change it to APAP with a min/max?
For now, leave it like it is and let's see what happens with that one change (removing the extra ventilation)

I changed the pressure to 7 and turned EPR off. Now that I'm used to CPAP, I feel like I can breath against the pressure so I don't think I need EPR anyway. I feel like I slept better than at 8 and I feel better today though not completely refreshed (perhaps that will come in time). I had some aerophagia but not as bad as with 8. I would call it "manageable" but I still woke up several times to belch or pass gas. From what I understand, this can be a matter of fine tuning. It appears the central events have gone down and the AHI went down to 4.7 (previously ~8 to ~4 now). In fact, most of the clear airway events seem to occur in the early hours of the morning for me. Maybe some of these are acceptable? Below is the chart from last night and the previous night for comparison. Should I stay with these settings for a few nights and basically take an average?

palerider · Post by **palerider** » Wed Dec 25, 2019 3:01 pm

KKWinOK wrote: ↑
Wed Dec 25, 2019 10:23 am
Should I stay with these settings for a few nights and basically take an average?

Yes, your numbers are actually pretty good at this point. the fairly small centrals aren't anything to be concerned about and your obstructive apneas and hypopneas are nice and low,

See how you're doing after a few days.

Geer1 · Post by **Geer1** » Wed Dec 25, 2019 3:22 pm

It is a minor change but you should turn ramp off. Will probably be more comfortable without it.

KKWinOK · Post by **KKWinOK** » Sat Dec 28, 2019 10:05 am

palerider wrote: ↑
Wed Dec 25, 2019 3:01 pm

KKWinOK wrote: ↑
Wed Dec 25, 2019 10:23 am
Should I stay with these settings for a few nights and basically take an average?
Yes, your numbers are actually pretty good at this point. the fairly small centrals aren't anything to be concerned about and your obstructive apneas and hypopneas are nice and low,

See how you're doing after a few days.

Below are 4 days worth of graphs. 3 of them are at a pressure of 7 and last night's was at 6. I experimented with this lower pressure to see if it would eliminate aerophagia. It was certainly less and it seemed like I slept with fewer interruptions than previous. On Thursday, Dec 26, I had an AHI of 2.89 but the most awful aerophagia. I hurt bad enough I took my mask off and fell back asleep briefly and passed a lot of gas and burped. My stomach still hurt somewhat off and on during the day. I think if I can get past the aerophagia, this can work very well for me. I wonder if trying to lessen the pressure to reduce aerophagia is worth it in order to try to get less broken sleep? As far as how I feel today, I think I'm feeling better but I think I may have come down with some sort of infection...perhaps sinus. Do you have any suggestions based on the charts below? What do I do about aerophagia? Is it better to reduce the pressure in hopes of better sleep quality?

KKWinOK · Post by **KKWinOK** » Sat Dec 28, 2019 10:06 am

Here is last night's chart at a pressure of 6.

KKWinOK · Post by **KKWinOK** » Sat Jan 04, 2020 10:20 am

I wanted to seek advice on how to lower the amount of apneas my CPAP machine is seeing. Some nights I have a low amount of central apneas and other nights it's higher, like last night. I don't feel as rested when I have more central events and today is no exception. I decreased the pressure to 6 to minimize aerophagia. At 7 it was a lot more difficult to get good sleep. I'm trying to find ways to deal with the lower esophageal sphincter as I have noticed increased reflux lately. I plan on changing my diet and taking supplements to strengthen it. I'm hoping it will eventually allow me to increase the pressure if I need to. Anyway, will the central apneas go away over time? I thought I read that they usually do after several months of CPAP therapy. Below is a graph from last night.

Pugsy · Post by **Pugsy** » Sat Jan 04, 2020 11:13 am

The central apneas might go away with time and they might not. Just depends on what is causing them.

You might try reducing or turning EPR off and see the centrals reduce....for a very small subset of people using EPR or any exhale relief actually is a trigger for centrals.

Jas_williams · Post by **Jas_williams** » Sat Jan 04, 2020 1:13 pm

Pugsy wrote: ↑
Sat Jan 04, 2020 11:13 am
The central apneas might go away with time and they might not. Just depends on what is causing them.

