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Leak rate does look a lot better.
So hopefully leaks don't/won't be a cause of the wake ups.

At this point I still would concentrate on sleep quality in general and put the FLs on the back burner for now.
The usual fix for FLs...either more baseline pressure or adding in pressure support with exhale relief (which you tried and didn't like)....seems to be a potential aerophagia monster creating factor.

We don't know for your situation that the FLs are a factor for anything other than an sort of not so pretty graph but we know for SURE that the aerophagia monster really is a problem. I don't advocate (at least for now) going off trying to kill something that isn't a proven bad guy with something that we already know causes problems with aerophagia.

Get used to the new mask first....one night doesn't a trend make...and then revisit what might be done to pretty up the FL graph if you want to try to reduce the FLs. Maybe start with adding only 1 cm EPR instead of 3...maybe that would work for you better than 3 did. I don't know how you will do...everyone is different and there are lots of people that simply don't like the way exhale relief feels.

There is no urgent need to go reducing the FLs at this point since we know that the usual FL reducing actions cause the aerophagia monster to come for a visit. The aerophagia monster is a known problem....the FLs are a maybe problem.

Use the new mask for at least a week or so and then we can revisit the FLs if you want to.

Pugsy wrote: ↑

Sat Dec 11, 2021 8:57 am

Leak rate does look a lot better.
So hopefully leaks don't/won't be a cause of the wake ups.

At this point I still would concentrate on sleep quality in general and put the FLs on the back burner for now.
The usual fix for FLs...either more baseline pressure or adding in pressure support with exhale relief (which you tried and didn't like)....seems to be a potential aerophagia monster creating factor.

We don't know for your situation that the FLs are a factor for anything other than an sort of not so pretty graph but we know for SURE that the aerophagia monster really is a problem. I don't advocate (at least for now) going off trying to kill something that isn't a proven bad guy with something that we already know causes problems with aerophagia.

Get used to the new mask first....one night doesn't a trend make...and then revisit what might be done to pretty up the FL graph if you want to try to reduce the FLs. Maybe start with adding only 1 cm EPR instead of 3...maybe that would work for you better than 3 did. I don't know how you will do...everyone is different and there are lots of people that simply don't like the way exhale relief feels.

There is no urgent need to go reducing the FLs at this point since we know that the usual FL reducing actions cause the aerophagia monster to come for a visit. The aerophagia monster is a known problem....the FLs are a maybe problem.

Use the new mask for at least a week or so and then we can revisit the FLs if you want to.

You’re saying Areopagia will come when we do EPR? I had gas and bloating this morning. Will keep working at it!

BatmanMatt wrote: ↑

Sat Dec 11, 2021 10:02 am

You’re saying Areopagia will come when we do EPR? I had gas and bloating this morning. Will keep working at it!

No...actually EPR is the first thing we suggest that people do when aerophagia makes an appearance

BUT

If if remember correctly when you tried EPR...you didn't like how it felt. You had problems adjusting to the 3 cm difference if I remember correctly what you reported when you did try using EPR.
That is why I am reluctant to advise EPR....you said you had trouble getting used to it and going to sleep with it.
Now to be fair...3 cm difference could simply be too big of a jump for you.
If you want to try EPR set at 1 and see how you do...by all means do it. That is the first thing we advise for aerophagia problems.

Just bear in mind that with the minimum pressure set to 5 cm...the most reduction you can feel when starting the night is 1 cm no matter if the setting is 2 or 3 because the machine can't drop below 4 cm. If you used a higher setting than 1 the machine can't drop more until the pressure increases to where it can drop that much. Example...if you set the EPR level to 2..that's a 2 cm drop during exhale and you won't get that drop until the machine goes from 5 to 6 during the auto adjusting process.

Pugsy wrote: ↑

Sat Dec 11, 2021 10:12 am

BatmanMatt wrote: ↑

Sat Dec 11, 2021 10:02 am

You’re saying Areopagia will come when we do EPR? I had gas and bloating this morning. Will keep working at it!

No...actually EPR is the first thing we suggest that people do when aerophagia makes an appearance

BUT

If if remember correctly when you tried EPR...you didn't like how it felt. You had problems adjusting to the 3 cm difference if I remember correctly what you reported when you did try using EPR.
That is why I am reluctant to advise EPR....you said you had trouble getting used to it and going to sleep with it.
Now to be fair...3 cm difference could simply be too big of a jump for you.
If you want to try EPR set at 1 and see how you do...by all means do it. That is the first thing we advise for aerophagia problems.

