New to CPAP - Help with pressure settings (ResMed AirSense 10)

Thanks everyone for your help and advice. I'm touched.

For now I've increased min pressure to 7 and after a few days gathering data I'll experiment with changing my EPR settings. I'm going to run 5-7 day experiments for each change I make.

I also went to three (!) different ENTs to ask what they think causes my sleep apnea. Two of them concur the cause being that the back part of my tongue is very large (they stuck a camera through my nose and described having difficulty even being able to see my vocal chords) and everything else looks normal. I already had my tonsils removed as a kid. Surgery was not advised.

I was also given a nasal spray called Ryaltris to see if it helps with my nose breathing before deciding whether to do surgery for my slightly deviated septum.

robysue1 wrote: ↑

Wed Nov 30, 2022 10:58 am

You might want to pick up a copy of Sound Sleep, Sound Mind by Dr. Barry Krakow.

Thank you I'll check this out.

Miss Emerita wrote: ↑

Wed Nov 30, 2022 12:00 pm

Do you have any sense of whether that's true or whether the leaks are mostly from your mask or your mouth?

I've been taping my mouth closed so I'm quite sure that the leaking is coming from my nasal mask. Later in the night (after 6 hours or so) I often get woken up by mask leaking into my eyes, but I can usually adjust it. But often I rip the thing off my face without realising it.

The mouth tape doesn't create a perfect seal so mouth leak could be a factor.

Miss Emerita wrote: ↑

Wed Nov 30, 2022 12:00 pm

Are you using ramp?

Yes I am (doctor set it up that way). I'll experiment with this, thanks.

I've been testing EPR 3 (min pressure 8, max 15) the last three days and I feel a lot worse when I wake up. I'll give it another day until I change it just in case it's a fluke.

Can anyone help me to understand, looking at my charts above, the appropriate pressure settings with EPR 3 turned on? It feels very light - like I'm not wearing a CPAP at all. I suspect min pressure should be higher.

PressurisedPete wrote: ↑

Sun Dec 11, 2022 1:51 am

I've been testing EPR 3 (min pressure 8, max 15) the last three days and I feel a lot worse when I wake up. I'll give it another day until I change it just in case it's a fluke.

Can anyone help me to understand, looking at my charts above, the appropriate pressure settings with EPR 3 turned on? It feels very light - like I'm not wearing a CPAP at all. I suspect min pressure should be higher.

you should post your most recent chart.

lynninnj wrote: ↑

Sun Dec 11, 2022 4:02 pm

you should post your most recent chart.

Good point! I've included 4 nights of me using EPR 3 below.

On all of these days I woke up feeling pretty awful and had quite bad fatigue for the entire day.

Anyone have any ideas? I'm a bit stuck at this point. I went back to min 7 max 15 (without EPR) and I sleep pretty well 60% of nights but otherwise I feel quite bad during the day.

You're back at 7 max 15 (without EPR)

The charts you uploaded on 8-15 with EPR.

How will our responses to the once again no longer relevant charts help you?

PressurisedPete wrote: ↑

Tue Dec 20, 2022 3:54 am

I sleep pretty well 60% of nights but otherwise I feel quite bad during the day.

When have you last had an overall phyiscal? Maybe you're not feeling well for a reason not related to sleep apnea?

robysue1 wrote: ↑

Tue Nov 29, 2022 6:51 pm

My guess is that you need to more or less keep doing what you are doing and keep track of how many days each week you feel good and how many days you don't. My guess is that in another few weeks, you might be feeling "good" 5-7 days every week.

But if you aren't, then I'd spend some time thinking about those leaks. They're not big enough to be triggering Mr. Red Frowney Face each and every morning, but they are long enough and persistent enough to ask the question: Could they be triggering some spontaneous arousals? And would eliminating the leaks make you feel better on more days than you do now?

My emphasis. The charts you uploaded still show bad leaks

ozij wrote: ↑

Tue Dec 20, 2022 5:51 am

How will our responses to the once again no longer relevant charts help you?

Sorry let me be more clear: a few people suggested turning EPR up to 3 and I tried that but I felt worse. I think perhaps the pressure needed to be higher to compensate for it. I don't understand how to figure out what it should be, though.

ozij wrote: ↑

Tue Dec 20, 2022 5:51 am

When have you last had an overall phyiscal?

Quite recently and it all came back okay.

ozij wrote: ↑

Tue Dec 20, 2022 5:51 am

The charts you uploaded still show bad leaks

Okay thanks. I'll give my nasal pillows another go. I experienced a lot of discomfort last time I tried. But they leak a lot less.

