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2 full years of CPAP usage - zero improvement
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vsheline Online

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Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #51
RE: 2 full years of CPAP usage - zero improvement
(08-23-2014 09:01 PM)retired_guy Wrote:  I'd like to see the bottom end of your range come up a little. Turning the EPR down a little will allow you to test that without any dramatic things. Raising the minimum pressure would do that as well, but it would have to go up 2 or 3 notches to make any difference.

Hi Route67,

Actually, since you have virtually no central apneas, raising both the EPR (Exhalation Pressure Relief) setting and the Min Pressure settings would be safe and may lower RERA (Respiratory Effort Related Arousal) events, which are arousals (and therefore keep us from achieving deep restorative sleep) but which are not detected by the ResMed S9 series machines and which are not counted in the AHI numbers.

So your AHI may be great but you may be suffering from many RERA events which your machine does not report.

Bi-level CPAP therapy is often able to eliminate RERA events and allow good sleep quality, and EPR is a form of bi-level treatment, so increasing EPR my be able to help reduce RERA events.

So increasing the EPR may help, but EPR lowers the pressure during exhalation (EPAP), so we would need to increase the Min Pressure setting to compensate.

Also, your Min Pressure setting is probably too low, anyway, even if EPR is not increased. It is usually not helpful to have Min Pressure lower than about 5 lower than the 90% or 95% pressure. Raising the Min Pressure may also help reduce RERA events. Also, some patients actually find they do best when their Min Pressure setting is as high as 1 or 2 less than their 95% pressure, or even higher, because they find they feel better when the pressure stays more steady.

I suggest raising the Min Pressure to be not lower than 5 cm H2O lower than your 95 percentile pressure, and to turn EPR to its max setting (3), if that would not be uncomfortable for you.

And after doing that, I suggest you then watch your ResScan data for a week or so between changes. In particular, I would suspect it may help to keep EPR setting at 3 and to walk your Min Pressure higher by 1 cm H2O each week until your Min Pressure gets close to your 95% pressure, or until you see whether that is helping or not.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 08-25-2014 02:13 AM by vsheline.)
08-24-2014 07:55 PM
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Peter_C Offline

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Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #52
RE: 2 full years of CPAP usage - zero improvement
(08-23-2014 07:31 PM)retired_guy Wrote:  Good for you Route,

Yes we're all just giddy with anticipation awaiting your results. Again, the things we'll like to see are ahi, and what comprises it. In otherwords how many OA, CA, and so forth. Secondly your pressure settings and the actual results the machine reports. And the leak numbers. And your moon sign. And your favorite song. And your favorite ice cream flavor (flavour for our Suburban friends up north and south)....... Can't think of anything else right now.

And do you have furry kids (err pets), and if so what kind, ages, names and recent photos too please?

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
08-24-2014 11:44 PM
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JohnNJ Offline

Preferred Members-2

Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #53
RE: 2 full years of CPAP usage - zero improvement
Route67 - Not sure if this makes a difference but do you drink a lot before going to bed? I drink a lot from the time I wake up until mid-afternoon. Then I reduce my drinking to a minimum and "empty out" before bed. I sleep straight through most nights.
08-25-2014 10:52 AM
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Route67 Offline

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Posts: 68
Joined: Aug 2012

Machine: S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Resmed
Humidifier: Resmed
CPAP Pressure: Auto
CPAP Software: SleepyHead Other Software

Other Comments: On CPAP for 2 years, still can't sleep. Edit; make that 4 years now, still can't sleep.

Sex: Male
Location: New Hampshire, USA

Post: #54
RE: 2 full years of CPAP usage - zero improvement
(08-24-2014 07:55 PM)vsheline Wrote:  I suggest raising the Min Pressure to be not lower than 5 cm H2O lower than your 95 percentile pressure, and to turn EPR to its max setting (3), if that would not be uncomfortable for you.

And after doing that, I suggest you then watch your ResScan data for a week or so between changes. In particular, I would suspect it may help to keep EPR setting at 3 and to walk your Min Pressure higher by 1 cm H2O each week until your Min Pressure gets close to your 95% pressure, or until you see whether that is helping or not.

The problem is, the EPR setting was on three before I started this thread .....I turned it down to zero based on the comments of another poster. If I go back to three am I not right back to where I started?

You also mention watching the ResScan data for a week or so between changes and adjusting for the proper pressure, etc......since 2 nights ago was the first time I have ever used the Sleepyhead software, how can I figure out what is good or bad for my particular situation? It it all just by trial and error and trying different settings over a period of a week's worth of sleep?

