HELP needed for 13-yr CPAP user!

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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JoyD.
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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Thu Nov 10, 2022 1:08 pm

OZIJ wrote:
I'd say you were making too many changes at once since the beginning of November.
Your best results are with EPR off (or ramp only). The only change I'd make at this point is not use EPR for a week and see what it does.

PUGSY wrote:
Pick something and plan to stick with it. If you like how EPR feels...use it but I suspect you will need a little more minimum if you want to use EPR and even if you don't use EPR there's a chance you might need a little more minimum.

I would really like to see a full night in regular auto adjusting mode though....with whatever settings you like, feel good with and promote sleep. Gotta start somewhere.

Do you ever sleep on your back? The clustering of the flagged events makes me think of REM or supine sleeping or maybe a combination of both. I don't think it is solely REM related though. First REM doesn't normally last all that long.
I totally agree that I need to make one change at a time. Considering both your feedback, here's what I'll try first:

First - Tonight (Thursday) I'll set the Mode to regular AutoSet so Pugsy can see a full night on that setting. (You can tell me whether to leave it there or move back to "for Her")
THEN, Tomorrow (Friday) night I'll set the 2 EPR to Ramp only and leave it there for a week, then we can look at minimum pressure changes.

- OR -

Shall I do BOTH tonight: Set the Mode to regular AutoSet AND set the 2 EPR to Ramp Only . . . and stay there for a week or so? That would be my preference unless I should stick to one change at a time.



JoyD.

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Last edited by JoyD. on Thu Nov 10, 2022 1:13 pm, edited 1 time in total.
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Re: HELP needed for 13-yr CPAP user!

Post by Pugsy » Thu Nov 10, 2022 1:11 pm

Sounds like a plan.
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Re: HELP needed for 13-yr CPAP user!

Post by lynninnj » Thu Nov 10, 2022 2:28 pm

JoyD. wrote:
Wed Nov 09, 2022 8:41 pm
Lynn wrote:
I just looked here https://document.resmed.com/documents/p ... er_eng.pdf
You have an outlet but it doesn’t say it’s removable like the as11 so maybe that’s not the issue?
Yes, Lynn, it IS removable, but I have never removed it as some people do to clean it.
Ahh ok. Just thought if there was any sort of crack or break there it would be optimal and preferable to having something more serious.

Ignore the mean girl.

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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Thu Nov 10, 2022 5:37 pm

PUGSY WROTE:
Do you ever sleep on your back? The clustering of the flagged events makes me think of REM or supine sleeping or maybe a combination of both. I don't think it is solely REM related though. First REM doesn't normally last all that long.
Sorry, Pugsy, I forgot to answer this question in my last response to you with regard to sleeping supine. YES, occasionally I DO sleep on my back, though the majority of the time I'm a side sleeper (I'd guess 80% or more). Of course I can't see myself while I'm sleeping, but when I go to bed and lying there awake, I'm occasionally on my back. I'm NEVER on my stomach, very uncomfortable for me.

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Re: HELP needed for 13-yr CPAP user!

Post by ozij » Thu Nov 10, 2022 10:14 pm

Sounds like a reasonable plan to me too.

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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Fri Nov 11, 2022 6:46 am

OSCAR Reports for last night, Nov 10th. -- Mode: Regular AutoSet (Soft) & EPR at OFF:
EASY-TO-SEE STATISTICS: https://imgur.com/a/rOYidup
GRAPHS (now correctly formatted): https://imgur.com/a/ypUmXzk

* Pugsy, TWICE when I woke up I found myself SUPINE! (Now you have me noticing that.)
* I had reused my 4 pieces of 1" blue Nextape (since it seemed to still stick well). - But in the morning the right corner was just "a bit" loose. Will not reuse my tape anymore. Obviously that accounts for the increase in LLs compared with last night! :( :oops:
* I did put the Ramp on AUTO which seemed great since it waits for me to fall asleep until it increases pressure, making it very comfortable sleeping w/ EPR on OFF.

NOTE: With the AutoSet Mode, you can either use STANDARD or SOFT. I chose SOFT.

Looking forward to your comments.

JoyD.

