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[CPAP] Am I Doing it Right?
#1
Question 
Am I Doing it Right?
I'm a mid 30s male, no significant health issues other than a diagnosis of OSAS.  I snore extremely loudly and was noticing problems in concentration and general sleepiness.  I had an at-home study and had an AHI of 78.  I have been issued a ResMed AirSense 10 AutoSet and an AirFit F10 mask with humidifier.  I have been using the equipment for over a year.  I have some sleep hygiene issues, often falling asleep on the sofa rather than taking myself to bed; I do try to get six hours or more of CPAP sleep though with compliance of 92% over the past year.

I generally sleep on my side of back, often moving during sleep to counter general discomfort.

I've not seen anyone about my condition since the equipment was issued.  They sent me a replacement mask on request though.  They have remote telemetry on the machine and I guess they review it in order to sign off my driver's licence renewal.  My 30 day AHI is 1.83.  I have no idea if I'm doing things right, whether I need any tweaks on my settings etc.  I feel that I am sleeping 'ok' but often do not wake feeling rested.  I tend to have some sleepiness in the early evening and then 'crash' around 11 PM without enough energy to take myself upstairs to bed hence the falling asleep!  Of course this is a bad cycle because I wake myself up with choking dreams and rapid heart rate!  I also seem to suffer with a very dry mouth while using CPAP (this is what tends to wake me up if I don't set an alarm) and occasional problems with the mask filling of drool!  I don't really want to turn the humidifier up more because any moisture on my nose wakes me up itching.  I assume I must still be having events which is causing the pressure to raise; indeed I have noticed that if I drink alcohol my AHI is lower that night (I assume because I have more events which ups the pressure and lowers the AHI).

I have OSCAR and have been backing up my SD card to it now and then.  Would someone take a look?  Screenshots from last night (weekend so I had a lay in).  I'm curious as to whether it generally looks 'OK' and also what is happening with some of the events I do see.


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#2
RE: Am I Doing it Right?
Results based on AHI are good, but very high flow limits, confirmed by the flattened inspiratory wave show you have a lot of airway resistance. Your Resmed Airsense 10 Autoset has a built-in solution to this. Go into the clinical settings and enable EPR (exhale pressure relief) full-time at a setting of 3. This will give you bilevel therapy and give pressure support to inspiration with 3-cm higher pressure than expiration. Give it a try and post results tomorrow if possible. Should be much more comfortable, but sometimes we need to increase minimum pressure to account for lower expiratory pressure.
Sleeprider
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#3
RE: Am I Doing it Right?
As above, enable EPR fulltime, and consider raising your base pressure from 4.
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#4
RE: Am I Doing it Right?
Yes, I would do those 2 things.

EPR3 full time
Min move from 4 to 7
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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#5
RE: Am I Doing it Right?
Based on media pressure of 9.68, setting the minimum at 7 seems appropriate and will allow EPR to work all the time.
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#6
RE: Am I Doing it Right?
Set EPR = 3, Fulltime (you are currently on Ramp Only at 1)
Min pressure= 7 to give EPR room to work.
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#7
RE: Am I Doing it Right?
I switched EPR on to 'full' with a level of 3 and went off to bed having only seen the first reply here.  I feel that I did not sleep well, I was rousing several times during the night, not enough to wake me but definitely a feeling of consciousness laid in bed.  I felt like I wasn't getting the pressure I am used to, it almost felt like the machine was off when I was awake with it on.  I had a higher score too (admittedly I didn't go to bed until quite late).

Do I need to change pressure levels?  What is the purpose of the EPR setting?


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#8
RE: Am I Doing it Right?
As noted above, you need to raise your minimum pressure to at least 7 cm to allow for the EPR of 3 to be effective. A minimum pressure of only 4 cm is rarely effective or comfortable for most adults.

EPR=Expiritory Pressure Relief. This lowers your pressure on exhaling to make it more comfortable.
My get-up-and-go musta got up and went.  Cool

Download OSCAR for your sleep data.  
https://www.sleepfiles.com/OSCAR


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#9
RE: Am I Doing it Right?
Get a soft cervical collar. Look at the bottom of Sleeprider's post. There's a wiki link for cervical collars. Also, like the above poster said, try raising you pressure to 7. There's no need for it to be at 4.

I don't think minimum of 4 is the issue with your clustering. Your clustering happens at greater pressures. Try the collar.

Don't worry about EPR. It's not making anything worse. It's a coincidence you got clustering after you raised EPR. Clustering is caused by other factors. Keep the EPR 3 setting.

OSCAR charts assessments are complex. There's a lot of factors involved, and they can happen at any time. You have to see several days data to get a decent grasp. Just because a setting was changed doesn't mean it's the blame for it because there are other factors involved, and there's many external factors that are circumstantial. As you discover these factors you get a bigger picture.

You will get a feel of this the longer you use OSCAR.

Actually, look at your pillow as well. Does it make your head tilt downward? Too thick? Make sure to get something that will level your head better because head tilted downward can restrict airflow. Which is what causes clustering. Which is why we recommend collars for that here. To keep your head neck position from bending to kink your airways.
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#10
RE: Am I Doing it Right?
You may have had a bad nights sleep BUT not because of changing the EPR

EPR is exhale pressure relief meaning it lowers the exhale pressure nothing more. You have the min at 4 and 4 is the absolute lowest it can be set so… min 4 - EPR 3 still = 4. You would HAVE TO raise the min above 4 to make ANY difference in pressure settings.

That is why we suggested min 7. Min 7 - EPR 3 =4. The same exhale pressure you have now.
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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