You might try reducing or turning EPR off and see the centrals reduce....for a very small subset of people using EPR or any exhale relief actually is a trigger for centrals.

Dispite what the setting pane shows I don’t think KKWinOK is using EPR as the pressure stats don’t seem to show a reduced epap. If EPR is not being used then all we can ask is you give it time and discuss with your sleep dr as the machine you have will not treat Central Apnoea

Pugsy · Post by **Pugsy** » Sat Jan 04, 2020 1:21 pm

Jas_williams wrote: ↑
Sat Jan 04, 2020 1:13 pm

Pugsy wrote: ↑
Sat Jan 04, 2020 11:13 am
The central apneas might go away with time and they might not. Just depends on what is causing them.

You might try reducing or turning EPR off and see the centrals reduce....for a very small subset of people using EPR or any exhale relief actually is a trigger for centrals.
Dispite what the setting pane shows I don’t think KKWinOK is using EPR as the pressure stats don’t seem to show a reduced epap. If EPR is not being used then all we can ask is you give it time and discuss with your sleep dr as the machine you have will not treat Central Apnoea

Settings show fixed cpap at 8 cm which should equal IPAP at 8....statistics show EPAP at 6 and IPAP at 8...so that's 2 cm EPR and not the 3 that shows on the settings.
Probably need to see the actual pressure graph and not the mask pressure to see for sure but it looks like some sort of EPR is being used.
Might want to confirm all the actual settings by looking in the machine since sometimes the software likes to play games.

KKWinOK · Post by **KKWinOK** » Sat Jan 04, 2020 4:07 pm

Pugsy wrote: ↑
Sat Jan 04, 2020 1:21 pm

Jas_williams wrote: ↑
Sat Jan 04, 2020 1:13 pm

Pugsy wrote: ↑
Sat Jan 04, 2020 11:13 am
The central apneas might go away with time and they might not. Just depends on what is causing them.

You might try reducing or turning EPR off and see the centrals reduce....for a very small subset of people using EPR or any exhale relief actually is a trigger for centrals.
Dispite what the setting pane shows I don’t think KKWinOK is using EPR as the pressure stats don’t seem to show a reduced epap. If EPR is not being used then all we can ask is you give it time and discuss with your sleep dr as the machine you have will not treat Central Apnoea
Settings show fixed cpap at 8 cm which should equal IPAP at 8....statistics show EPAP at 6 and IPAP at 8...so that's 2 cm EPR and not the 3 that shows on the settings.
Probably need to see the actual pressure graph and not the mask pressure to see for sure but it looks like some sort of EPR is being used.
Might want to confirm all the actual settings by looking in the machine since sometimes the software likes to play games.

Pugsy, yes that's what it shows but the settings are actually different when you go into the clinical menu on the machine. I don't know why OSCAR doesn't update the "Machine Settings" portion after I make changes.

EPR is turned off and it's in straight CPAP mode at a pressure of 6. If it's a matter of time, I can certainly do that. I know on nights where my AHI is lower, I feel much better the next day. This past Wednesday night, I had an AHI of 2.89 and I felt pretty good on Thursday...not great but good. I just don't know how to get rid of the CSAs.

Pugsy · Post by **Pugsy** » Sat Jan 04, 2020 9:32 pm

If you aren't using EPR then it can't be triggering the centrals.

You might take the time to learn how to figure out if you were really asleep or not when those centrals were flagged.
If you weren't really asleep they may be a symptom of poor sleep quality and not necessarily the cause of poor sleep quality.

Go here and watch the videos and learn how to zoom in and figure out asleep vs arousal/awake flagged events.
http://freecpapadvice.com/sleepyhead-free-software

Since EPR is off...not really much you can do about the centrals if you were really asleep except hope they reduce with time.
They won't likely respond to any pressure changes. More pressure sure won't help with centrals.

zonker · Post by **zonker** » Sat Jan 04, 2020 9:39 pm

to add on to what pugsy is saying about figuring out if you are awake or not? when you are awake, reach over and turn the machine on and right back on. that will show up in your oscar graphs the next day. and you'll see if it coincides with your cas.

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