PressurisedPete wrote: ↑

Tue Nov 29, 2022 9:25 am

I did hospital lab study and it came back with AHI 31. I then did a separate at-home study (set up by a technician) that came back with AHI 10.1 (and also showed my blood oxygen fell to 86%). Both of them flagged hypopneas as the cause.

For some reason my original healthcare provider encouraged me to set a very high pressure (min 14, max 20) and it was causing me a lot of discomfort. I then sought a second opinion with a different provider who thought these settings were crazy and recommended min 4, max 15 and I'm now feeling better most days.

But many days I still feel awful and can barely function.

palerider wrote: ↑

Wed Nov 30, 2022 3:25 pm

PressurisedPete wrote: ↑

Wed Nov 30, 2022 9:40 am

palerider wrote: ↑

Tue Nov 29, 2022 6:50 pm

Now, THOSE settings are crazy.

Why is that?

Because a setting of 4 is correct for very very *very* few people. many people have trouble even breathing at a pressure of 4.
Reducing the max pressure is also foolish except in a few cases.

Based on the screenshots you provided, your pressure should probably be 9-20 Or 12-20 if you're going to use EPR.

PressurisedPete wrote: ↑

Sun Dec 11, 2022 1:51 am

I've been testing EPR 3 (min pressure 8, max 15) the last three days and I feel a lot worse when I wake up. I'll give it another day until I change it just in case it's a fluke.

Can anyone help me to understand, looking at my charts above, the appropriate pressure settings with EPR 3 turned on? It feels very light - like I'm not wearing a CPAP at all. I suspect min pressure should be higher.

Palerider suggested a mimimum pressure.
So did your doctor:

PressurisedPete wrote: ↑

Wed Nov 30, 2022 9:40 am

I forgot to mention that during my first sleep lab they did split study on me. The same doctor first put me on min 9 max 20. Then a few days later she checked the data and bumped me up to min 12 max 20. Then min 13 and finally min 14

I know its difficult to keep track of things when were' sleep deprived.
For the coming week:
Stick to min 7 max 15 no EPR.
Keep a daily diary of how you felt when you got up.
Then post the charts, and for each one, separately, tell us how you felt.

EPR lowers the effective minimal pressure, which is why PR said "if you're using EPR = 3, and you need a minimal pressure of 9, then tell the machine to give you a miminum of what you need + the EPR its' subtracting from the exhale pressure. EPR is there to make exhaling agains the minimal pressure feel easier.

You didn't say what made 14 feel so bad - but maybe you do need it to get rid of those flow limitations.
Your flow limitation may be impacting your oxygenation - and a gradual raise in pressure may be necessary.

ozij wrote: ↑

Tue Dec 20, 2022 8:09 am

Palerider suggested a mimimum pressure.

Good point. Soon I'll test 12-20 with EPR 3.

ozij wrote: ↑

Tue Dec 20, 2022 8:09 am

Keep a daily diary of how you felt when you got up.
Then post the charts, and for each one, separately, tell us how you felt.

I did that for the original charts at the start of this thread. There doesn't seem to be an obvious pattern in Oscar as to why I feel bad on certain days.

I've also been wearing an oximeter on my finger for the past two weeks and can see no obvious patterns (although I do get some drops to around 92% blood oxygen each night)

I tried the doctor's recommended high min. pressures for a few weeks and I just felt a lot worse and I was getting a lot of leaking with my nasal mask. Pillows leak less but they cause me a lot of discomfort.

Will continue testing! Thanks for your advice.

palerider wrote: ↑

Wed Nov 30, 2022 3:25 pm

PressurisedPete wrote: ↑

Wed Nov 30, 2022 9:40 am

palerider wrote: ↑

Tue Nov 29, 2022 6:50 pm

Now, THOSE settings are crazy.

Why is that?

Because a setting of 4 is correct for very very *very* few people. many people have trouble even breathing at a pressure of 4.
Reducing the max pressure is also foolish except in a few cases.

Based on the screenshots you provided, your pressure should probably be 9-20 Or 12-20 if you're going to use EPR.

This was a very important lesson you (PaleRider that is) taught me early on in my journey. Just bumping it for those starting out and searching for pressure settings that work.

Please correct me if I say this wrong, but for many if you need to increase EPR you should consider increasing min pressure by the same amount.

Jlfinkels wrote: ↑

Wed Dec 21, 2022 9:13 am

Please correct me if I say this wrong, but for many if you need to increase EPR you should consider increasing min pressure by the same amount.

Exactly right. As a rule of thumb, when you're experimenting with EPR, do that. Now, if you're fine tuning? maybe not. but by that time, you're already quite close to 'good' settings.