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Last edited by JoyD. on Fri Nov 11, 2022 7:33 am, edited 3 times in total.
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Re: HELP needed for 13-yr CPAP user!

Post by Pugsy » Fri Nov 11, 2022 7:24 am

JoyD. wrote:
Fri Nov 11, 2022 6:46 am
Why is the end of the Event Flags graph grayed-out from 4:30 on? That's not a Large Leak is it ???

That big chunk from 4:30 on is gray because you have highlighted the time before 4:30 and the screen shot was taken with that section after 4:30 being omitted and the graphs all below the 4:30 time frame don't include the details.

Now there is a bit of a large leak but it doesn't really start until 08:00....but you can't see past 4:30 on those other graphs because you took a screenshot of a slightly zoomed in section of the night.

You need to have zoomed out...when you see gray on the events graph like that it means you are zoomed in on things in some fashion...big or little. It's not leak though. Note the smaller gray section at the very beginning of the night....that's omitted also from the detailed graphs.
Same thing as what happened at the end of the night.

FWIW....I think you are going to need more minimum and at some point I also think you should consider adding in EPR again to see if EPR helps reduce the FLs.
Now how much more minimum??? That's really something we can't tell for sure but I am thinking somewhere around where the median average is which is around 10 cm. Probably for sure 9 cm and there's a good chance a little more.

Also...I wouldn't be surprised if you were actually on your back more than you think. :lol:
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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Fri Nov 11, 2022 7:32 am

PUGSY WROTE:
That big chunk from 4:30 on is gray because you have highlighted the time before 4:30 and the screen shot was taken with that section after 4:30 being omitted and the graphs all below the 4:30 time frame don't include the details.

Now there is a bit of a large leak but it doesn't really start until 08:00....but you can't see past 4:30 on those other graphs because you took a screenshot of a slightly zoomed in section of the night.

You need to have zoomed out...when you see gray on the events graph like that it means you are zoomed in on things in some fashion...big or little. It's not leak though. Note the smaller gray section at the very beginning of the night....that's omitted also from the detailed graphs.
Same thing as what happened at the end of the night.
I just figured that out, and edited my post & POSTED THE CORRECTLY FORMATTED GRAPHS. You can check them out.
FWIW....I think you are going to need more minimum and at some point I also think you should consider adding in EPR again to see if EPR helps reduce the FLs.
Now how much more minimum??? That's really something we can't tell for sure but I am thinking somewhere around where the median average is which is around 10 cm. Probably for sure 9 cm and there's a good chance a little more.
So, should I MAKE CHANGES already? I can do one change tonight: maybe changing the minimum from 7 to 9 for now?? Then after seeing the results of that, the next night or so consider adding EPR 2 Full Night if FLs still need to be reduced??

Another question for you, Pugsy: I have my regular AutoSet set at SOFT. Do you know if that is going to make a difference in my Events compared to if it was set to STANDARD?

Thanks, Joy

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Re: HELP needed for 13-yr CPAP user!

Post by Pugsy » Fri Nov 11, 2022 7:44 am

Yep...that's better.

Which mask were you using? The P10???? You know some of that leak could simply be mask movement ...and some could be the tape coming loose. If it were my report ..and those leaks didn't really cause much in terms of wake ups...I don't know that I would do much worrying about them. I know when I sometimes end up using the P10 and not the Bleep/Eclipse and when I do I know for sure that on occasion the P10 has moved and I am having some large leak and it's not mouth breathing because I wake up and the mask is leaking at the nostrils because the straps have moved.

My above thoughts about last night ....unchanged after seeing the big picture.
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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Fri Nov 11, 2022 7:54 am

PUGSY WROTE:
Which mask were you using? The P10???? You know some of that leak could simply be mask movement ...and some could be the tape coming loose. If it were my report ..and those leaks didn't really cause much in terms of wake ups...I don't know that I would do much worrying about them. I know when I sometimes end up using the P10 and not the Bleep/Eclipse and when I do I know for sure that on occasion the P10 has moved and I am having some large leak and it's not mouth breathing because I wake up and the mask is leaking at the nostrils because the straps have moved.

My above thoughts about last night ....unchanged after seeing the big picture.

