CPAP to Autoset

Today's episode of "Messin' with CPAP"

A few weeks ago, I turned my EPR off and that seemed to help daytime issues briefly. It did take my AHI down even further.
Last night I changed straight CPAP at 10 to Autoset from 10-13 (I still prefer a short 15 min ramp at 7). I checked my reading this morning:

AHI 0.1
Pressure 11.8!

In my sleep study, they stated at 11, my limb movement increased noticeably, so that's how they decided on 10. However I don't know how long they left me at 11 to decide 10 was more appropriate.

So far I don't feel too bad...I expected to drag today, since I went to my fitness class last night.
So now Autoset will be my new trial in treatment........

It may well be that all you needed was a bit more pressure!

Looking forward to tomorrows exciting episode

From what I understand about how these machines work, when you use the EPR function you need to increase your pressure by however many number settings you have the EPR set on. This apparently compensates for the less pressure used on exhale. If I am wrong in this I am sure someone will correct me.

Good luck

Congratulations, SnoozyQ! I've been reading your posts and have been trying to think of something that hadn't already been said that could help; guess I didn't realize that you were using straight cpap. I was titrated at 10, but made small adjustments over time, and now realize that the "10" was just a place to start. I've come to believe that 1 night in a bizarre set-up does NOT (necessarily) = optimal pressure. I recommend staying in this new range a few days, tracking your data & how you feel, and adjusting from there. Keeping my fingers crossed that apap with higher pressure improves your situation!

@snoozyq: I would take them at their word. It's entirely possible that 11 or 12 is the optimal pressure for AHI reduction; BUT, if it induces limb movements you're looking at a compromise. Your APAP has no way to sense limb movement. Finding that "sweet spot" is not something you can easily do at home.

@bap40: EPR is relief during the exhale part of the cycle (where no OAs occur). If you set EPR, then raise the lower limit, you have negated any benefit of exhale relief, while raising the inhale pressure above the optimal.

True, it doesn't have a way to check for limb movement. But at this point, I'm just looking to see if I feel worse, better, or the same. I certainly don't feel better at CPAP @ 10.

Correction though, my arousal was higher at 11, not limb movement. I double checked my report:

REPORT: During CPAP titration, pressures between 5 cwp and 11 cwp were used. The total sleep time
was 279 minutes with an overall sleep efficiency of 77%. The sleep latency was 12 minutes and the
REM latency was 183 minutes. At CPAP of 10 cwp, the best sleep was noted, and the AHI was 1.2 per
hour. At this pressure the desaturation index was 0 per hour and the arousal index was 8 per hour.
At pressures of 10 and 11 cwp, REM supine sleep was noted. However, the arousal index was higher at
11 cwp(18.6/hr). The overall periodic limb movement index was 16 per hour and the periodic leg
movement arousal index was 6 per hour.

I was also taking benzos to sleep at that time, where as now I do not. I do think that impacted my sleep.

11.8 again last night, AHI 0.4

I didn't wake up too early unable to go back to sleep. I actually slept until I was finished.

LinkC wrote:@snoozyq: I would take them at their word. It's entirely possible that 11 or 12 is the optimal pressure for AHI reduction; BUT, if it induces limb movements you're looking at a compromise. Your APAP has no way to sense limb movement. Finding that "sweet spot" is not something you can easily do at home.

@bap40: EPR is relief during the exhale part of the cycle (where no OAs occur). If you set EPR, then raise the lower limit, you have negated any benefit of exhale relief, while raising the inhale pressure above the optimal.

Some people do have obstructive apneas at the end of the exhale cycle -- EPR makes their results worse.

For the majority of people, the feeling of a difference between IPAP and EPAP is what gives them exhale relief. Thus, there are people - and I'll wager that not a few of them - for whom counting up from the EPR may be the right way to go.

