Tips/Suggestions for REM specific apnea and pressure sensitivity.

Greetings,

Does anyone have tips for someone who predominately has OSA in REM sleep but has a difficult time sleeping with higher pressures? My machine sometimes spikes to a pressure of 10-12 (sometimes higher) when an apnea event occurs. When I am not in REM sleep, a pressure of about 6 seems to work fine. Once REM sleep comes around, things get rocking. I have to tighten the mask down when preparing for sleep in anticipation of higher pressures happening which makes CPAP use more uncomfortable and disruptive to the quality of sleep. I know a pressure of 10-12 may not be a high pressure for some, but for me it is. Any tips on how I can get more accustomed to sleeping with the high pressure and not waking up with the issues associated with the pressure spiking?

Edit: EPR is set at 3

Try using a straight/fixed pressure and see if that helps.
Pressure ranges aren't for everybody. That's why Auto machines can also be set to straight pressures.


Den

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Doce wrote: ↑

Wed Nov 11, 2020 9:22 pm

Greetings,

Does anyone have tips for someone who predominately has OSA in REM sleep but has a difficult time sleeping with higher pressures? My machine sometimes spikes to a pressure of 10-12 (sometimes higher) when an apnea event occurs. When I am not in REM sleep, a pressure of about 6 seems to work fine. Once REM sleep comes around, things get rocking. I have to tighten the mask down when preparing for sleep in anticipation of higher pressures happening which makes CPAP use more uncomfortable and disruptive to the quality of sleep. I know a pressure of 10-12 may not be a high pressure for some, but for me it is. Any tips on how I can get more accustomed to sleeping with the high pressure and not waking up with the issues associated with the pressure spiking?

Edit: EPR is set at 3

Well, first, let's figure out what kind of a machine you have, since there's no such thing as a ": Resmed Airsense 9"

pick one off the list: wiki/index.php/CPAP_models

and ignore wulfman's suggestions, since his is to set your pressure to 12 and leave it, he's been beating that dead horse for years. (alternately, he's saying to leave the pressure too low to keep you from having apneas in REM, which is another bad idea)... but, you know how it is, when your pony only knows one trick....

Don't follow palerider's questionable advice! He thinks that "AUTO" means it will automatically get to the pressure needed........even if the user doesn't have the necessary precursor breathing events to trigger pressure changes and that pressure changes don't disturb sleep.


Den

.

As someone with OSA that is 5 time worse in REM with significant pressure differences needed in REM only (6 to 8 cm more in REM) here are your options.

1....you can use fixed cpap at the lower pressure and risk apnea events happening during REM because the pressure couldn't prevent the airway from collapsing. Just accept the fact that you will have some events during REM because the pressure can't prevent them.
2....you can use auto adjusting mode but limit the max to something that might not cause so much disruption and cross your fingers it prevents the bulk of the airway collapses....so maybe let a few apnea events slip past the defenses.
3...you can use fixed cpap at a higher pressure (but less than your max) all night and hope the higher pressure holds the airway open well enough.
4....you could use 12 cm all night and just deal with the worst case scenario thing in advance
5....you could use auto mode but with a higher minimum and a limited range and hope the higher minimum did a better job of preventing the REM related events and/or pressure increase needs.

Finally...side note...I see people stating that the higher pressures cause them to wake up but there is the possibility that it is the apnea events happening that are causing the wake up and then we notice the higher pressures. So they assume it was the pressure but in reality it was the apnea events that the pressure was trying to prevent in the first place which caused the wake up.

These machines don't go from 8 to 12 in 2 minutes....there isn't a fast abrupt change at all. You are already using EPR at 3 cm which is a 3 cm change with every breath and sleeping through it quite nicely. I doubt the gradual change in pressure over 5 or 10 minutes to 10 or 12 is responsible for the wake ups.

So you have options. Some might not be real attractive like using 12 cm all night long just to deal with 20% of the night pressure needs but you have options.
If it were me I would maybe look at number 5 which is what I ended up doing.

Doce wrote: ↑

Wed Nov 11, 2020 9:22 pm

My machine sometimes spikes to a pressure of 10-12 (sometimes higher) when an apnea event occurs.

My titration was for BiLevel 18/24. That was intolerable for me. I started wearing a firm, foam cervical collar ( https://www.amazon.com/Coreline-Cervica ... ef=sr_1_12 ). My pressure needs are now AutoSet and range from 10 to 12.5.

The collar holds the neck in the optimal position for airway patency and also helps prevent jaw drop.

The collars are available at most pharmacies. They are cheap to try out.

I like Pugsy's approach:

Pugsy wrote: ↑

Thu Nov 12, 2020 1:52 pm

5....you could use auto mode but with a higher minimum and a limited range and hope the higher minimum did a better job of preventing the REM related events and/or pressure increase needs.

Then........

Slowly start increasing your maximum. No hurry, do it very slowly. Increment by the machine's minimum increment value (0.2 if it's a resmed) over a long time, say once a week.