How Am I Doing?

wacomme wrote: ↑

Thu Apr 30, 2020 12:31 pm

Thanks for this feedback.

Regarding EPR - I think I only have it set for ramp. So, how does lowering it from three to 2 help my hypops? And why would lowering EPR help hypops anyway? That seems counter-intuitive.

And how can raising the minimum pressure help with aerophagia? That also sounds counter-intuitive. Granted, the aerophagia tends to come during the last half of my sleep; I don't know why I don't have the problem, as well as chipmunk cheeks, earlier during my sleep. Most of my issues are after 4 hours of sleep.

For starters, I'll lower the max pressure to 15; this is what it was set at by the CPAP tech.

Michael

So many counter intuitive things, I know! So EPR is on ramp only. Yeah, that's not going to make a change in the bulk of your night. Agreed. Thanks for catching me on that. As for the EPR and Hypops, here's a post on Apneaboard that discusses it to some extent.

Sometimes, raising the min pressure will reduce events enough that your pressure never spikes too high, so you never make it into the realm of pressures that induce aerophagia. This may not be the case with you.

Setting your max back down to its original pressure set by the sleep tech sounds like a great next step.

I know working with mask that isn't sitting quite right will make things less than ideal, but if your large leaks are solved, why not try that for a few nights and see how it works?

Yep. Lots of us have more issues after the first four hours of sleep.

Chris

Since the highest your pressure got during the night was 14.66, lowering your max pressure from 20 to 15 will do nothing for your aerophagia. Increasing your min pressure from 7 to 9 should reduce some of the apnea events and lower the AHI. It doesn't look like you are using EPR at all on the latest Oscar chart. Try a setting of 2. It will decrease the pressure on exhale by 2. If you are inhaling at a pressure of 10 you will be exhaling at a pressure of 8.

Yikes. This is my worst Oscar daily reading by far. And I thought I slept pretty good last night. From my perception, the F20 mask wasn't leaking, I had minimal aerophagia, and only minor incidences of chipmunk cheeks. I was thinking the F20 mask may actually work for me.

And then I downloaded my data to Oscar. Wow! I'm not sure what to make of it - lots or hypo's and obstructions. And lots of mask leaks. Really?

I set my max pressure back to 15. I set EPR to 2 - first night using EPR. I seemed to like it. However, I don't think it's good for my apnea. So, now what?
Michael

Thinking about it, I do recall waking up several times during the night feeling I was suffocating. I took a few deep breaths and went back to sleep.

wacomme wrote: ↑

Fri May 01, 2020 8:31 am

Thinking about it, I do recall waking up several times during the night feeling I was suffocating. I took a few deep breaths and went back to sleep.

LSAT suggested upping your minimum from 7 to 9, as well as the EPR to 2.

Chris

Tonight I'll try with the min. pressure at 9. The EPR is at 2. In fact, the only real change from the previous night was adding EPR. I had EPR for ramp only until last night. Could EPR be causing the rise in apnea?

NO....Low pressure is causing the increase in AHI. EPR is only for comfort.

Using EPR can cause an increase in obstructive events because of the drop during exhale IF a person is already near the line where just a little less pressure allows apnea events to happen.

Example....suppose a person needs 8 cm to hold the airway open and they elect to use a minimum of 9 cm but they add in EPR of 3 which drops the pressure down to 6 during exhale...that's below that 8cm line and there's a good chance that apnea events will happen upon exhale due to the drop.
Not everyone is always at there bottom line minimum pressure though...so this isn't always a given but some people needed to increase the minimum a bit to offset what happens during the drop...or they can just not use EPR but if a person likes EPR or needs it to be comfortable then a little increase to offset the drop is a better solution than turning EPR off.

I think you were already at the bare minimum to hold the airway open and when you added in the drop during exhale by using EPR all night...the airway couldn't stay open.
You need more minimum.

Oh..those leaks you see...unless they woke you up they are nothing to be concerned about. The machine can handle leaks up to 24 L/min easily and you really didn't make it halfway at the worst.

How was your aerophagia?

Chris

Thank for the info and feedback. Tonight I'll raise the minimum pressure from 7 to 9 and keep the EPR at 2. I think the EPR helped my aerophagia and chipmunk cheeks - I had some, but it was minimal.

Again, so very strange. It's been almost a month since I started CPAP, and this is the second night my AHI has been over 5. I don't think it's the mask. The first night with the F20 I had a very low AHI, but the last two nights it's been 11 and 7, respectively. The ONLY constant change for the past two nights is the introduction of EPR. I like the feel of EPR (setting 2), but I'm wondering if EPR doesn't like me.

I think for tonight I'll turn off EPR, lower my minimum pressure back to 7 (the best AHI results with my nasal mask) and see what happens.

Last night I experienced quite a bit of aerophagia and chipmunk cheeks.
Michael

wacomme wrote: ↑

Sat Apr 25, 2020 1:50 pm

and my wife hates the taping because I literally cannot talk.

Well, my wife *loves* the taping exactly for the same reason ...

Mike

Dang. What's going on? I switch to my the F20 mask. I generally feel like I'm sleeping well, and my AHI skyrockets. What's the deal? With the N30i my AHI was well below 5, often below 1. And now, especially last night, I felt I had a great night of sleep and my AHI is very high. Is it the mask?

I think I'll try the N30i mask tonight and see if what happens. This is perplexing.
Michael

For the first time last night I had dry mouth. I must be breathing more through my mouth. I also had less chpmunk cheeks and very little aerophagia.

I DID turn off EPR compared to the last two nights, thinking the high AHI was due to that - apparently not.

Michael

We don't sleep the same each night.
Two main culprits when we see clustering of obstructive events that will/can vary a lot during the night.
Supine sleeping and REM stage sleep....both can cause our OSA to worsen (sometimes quite markedly) and the need for more pressure.

Your first cluster looks like there's a good chance it is REM related. It happened about 90 minutes into sleep which is where we normally would expect to see REM. The second cluster...I don't know because the first REM doesn't normally last that long but it might be REM or it might be supine related or maybe a combination.
The other clusters...definitely go along with the pattern for when we would expect to see REM happen.

The first REM is normally about 90 minutes after sleep onset and is relatively brief and then as the night progresses REM comes on more frequently and will last longer. The greatest amount of REM happens in those wee hours of the morning.
Google "sleep stages" and take a look at the normal hypnograms and you will see the typical pattern.

It's very common for REM stage sleep to worsen OSA. My own OSA is 5 times worse in REM than in non REM and I sometimes need 6 to 8 cm more pressure during REM.

Since we don't sleep the same each night we shouldn't be changing things every night based on last night's data. Instead pick some settings that did work well and give them several nights to see if the good was a fluke or not. Pick a mask that is comfortable and you like and you want to use. Bear in mind that often those people using a full face mask end up needing higher pressures than when they use a nasal mask. In theory it shouldn't matter if everything is equal but everything isn't always equal and I think the primary culprit is the subtle change in position that the straps needed for full face masks need to be stable. They tend to pull the lower jaw back ever so slightly and make it a little bit more difficult to keep the airway open and prevent the collapse. Normally not a big deal but for some people that "more pressure" is enough to trigger aerophagia issues.

I suspect you have a strong REM making things worse factor in your OSA. Not much we can do about REM ....we need REM as part of the cycle and there's no way to restrict it and we wouldn't want to even if we could.
If you had a diagnostic sleep study that included sleep stage data it might confirm that REM plays a significant factor.
If you didn't get much REM....might have been from just waking up when you hit REM so not much REM data to document.