Switching from CPAP to APAP advice

i just wanted to sneak back in here and say that i admire the hell out of you, sleepycpap!

you seem to be doing a great job here and i hope you continue to do so. it's VERY important that a cpap user takes charge of their own therapy. and you seem to be doing that.

keep up the good work!

SleepyCPAP wrote: ↑

Sat Jul 31, 2021 3:13 pm

palerider wrote: ↑

Sat Jul 31, 2021 1:36 pm

they're tiny and scrunched, too small to see anything.

right click on the title 'flow rate', select 'x-axis' and change it to -60 to 60.

Hi palerider,
Here are the same moments, with the Y-axis adjusted -60 to 60.

Sleep waveform 1rev Screen Shot 2021-07-31 am.png
Sleep Waveform 2rev Screen Shot 2021-07-31 am.png

Both of them show a fair amount of flow limitations on the waveforms.

zonker wrote: ↑

Sat Jul 31, 2021 5:04 pm

i just wanted to sneak back in here and say that i admire the hell out of you, sleepycpap!
you seem to be doing a great job here and i hope you continue to do so. it's VERY important that a cpap user takes charge of their own therapy. and you seem to be doing that.
keep up the good work!

Thank you zonker! According to OSCAR I’ve been using CPAP for over 3900 nights. I’m proud of that - it was tough going at first.

I would have been handed a PRS1 250 (brick) if I hadn’t gone forum hunting back in 2010. From all that reading I’d done, I walked out of that DME store. I knew I wanted a full-data machine, and to take charge of my therapy. Ordered a PRS1 “Pro” 450 from our sponsor so I could get an idea of AHI. Zeroed out my machine every day so I could see the daily numbers on the screen. Then brought myself up to speed on how to read the SD card (I think Pugsy pointed me to the Encore Pro software), and then later was reading the hex code myself (about the time of “Onkor” beginnings, and way before “Sleepyhead”). Up until the pandemic my AHI averaged 0.42 from 2010-2020. I’d managed to help my overall health, including going from an obese BMI, down to a high-normal BMI. But then during the pandemic I got distracted and stopped checking the forum, or Sleepyhead (didn’t even know OSCAR had come out). I inched back up a little in BMI (low overweight range). My AHI rose to an average 1.65, and large leaks were all over the place. So… mostly doing a good job all these years, until recently, and now trying to get back to that.

Here are some screen shots from last night in CPAP mode. I tried EPR set to 1. That was a success!! I feel I can increase EPR tonight, to see if I like it set to 2.

AHI came down under 1.0 again. I’m guessing the real AHI is even lower: The first two hypopneas I would throw out - I wasn’t asleep yet, so they don’t count. I’m not sure about the centrals later in the night - I think I was asleep but maybe I had a brief change of sleep state.

Yes palerider, still seeing flow issues on the waveforms. I’ll post the “asleep waveforms” next.

Breathing patterns while asleep. One during large leak marking, the other during normal leak marking. Double taping my mouth wasn’t enough last night and my lips opened.

SleepyCPAP wrote: ↑

Sun Aug 01, 2021 10:18 am

zonker wrote: ↑

Sat Jul 31, 2021 5:04 pm

i just wanted to sneak back in here and say that i admire the hell out of you, sleepycpap!
you seem to be doing a great job here and i hope you continue to do so. it's VERY important that a cpap user takes charge of their own therapy. and you seem to be doing that.
keep up the good work!

Thank you zonker! According to OSCAR I’ve been using CPAP for over 3900 nights. I’m proud of that - it was tough going at first.

here i thought you were a newbie! that's what i get for not looking closely at user avatars.

still, what i said holds and is a lesson for the genuine newbie coming in. i really don't like it when a new user comes in just to argue.

SleepyCPAP wrote: ↑

Sun Aug 01, 2021 10:40 am

AHI came down under 1.0 again. I’m guessing the real AHI is even lower: The first two hypopneas I would throw out - I wasn’t asleep yet, so they don’t count. I’m not sure about the centrals later in the night - I think I was asleep but maybe I had a brief change of sleep state.

did you know there is a "cheat" for that? in the events graph, hover your mouse at the point just behind those false events. left click and drag the mouse across. you'll see tiny print show up under the graph stating something like"time: 7:20 ahi .77" or whatever it is.

pugsy taught me that a long time ago and it really got me through some tough times.

I don't think the 2 centrals you zoomed in on are asleep centrals. The second one for sure isn't and I can't see the flow rate prior to the flag on the first one but I am betting not asleep.

Remember just because we don't remember an arousal or awakening doesn't mean it didn't happen.
Just means it was so brief we didn't form a memory of it.

So glad you like the EPR of 1. I'll be curious how you like 2.

Two things you could try to get taping to work better for you. Before you tape, wipe the skin around your mouth with an alcohol wipe, then blot with a kleenex; and before you tape, purse your lips. (In my local pharmacy, alcohol wipes are sold in the diabetes-care section.)

SleepyCPAP wrote: ↑

Sun Aug 01, 2021 10:43 am

Breathing patterns while asleep. One during large leak marking, the other during normal leak marking. Double taping my mouth wasn’t enough last night and my lips opened.

When you're looking at waveforms you need to zoom in a little more, maybe one or two more zoomed in, so you can better see the shape. also, right click on the name and turn on the zero line.

The inhalations are still a little flow limited, they're not as rounded as it would be nice to see.