I'm staying with the ZEST since we are making CHANGES incrementally now, and I don't want a different mask to enter into the picture. ( I HAVE come to prefer the P10, but I don't think it's as stable as the ZEST, so I'm staying away from it for now.). Yep, as long as the LLs are no worse that last night, I won't worry about them as long as I'm sleeping comfortably.

Eager to hear what you know about the SOFT or STANDARD settings for regular AutoSet Mode, and if I should continue using SOFT for now.

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Re: HELP needed for 13-yr CPAP user!

Post by Pugsy » Fri Nov 11, 2022 8:01 am

I am so sorry but back when I was experimenting with the AirSense 10 for Her AutoSet it was relatively early in the release of that model and the early models didn't offer the "soft" vs "standard" response at all. So I have never had the chance to compare soft vs standard.

I do think that likely it is going to be that you have to go with a more subjective evaluation....how does it feel or how do you feel kind of thing. Does one or the other seem to cause you to sleep better????? That sort of evaluation.

What I would do is start with the obvious that needs some work....that minimum and those maybe FLs. Reduce your AHI kind of thing and then once you have that part of your therapy a little better manage THEN maybe play with soft vs standard and see if it changes anything or not.
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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Fri Nov 11, 2022 8:12 am

PUGSY WROTE:
What I would do is start with the obvious that needs some work....that minimum and those maybe FLs. Reduce your AHI kind of thing and then once you have that part of your therapy a little better manage THEN maybe play with soft vs standard and see if it changes anything or not.
That sounds good to me. I've just set my minimum to 9 for tonight.

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Re: HELP needed for 13-yr CPAP user!

Post by Iamstumped » Fri Nov 11, 2022 3:02 pm

@JoyD.
The soft or standard refers to the machine's response to pressure increases needed to keep your airway open
The "soft" will gradually increase pressure, more of a curve type of change, think of a hill shape.
while the standard will be more of a sharper pressure increase, more like a squared off type of increase.
ResMed believes that as a woman, you might want, or like the soft response

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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Sat Nov 12, 2022 9:59 am

Well, last night I had a terrible night. I had back pain that hurt sleeping on both my R and L sides . . . and I was trying to endure the pain & AVOID going supine! Therefore, I was extremely restless ALL night, and barely got to the 4-hour mark on my machine so I could use OSCAR. So any data is, no doubt, useless. I tossed & turned all night, turned my machine off several times to get up to get some relief. The good news is that after a terrible night & sleep deprivation my BP was normal this morning: 125/74 (noting PVCs as usual; my cardiologist isn't medicating me due to being asymptomatic, & drug side effects).

When I went to bed, I had the Minimum set to 9, but I was bothered by the air pressure (seemed that I was sensing some aerophagia, because I was uncomfortable & felt the need to burp). I envisioned AutoSet shooting up later to higher pressures & didn't want to face aerophagia & burping with my taped mouth . . . so panic set in & I reduced the Minimum down from 9 to 8 (originally it had been 7), and moved the MAX down just a bit from 18 to 17.4 (not that this would do much).

I'd like to get that MAX down to have a narrower range so that I won't get those occasional Autoset pressure surges. My WEEKLY report currently says that 95% of the time the pressure is 13.20 or below. Maybe it's too early to do this (because of any erroneous results when I was dealing with LLs several days ago & using the "For Her" Mode), but I'm tempted to set my pressure at 8-14 tonight and see what happens. Is that unreasonable?

FWIW: here are my last night's 4-hour stats & graphs:
https://imgur.com/a/TJUxhBg
https://imgur.com/a/JNHgIXo

I want to find a good Sleep Specialist near me, now that I've moved to Indiana. I live in Carmel, IN (just north of Indianapolis) in case anyone here might know. I plan to ask my Cardiologist & PCP who they recommend, as well as the ENT who I recently saw for my hearing. I'd love to have another in-house PSG - my last was in 2009 diagnosing me with Severe Sleep Apnea, w/ the O2 sat dropping as low as 84!
Here is some data from my 2009 sleep study interpretation by my sleep doc back then:
https://imgur.com/a/QdTOQEr.

(I don't even remember being diagnosed with Sleep Apnea "several years before" this 2009 study, and refusing treatment - what a stupid decision that was!). BTW, my weight is at 170 now, and would like to get it down closer to 160.