Oooooohhhh! Congratulations, SnoozyQ! 2 nights in a row = you're on your way now!

ozij wrote:

LinkC wrote:@snoozyq: I would take them at their word. It's entirely possible that 11 or 12 is the optimal pressure for AHI reduction; BUT, if it induces limb movements you're looking at a compromise. Your APAP has no way to sense limb movement. Finding that "sweet spot" is not something you can easily do at home.

@bap40: EPR is relief during the exhale part of the cycle (where no OAs occur). If you set EPR, then raise the lower limit, you have negated any benefit of exhale relief, while raising the inhale pressure above the optimal.

Some people do have obstructive apneas at the end of the exhale cycle -- EPR makes their results worse.

For the majority of people, the feeling of a difference between IPAP and EPAP is what gives them exhale relief. Thus, there are people - and I'll wager that not a few of them - for whom counting up from the EPR may be the right way to go.

Wow Link, that is one ridiculous statement, "where no OA's occur" just as ozji points out. Wherever you get your information, ahh wait, you don't get information I forgot, you just post what you think is true....

Also as ozji points out, in some cases it is not always the exact lower pressure but the difference and drop in pressure that provides the relief.

You really should consider NOT posting advice unless you actually know something as fact, which this is now the third time in a week you posted misinformation.

SnoozyQ wrote:Correction though, my arousal was higher at 11, not limb movement.

That's very different. It's likely the change in pressure is arousing...not necessarily the actual pressure.

ozij wrote: Some people do have obstructive apneas at the end of the exhale cycle -- EPR makes their results worse.

For the majority of people, the feeling of a difference between IPAP and EPAP is what gives them exhale relief. Thus, there are people - and I'll wager that not a few of them - for whom counting up from the EPR may be the right way to go.

Any apnea would occur at the pause before inhale or during inhale. Not during any part of exhale. It's simple physics. The airway will not collapse until the exhale is finished. But it's too fine a point to really make a difference.

I suppose counting up is one way of keeping the relief...but at the cost of increased overall pressure. Is the benefit worth the cost?

LinkC wrote:It's simple physics. The airway will not collapse until the exhale is finished.

Physics is not always as simple as you imagine. My airway will sometimes obstruct during exhale. Not sure I would call it a collapse, but I can certainly have a huge amount of difficulty exhaling.

LinkC wrote:

ozij wrote: Some people do have obstructive apneas at the end of the exhale cycle -- EPR makes their results worse.

For the majority of people, the feeling of a difference between IPAP and EPAP is what gives them exhale relief. Thus, there are people - and I'll wager that not a few of them - for whom counting up from the EPR may be the right way to go.

Any apnea would occur at the pause before inhale or during inhale. Not during any part of exhale. It's simple physics. The airway will not collapse until the exhale is finished. But it's too fine a point to really make a difference.

It is not too fine a point to make a difference it people's results -- some people do not do well with EPR on.

I suppose counting up is one way of keeping the relief...but at the cost of increased overall pressure. Is the benefit worth the cost?

Link, you have an exceptional ability to breathe out against stratospheric pressure - others have an exceptional inablility to breathe out agains far lower pressures.
In healthy human beings with healthy lungs, exhalation is not a result of muscular, effort, it's a result of relaxing the muscles (see " The mechanics of breathing " in the Encyclopaedia Britannica). By giving a person lower exhale pressure, you emulate natural breathing conditions - the expanded lungs/ribcage drop down and the exhale is more natural.
The benefit - of an easier exhale - and the cost of higher pressure have to be decided by each user in person.

Edited to correct typo...

pressures.
In healthy human beings with healthy lungs, exhalation is not a result of muscular, effort, it's a result of result of relaxing the muscles (see " The mechanics of breathing " in the Encyclopaedia Britannica). By giving a person lower exhale pressure, you emulate natural breathing conditions - the expanded lungs/ribcage drop down and the exhale is more natural.
The benefit - of an easier exhale - and the cost of higher pressure have to be decided by each user in person.[/quote]

Okay, I just have to say it--this was beautifully explained and I actually learned a few things from this thread. I'm glad that people like you are here to correct misinformation! Thank you for what you do!