Last night I tweaked EPR (increased it to 2) and humidity (rise to 5). I found both to be uncomfortable. I didn’t feel breathing was natural at EPR 2, and had trouble falling asleep to it (both sessions in night). At some point I remember waking to water droplets, so that wasn’t good for humidity. I’m pretty sure the events marked for the night that are at the beginning of the night and just before I got up are while I was awake or transitioning, so shouldn’t count. I picked one hypopnea for focus today that I think was while I was sleeping. My breathing seemed to be in a sputtering pattern. I’ll give a long-lead-up-view for Pugsy’s preference, and a zoomed in shot for palerider’s preference. The flow limit range at EPR 2 is just about the same as the previous night when I was on the same 10cm pressure and EPR 1. I know it is only one sample night for each EPR, which has limits, but I don’t want EPR 2 again, nor do I want to go to EPR 3 since I don’t like 2.

I feel as if this return to CPAP mode was good to experiment with EPR. I definitely was good with EPR1, and want to keep that as I switch back to APAP now. Since 10cm can get me <1 AHI on its own (last night, and prior nights on my PRS1), I’m thinking that 10cm should be my APAP min. I’m thinking I’ll set the max to 12 - which can show whether the machine wants to go higher than the previous 11cm limit, though I’m afraid 12cm will give me air in my belly (but maybe not with EPR 1). It will be a balancing act.

Here are zoomed-in peeks at two times I was asleep. One with leak going on (I think my leaks correspond to sleep stage), and one without leak (so maybe different sleep stage). Flow limitations evident. If I were sticking to CPAP mode I’d want to go higher than 10cm setting to clean this up. Palerider, I apologize about the flow rate range resetting to -100 to 100. I don’t remember doing that. I hope it is still readable. Here is the one in leak again, set right:

The reason I like the viewing scale showing so much flow rate prior to the flag is to evaluate the flow rate for evidence of arousal/awake breathing.
For evaluating flow rate for flow limitations in each breath PR's scale is preferred. Just have to see more of the breaths which means we see less number of breaths.
No big deal really and there is a way to do both at one time. Just do a little more zooming in on "my" preferred scale.
But even at the one you did for me I could see some FLs in each breath....just not as clearly.

You are still having some FLs with 10 fixed and EPR 1. Since EPR at 2 is uncomfortable just stick at 1 EPR for now. You can always revisit higher EPR down the road if you wish.

It remains to be seen if the machine will increase the pressure (which is the next logical step to smooth out FLs) in auto mode but worth a try.
It remains to be seen if more pressure will cause aerophagia issues as well. Sometimes there is a fine line that keeps the aerophagia monster at bay or that opens the door and he rushes in.
It remains to be seen if you can do much to fix the FL breaths or even if they need to be fixed.

At some point you need to pick a setting and run with it for a few days just to give your body time to adjust and establish trends and patters and see how you actually sleep.

Moisture in the mask or hose from the humidity setting...common problem but if you don't like or need more moisture then just set it back to what worked well in the past. The most common symptom of needing more moisture is something like what we get with a common cold or allergy attack...sneezing, congestion, drainage, pressure in the sinuses, itchy...and if you aren't experiencing any of those symptoms you don't need to increase the setting anyway.
If anyone should need more humidity and that humidity does cause condensation in the mask or hose...there are ways to deal with it though. I am one of those people myself and I have lots of experience dealing with condensation/rain out in the mask or long hose. So it can be done if needed but if it isn't needed or wanted...just set humidity lower and not worry about it. Humidity preference is truly a comfort setting only.

Time to move on to apap mode and 10 minimum and 12 max (since you are aerophagia leery) is a good start.
Gotta start somewhere.
Please don't just report numbers and graphs without subjective results as well. How you sleep and feel is just as important as numbers and graphs.

SleepyCPAP wrote: ↑

Mon Aug 02, 2021 6:38 am

.

The curves on the last image look good, though it's harder to tell since the limit they've got a 100liter swing on either side. you turned on the red lines, but set the limits back to -50 to 50

Last night my bladder let me go a long time. I’m sorry I could not have had another half hour, but I think the leaks at the end, and the pressure climb, were enough to bring me out of sleep long enough for my bladder to complain to me so I had to get up.

As far as sleep quality, I feel as if I got up a little too early, so sleepy, and my body doesn’t feel fully refreshed, so maybe I didn’t get much uninterrupted time in deep sleep.

EPR1 and humidity 4 settings felt fine. I fell asleep quickly and comfortably, and my nose and sinuses feel fine in the morning.

Leaks - just got worse. This 3M micropore tape is not holding up through the night. I purse my lips when putting it on, and then layer another overlapping, and then two vertical strips overlapping again at the corners of my mouth.

I’m ignoring the events in the first 12 minutes - those are sleep transition events. It is clear the machine wants to ramp up for them though! The four neatly spaced hypopnea later in the night (with one CA) seem to come after my leak stops or a transition in sleep (big breaths first which broke the even breathing pattern that preceded it). I think they are _after_ awakenings so I am not bothering with them.

The only apnea of note is the one CA around 4:24 in the morning. That had even breathing right up to it. Oscar says it was for 13 seconds. My leak stopped as I came out of the apnea, and I had the big breath pattern following. So that one seemed real. Given the flow / flattening just before it I wonder if it was really an Hypopnea or Obstructive Apnea.

Interesting that the data does not include the length of hypopneas. The 34 secs total time in apnea for the night is just the OA and CA total.

If I’ve got that continued flattening curve / Flow Limitation through the night, why isn’t APAP keeping up my pressure? Is it because I’m in soft response mode, with the slow rise and decent of pressure adjustment? Again I am sorry I don’t have a “For Her” model, as that algorithm is more sensitive to flow issues. (I’m grateful to have this well used AutoSet though, and be off my recalled PRS1).

After falling asleep I go into a weird shallow breath pattern (I’ll save that snapshot for the next post) that lasts a long time.
-SleepyCPAP