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1 month into therapy and still struggling
#1
1 month into therapy and still struggling
            I've been struggling to adjust to treatment for about a month now and it feels like it's getting more and more difficult.  

I have been diagnosed with severe obstructive sleep apnea (33 events per hour), sometimes holding my breath for up to 50 seconds at a time.  Oxygen drops to 91%, snoring is moderate, no irregular heartbeat and I have periodic leg movements at 44 times per hour.  I also have chronic insomnia just to keep things interesting.  I have struggled with sleep for as long as I can remember but never felt like I would wake up gasping for air, so sleep apnea was never on my radar.  I came about my apnea diagnosis because I am under investigation for heart failure/enlarged heart.  Researching sleep apnea I have other health issues that are probably related to not treating it sooner: forgetfulness, brain fog, macular degeneration, depression and anxiety.  

The Dr. started me on APAP pressure 6-12 with a nasal pillow mask.  Some nights I am OK, other nights I cannot sleep.  I find I am waking up 3-6 times a night on average with an overwhelming feeling of being suffocated or not being able to breathe.  Each time I would look at my pressure and most of the time it would be over 10.  I contacted my Dr. and I have been changed to CPAP pressure of 7.0.  I still feel like I being blown up like a balloon, I just can't sleep with all this pressure.  I am using a humidifier of 5, ramp is on auto (4), EPR is at 3.

I'm supposed to be going to see the tech for a possible new mask on Wednesday.  I am already struggling with just having the nasal pillow under my nose and the straps on my face are driving me nuts.  I can't imagine trying to sleep with a full or nasal mask.

I would really appreciate it if someone could take a look at my OSCAR data, the February stats are with APAP and the March is when I have been switched over to CPAP.

Any advice is greatly appreciated.  I have to make this work, my heart is really struggling and I do not want to do anymore damage to it.
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#2
RE: 1 month into therapy and still struggling
Welcome to Apnea Board,

Flow Limits seem to be your worst stat. Since you're already on EPR 3, you need to increase minimum pressure to realize the full benefit of that EPR. To run EPR 3 you need a Min pressure of 7. Your PAP cannot reduce exhale below 4, which is what's attempted by the EPR of 3 and pressures below 7. The math just won't permit this. Pressure of 7 minus EPR 3 equals 4. Try it and see how it goes.

PS have you tried the ResMed P10 pillows mask? It's said to be one of the best.
Dave

OSCAR
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: 1 month into therapy and still struggling
Your numbers are good and the Dr. moved your inhale up to only 7 - most adults have to have at least 8.  If I am below 9 I am waking up gasping for air.

What do the pressure numbers mean?  If you had a drinking straw and made marks on it of 1cm all up the straw. Now putting that straw in the water and push just enough air out so you blow bubbles.  Of each centimeter the straw is in the water that is a cm of pressure.  So what you think as a lot of pressure is a straw in water 7cm is the air pressure to make bubbles.

That is not much pressure in fact any less than that you would be complaining that you are not getting enough oxygen to breath in.  In fact that is what you told the Dr. and he moved the pressure up so you could breath.

Most of the time it is just a fear of what is new and you have not experienced before.  You might try(quite a few do this when they are first starting)  hook up everything and don't go to bed.   Sit in comfortable chair and read a book for a couple of hours and get use to it before going to bed.  If you don't like a book watch tv and don't think about it.  Soon you well get accustomed to it and you will be able to sleep with it.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: 1 month into therapy and still struggling
Let's see if I understand what you're saying  Thinking-about  The problem is my ramp setting starting at 4, is this the reason why I feel like I can't breathe?  Honestly, this is all so confusing.

Last night I had my ramp at 4 but only on for 20 minutes and the pressure gradually climbed to 7 and this felt much better.  I actually slept for a full 7 hours, still woke up twice but was so comfortable I didn't want to get out of bed or turn the machine off, which I have done in the past.

Is this the probable issue?  I will ask to see the ResMed mask tommorrow  Thanks
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#5
RE: 1 month into therapy and still struggling
The Dr. said they wanted to put me on a low CPAP pressure of 7 because when I was on APAP and the pressure went above 10 to correct an apnea it would wake me up.  Not sure if it was the apnea that woke me up or the pressure rising that woke me up.  Since being changed to a constant stream of air it seems to be less disruptive.

I think if I understand correctly my issue with not feeling like I'm getting enough air is because my ramp is set to start at 4 and with the EPR on at 3 that is just not possible?

I will try starting with a higher ramp number tonight and see how it goes.
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#6
RE: 1 month into therapy and still struggling
We can set you to a fixed pressure to help prevent sleep disruption, but you need both a higher pressure than the 6.0 your most recent graph shows, and you need to use the exhale pressure relief (EPR) to help you with the inspiratory flow limitations. You doctor also has ramp starting from 4.0 cm. That is a very low pressure and does explain why you feel suffocated.

I recommend you make the following settings to give you pressure high enough to use EPR and to give constant pressure as indicated by your doctor:
Mode: Autoset For Her
Minimum Pressure: 8.0
Maximum Pressure 8.0
EPR On Full time
EPR Setting: 3
Ramp: Off
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: 1 month into therapy and still struggling
I will give this a try tonight, thanks for the guidance.
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#8
RE: 1 month into therapy and still struggling
I tried turning the ramp off last night and pressure of 8 but it was just too overwhelming.  I set my ramp to start at 4.5 and for 15 minutes.  I kept the pressure at 7.0.  This is the result, my worst yet in terms of number of AHI.  How does this look?  I know I did not fall asleep until after 2 am as I was tossing and turning looking at the clock.


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#9
RE: 1 month into therapy and still struggling
Your session from 3:45 t0 8:30 was the longest one yet. An AHI of 1.27 is not something to be alarmed about and what we want to accomplish is comfort. Compared to the fixed pressure 6.0 with EPR 2, you achieved more time in therapy without breaks. By the numbers there is not much difference between 6/4 and 7/4 (Inhale/exhale). There was a small positional cluster of OA at 01:40, but you indicate you were awake. The AHI is not an issue at this level, and I would say it's a judgement call on comfort if you prefer the lower fixed pressure of higher pressure. One night is not much to go on.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: 1 month into therapy and still struggling
Thanks for the feedback.  I will continue on and see how the next few nights go.  Last night was the first time I was actually "comfortable".  What would cause the positional cluster of OA when I was awake?  I am a side sleeper, preferring my left side.
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