I also want to start monitoring my OXYGEN SATURATION levels during the night. DO ANY OF YOU HAVE RECOMMENDATIONS FOR AN AFFORDABLE DEVICE TO DO THAT . . . a watch, etc.?? (I do have an iPhone SE, if that might be involved.)

JoyD.

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Re: HELP needed for 13-yr CPAP user!

Post by robysue1 » Sat Nov 12, 2022 12:06 pm

JoyD. wrote:
Sat Nov 12, 2022 9:59 am
Well, last night I had a terrible night. I had back pain that hurt sleeping on both my R and L sides . . . and I was trying to endure the pain & AVOID going supine!
In my opinion you should NOT have been working so hard to avoid sleeping on your back. Pain is a real sleep killer. And if the pain was less while lying on your back, you would have been a whole lot better off getting some real sleep on your back rather than tossing and turning all night long enduring pain while trying to avoid back sleeping.

Here's the thing: If your pressure settings are pretty close to where they ought to be, you should be able to sleep on your back and still have the machine prevent most of your obstructive events from happening. In other words, one point of having the pressure set high enough is to allow you to sleep in all positions so that you can sleep on your back when you want to.

Therefore, I was extremely restless ALL night, and barely got to the 4-hour mark on my machine so I could use OSCAR. So any data is, no doubt, useless. I tossed & turned all night, turned my machine off several times to get up to get some relief.
Because you tossed and turned all night, yeah, the data in Oscar is "dirty" in the sense of having a lot of SWJ stuff mixed in.

But do note: There's no magic "4-hour mark" for using Oscar: If you use the machine for 5 minutes, Oscar will show the data for those 5 minutes.

In my opinion, the mistake you made was not so much trying to keep your mask on for 4-hours while tossing and turning all night long. In my opinion, the mistake you made was trying to stay off your back all night: Had you allowed yourself to roll onto your back while using the CPAP, you might have been able to have gotten comfortable enough to actually get some sleep while using the CPAP.

In other words, when you are in pain and trying to sleep, you have to fix the pain in order to sleep. If that means back sleeping, then sleep on your back while using your CPAP. Yeah, a few more events might happen, but getting some sleep on your back with the CPAP beats getting almost no sleep because you take your mask off because you're trying so hard to keep off your back and your in real, significant pain that is being aggravated by trying to sleep on your sides.

When I went to bed, I had the Minimum set to 9, but I was bothered by the air pressure (seemed that I was sensing some aerophagia, because I was uncomfortable & felt the need to burp). I envisioned AutoSet shooting up later to higher pressures & didn't want to face aerophagia & burping with my taped mouth . . . so panic set in & I reduced the Minimum down from 9 to 8 (originally it had been 7), and moved the MAX down just a bit from 18 to 17.4 (not that this would do much).
How long have you been dealing with aerophagia?

I'd like to get that MAX down to have a narrower range so that I won't get those occasional Autoset pressure surges.
Reducing the "occasional Autoset pressure surges" may also require increasing your MIN pressure in order to prevent the things that trigger the pressure surges in the first place. But if your pressure surges are always due to flow limitations, then capping the MAX around your 95% pressure level is a reasonable idea to try.
My WEEKLY report currently says that 95% of the time the pressure is 13.20 or below. Maybe it's too early to do this (because of any erroneous results when I was dealing with LLs several days ago & using the "For Her" Mode), but I'm tempted to set my pressure at 8-14 tonight and see what happens. Is that unreasonable?
Is reducing your pressure range to 8-14 a good or bad idea?

Well that depends. If you're trying to figure out what kinds of pressures your stomach can take because of aerophagia problems and you can handle the idea of your AHI being higher than usual, it makes some sense.

And given that your 95% pressure is usually 13.2, then setting the max pressure at 14 makes some sense: You are allowing your machine to go up to (and exceed by a bit) the pressure that is usually as high as you need it to be to treat your apnea.

But if you make this change in the settings, I would encourage you to keep these settings for at least 4 or 5 days, even if the first night seems like it's a disaster. Sometimes our bodies need a bit of time to really adjust to the new settings.

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