I am kinda more confused than ever, I certainly appreciate your reply but honestly I didn't understand most of it.
08-25-2014 06:17 PM
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Route67 Offline

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Posts: 68
Joined: Aug 2012

Machine: S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Resmed
Humidifier: Resmed
CPAP Pressure: Auto
CPAP Software: SleepyHead Other Software

Other Comments: On CPAP for 2 years, still can't sleep. Edit; make that 4 years now, still can't sleep.

Sex: Male
Location: New Hampshire, USA

Post: #55
RE: 2 full years of CPAP usage - zero improvement
I am now studying the Sleepyhead software thread at the top of the page for some more tips....
08-25-2014 06:23 PM
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retired_guy Offline

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Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #56
RE: 2 full years of CPAP usage - zero improvement
(08-25-2014 06:17 PM)Route67 Wrote:  
(08-24-2014 07:55 PM)vsheline Wrote:  I suggest raising the Min Pressure to be not lower than 5 cm H2O lower than your 95 percentile pressure, and to turn EPR to its max setting (3), if that would not be uncomfortable for you.

And after doing that, I suggest you then watch your ResScan data for a week or so between changes. In particular, I would suspect it may help to keep EPR setting at 3 and to walk your Min Pressure higher by 1 cm H2O each week until your Min Pressure gets close to your 95% pressure, or until you see whether that is helping or not.

The problem is, the EPR setting was on three before I started this thread .....I turned it down to zero based on the comments of another poster. If I go back to three am I not right back to where I started?

You also mention watching the ResScan data for a week or so between changes and adjusting for the proper pressure, etc......since 2 nights ago was the first time I have ever used the Sleepyhead software, how can I figure out what is good or bad for my particular situation? It it all just by trial and error and trying different settings over a period of a week's worth of sleep?

I am kinda more confused than ever, I certainly appreciate your reply but honestly I didn't understand most of it.

Sorry for the confusion. As in all things, everybody sort of has there own idea of a good time.

The one thing we sort of agree on is a modest increase to your minimum pressure might be a nice place to start. I elected to advise you to turn off the epr to try to accomplish that. My thought is that would allow for a very modest increase in the low pressure, particularly on exhale, where as in order to increase it the other way would be to jump it by 3 or more points so that the EPR didn't just take it back down where you start.

I do feel it is very important to just do one thing at a time. Since that at this point is to turn off your EPR, then I think you need to determine whether or not that makes any difference over the course of a few days before going anywhere else.
08-25-2014 07:16 PM
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Route67 Offline

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Posts: 68
Joined: Aug 2012

Machine: S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Resmed
Humidifier: Resmed
CPAP Pressure: Auto
CPAP Software: SleepyHead Other Software

Other Comments: On CPAP for 2 years, still can't sleep. Edit; make that 4 years now, still can't sleep.

Sex: Male
Location: New Hampshire, USA

Post: #57
RE: 2 full years of CPAP usage - zero improvement
OK, well I am going to leave it off for a few days and see where I stand.....I slept OK the past 2 nights but still more urination than necessary. At least I think so; a normal 52-year old should wake up once a night to void, maybe twice, max.....I am still 3+.

I have a DR appointment next Tuesday, a new person this time. The guy who told me a year ago that I was cured is off my radar screen, I am starting with someone new and I really really hope I can get some results, 4 years of this [2 on CPAP!] is really making me wiped out and literally tired of all this.

I was told at the start of therapy; "Once you use the CPAP you will feel like a window shade is opening up on life" - I have yet to experience that feeling.
08-25-2014 07:44 PM
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retired_guy Offline

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Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #58
RE: 2 full years of CPAP usage - zero improvement
Well, is OK an improvement? Maybe we're on the right track. Did you think to compare the Flow limit graphs for now versus a day or so ago? I'd kind of like to see what that graph looks like.
08-25-2014 07:50 PM
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Route67 Offline

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Posts: 68
Joined: Aug 2012

Machine: S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Resmed
Humidifier: Resmed
CPAP Pressure: Auto
CPAP Software: SleepyHead Other Software

Other Comments: On CPAP for 2 years, still can't sleep. Edit; make that 4 years now, still can't sleep.

Sex: Male
Location: New Hampshire, USA

Post: #59
RE: 2 full years of CPAP usage - zero improvement
Will do that right now and send an image, thanks for reminding me.....
08-25-2014 07:55 PM
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Route67 Offline

Preferred Members

Posts: 68
Joined: Aug 2012

Machine: S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Resmed
Humidifier: Resmed
CPAP Pressure: Auto
CPAP Software: SleepyHead Other Software

Other Comments: On CPAP for 2 years, still can't sleep. Edit; make that 4 years now, still can't sleep.

Sex: Male
Location: New Hampshire, USA

Post: #60
RE: 2 full years of CPAP usage - zero improvement
This is all I see when I go to File/Preferences/Graphs

None of these are clickable


http://imgur.com/a/IyTcK
08-25-2014 08:02 PM
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