Just bear in mind that with the minimum pressure set to 5 cm...the most reduction you can feel when starting the night is 1 cm no matter if the setting is 2 or 3 because the machine can't drop below 4 cm. If you used a higher setting than 1 the machine can't drop more until the pressure increases to where it can drop that much. Example...if you set the EPR level to 2..that's a 2 cm drop during exhale and you won't get that drop until the machine goes from 5 to 6 during the auto adjusting process.

I'll start 1 EPR tonight

Pugsy wrote: ↑

Sat Dec 11, 2021 10:12 am

BatmanMatt wrote: ↑

Sat Dec 11, 2021 10:02 am

You’re saying Areopagia will come when we do EPR? I had gas and bloating this morning. Will keep working at it!

No...actually EPR is the first thing we suggest that people do when aerophagia makes an appearance

BUT

If if remember correctly when you tried EPR...you didn't like how it felt. You had problems adjusting to the 3 cm difference if I remember correctly what you reported when you did try using EPR.
That is why I am reluctant to advise EPR....you said you had trouble getting used to it and going to sleep with it.
Now to be fair...3 cm difference could simply be too big of a jump for you.
If you want to try EPR set at 1 and see how you do...by all means do it. That is the first thing we advise for aerophagia problems.

Just bear in mind that with the minimum pressure set to 5 cm...the most reduction you can feel when starting the night is 1 cm no matter if the setting is 2 or 3 because the machine can't drop below 4 cm. If you used a higher setting than 1 the machine can't drop more until the pressure increases to where it can drop that much. Example...if you set the EPR level to 2..that's a 2 cm drop during exhale and you won't get that drop until the machine goes from 5 to 6 during the auto adjusting process.

1 EPR was totally fine, unnoticeable with the new mask I think. Should I increase to 2? No bloating or gas this morning.

Looks like flow limit is better, but AHI is up a lot. I think this is tied to the much better sleep I had last night. I had at least two good stretches of sleep which might be a first. Deeper sleep > higher AHI > starting to actually get an accurate picture of my AHI. The low scores were probably just from me waking up all of the time not allowing body to have events.

You are a bit like me...not big in the patience department. I preach it but don't always practice it.

But one thing I have always adhered to is one night does not a trend make and I never went changing things based on the results from one night unless the results were horrible...and I have had those experiments too. One change one night and have a horrible night and no way in hell would I want to repeat it.

Give yourself at least a couple more nights...preferably maybe even a week to see how things work out with this setting.
Your choice though. Everything is ultimately your choice.

Me...if I were in your shoes..and had the aerophagia monster hiding in the back ground.
I would ignore the AHI for now. I suspect a little of it is going to be arousal related (and not count)...it always is...and it's acceptable even if every single flagged event was a real asleep event it's an acceptable amount because to potentially bring it down we open the door for the aerophagia monster to come inside. Sometimes we just have to make compromises.
To reduce the AHI more minimum pressure is likely needed and more pressure could invite the aerophagia monster in.
Notice I said "for now"....I would want at least 3 nights with the new settings so I could see if these results hold or the results were a fluke or not.
I would not target "numbers" like the AHI and would instead still target my sleep quality and how I felt overall.
Numbers don't mean squat if we don't sleep well or feel like crap.

There is a lot of truth to the "give it time thing" when it comes to allowing the body to adjust to any change. For a lot of people the brain really only likes a nice predictable way of doing things and to keep throwing a change in the brain can cause problems. When the brain gets rattled it often goes in to hyper drive and we get insomnia in some form...not a good thing obviously.

Now sometimes I do end up advising a big change and fast because there is an urgent need for a big change. Maybe the AHI is so high that the need to bring it down is urgent...or maybe the aerophagia monsters presence is in itself a big problem.
In your case there is no urgent need for a rapid change or a big change.

Many years ago when I was trying out bilevel pressures and trying to figure out optimal pressures I did an experiment where I decided to pick a setting combination and stick with it for a period of time no matter what the results were unless they were horrible. I picked a setting and got "okay" numbers one night and some obvious "not okay" numbers some nights and even some horrible numbers on occasion but I still kept the same numbers. The goal was 6 weeks and then evaluate the results. As those weeks came about I started to notice a very gradual change...sometimes the "okay" numbers actually became "good/great" numbers and the nights with "not so okay" reduced. At the end of the 6 weeks I was consistently seeing an AHI that was half what my original "okay" AHI was and I was sleeping almost an hour longer..consistently.
This was with no changing of the settings at all. I went from and "okay" AHI of 2 to 3 to mostly seeing an AHI between 1 and 2 and sometimes less than 1.0.....and I was sleeping better/longer which always equals my feeling better during the day.
Even today I still will sometimes see some "not okay" numbers but they are very rare nights. Most nights are "okay" but sometimes I get like what I got last night which was 0.5 and I already know some of that 0.5 is arousal related because I don't sleep so great now but the reason isn't airway and instead related to pain issues this old body is having.

So your choice how much of a change you want to make or how quickly you make any changes.
Do give yourself at least 3 nights (at a minimum) to evaluate the change though...unless the change causes horrible results.

The aerophagia monster may always lurk outside your door or he might move on...we don't know.
You can always revisit higher pressures in 6 months or so if you want to or feel the need to but you may not even need/want to in 6 months.

Pugsy wrote: ↑

Sun Dec 12, 2021 8:56 am

You are a bit like me...not big in the patience department. I preach it but don't always practice it.

Here are the last few days with EPR 2. Any other thoughts at this point? I think I need to go back down to EPR 1, but it does seem to be working for the gas. I just dont like the sucking feeling of the EPR when im falling asleep.

I guess you have to decide which is the most annoying...the gas or the sucking feeling.
We always have choices....just sometimes the choices aren't particularly what we want.

On paper your results are well within acceptable limits either way....the thing we can't see on paper is how you feel and how you are sleeping and those are pretty darned important as well.

Pugsy wrote: ↑

Thu Dec 23, 2021 8:38 am

I guess you have to decide which is the most annoying...the gas or the sucking feeling.
We always have choices....just sometimes the choices aren't particularly what we want.

On paper your results are well within acceptable limits either way....the thing we can't see on paper is how you feel and how you are sleeping and those are pretty darned important as well.

Thanks. Is the goal 0 AHI or what? I’m not even sure what I’m after at this point. Clearly my doctor isn’t invested. Is my apnea even bad enough to warrant cpap? These are the things I’m questioning at the moment. I just want to sleep.

BatmanMatt wrote: ↑

Thu Dec 23, 2021 8:45 am

Is the goal 0 AHI or what? I’m not even sure what I’m after at this point. Clearly my doctor isn’t invested. Is my apnea even bad enough to warrant cpap?

I don't remember how bad your apnea was to start with but there was a reason .....symptom wise anyway...that you got the sleep study in the first place or started cpap on your own. I don't remember all your history ...sorry.
So just how bad was your apnea without cpap???

Remember what you see now is treated results...there is zero way to know how many apnea events were prevented by the machine. All we see on these reports are the ones that weren't prevented.

As far as having the goal of 0.0 AHI...unrealistic goal and not needed anyway. Everyone will/can have an occasional apnea event and it's not a big deal. Hold your breath for 10 seconds...any undue stress???? That's essentially a 10 second central apnea. Not a problem if random and rare. Even people who don't meet criteria to have earned the diagnosis of OSA will have occasional apnea events on a sporadic basis.

Then factor in the fact that some of the flagged events from our machines are not even asleep flagged events but instead they are awake/arousal breathing false positives. My AHI runs between 1.0 to 2.0 most nights and occasionally higher but most of the time 75% of that AHI is going to be awake/arousal related so those don't count. I know this because I have taken the time to go through the flow rate and evaluate awake vs asleep and I ignore the awake stuff.
I have pain issues that disturb my sleep. I know this and accept it.
It is extremely rare that I have an AHI of 0.0 because of the overall sleep quality issues I have and the false positives I know I have flagged.
Awake flagged events simply don't count other than they point to being awake when we need to be asleep.

I have always felt that AHI 0.0 is not my primary goal because it doesn't really guarantee that I will feel those nice low numbers. My number one goal has always been to eliminate O2 drops (mine went to 73%) and improve my overall sleep quality and how I felt during the day.

So....what was your AHI prior to starting cpap? Any desats? What symptoms were you having that started you down the cpap road? Have those symptoms reduced?