[CPAP] Newbie looking for help/opinions please!

[quiescence at last]

yes. so, as SR says - the EPAP is increased to correct as much as possible the OA, and the EPR is increased to help correct the hypopnea.  

so, my action if this were my data is -
keep EPR at either 2 or 3 to battle the hypopnea, and have the EPAP minimum pressure to about 13. so, my minimum pressure would be 13 plus EPR.
>  Option 1: with EPR set at 2, the min pressure would be 15.
>  Option 2: with EPR set at 3, the min pressure would be 16.
In either case, I would put max pressure at 20, but see how it works out (tempted to set my max pressure as min pressure plus 2. so pressure 15-17 or 16-18.)

good luck with your adjustments.

QAL

Hi quiescence

Have a look at my charts for last night and then have a look at my charts from when i had the EPR set higher. My Hypoapnea score is lower now than when my EPR was higher. What do you think , as my numbers have fallen again I'm tempted not to mess with the settings and spoil it.

My biggest issue now is mask leak! it's not mask leak from how I've got it on but more from when i sleep on my side as the mask gets slightly dislodged and causes the leaks. As soon as i move to turn over it stops!

Regards

Buck

REALLY SORRY THOSE PROS ARE BEING dittos


I liked what deep breather said, and was getting at.  you show what one day at 15-20 and EPR 3 is, and one day at 15-20 at EPR 1.  The attached chart was created for a bad-CA issue, but for you, the important thing was keep the exhale pressure high enough (looks like about 14.50 but acceptable at 13 cm) and increase the EPR - so the settings that match that are:

EPR 0  ->  min pressure 13.  - or -
EPR 1  ->  min pressure 14 (for exhale pressure of 13)  - or -
EPR 2  ->  min pressure 15 (for exhale pressure of 13) - or -
EPR 3  ->  min pressure 16 (for exhale pressure of 13)
so, if you get a chance at some future date test each of the above to see which ones get you the best H score.



QAL

[buckrogers76]

Well Folks

After all that and going to bed with trepidation expecting to wake up to poor results to greet me on the machine screen, i wake up to the SH data posted below! best stats ever and if this is not a one off then i guess my body/mind has started to adapt to CPAP treatment. Thinking all the adjustments bar EPR may have turned out to be not required.

Anyway i'm not going to get to far ahead of myself as it's only one night! on a separate note i have a question on alcohol consumption. How do you find having a few scoops effects your results?

Regards

Buck



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[Gideon]

I never noticed anything terrible from my drinking. but then I like to think I drink responsibly.
Starting October I'll be teaching a beer class 2 nights every other week.

[buckrogers76]

Hi folks

Been away for a short while but i'm back with some news. Could really do with some input/ideas as i'm feeling pee'd off with how it's all going.

Please see below for last nights SH data. Just to refresh your memories i got rumbled by the hospital (NHS) for making my own adjustments.
Got bollocked and my pressures ended up being reset from 15-20 to 6-20. It started out well with my best AHI score thus far on that first night but i'm now thinking that was a hangover from the previous set up i was on. Fast forward to last night which is 4 days on and my AHI was up to 16+ with according to my machine over 80 hypoapnea's through the night and 50 odd obstructive apneas. This was about 20 mins in apnea which i'm not happy with!

Called the clinic today and they refuse to raise my min pressure as the consultant doesn't agree with it. I am due to go in to see the consultant next week and am planning on going in with lots of print outs and info.

Found out some other stuff to like they have 5 nurses dealing with over 1000 patients (thats the NHS for you) , they won't accept emails with my SH data and they don't have time to go through my charts etc.

The data they are looking at in the clinic is just the basic resmed unit info that you can view on their website , this is the same website that will score your sleep 100/100 even if your AHI is 16+ and you have had over 100 untreated apnea events! , this is a sleep clinic for fucks sake and they don't have the staff the time or the required software (detailed wise) to concur with what i'm finding!

So my home oximetry test had me scored at 17 AHI which is obviously without using CPAP and last night whilst using CPAP on their prescribed settings in at 16 AHI one point below so CPAP is currently doing f all for me.

Can i copy the SD card onto another SD card and turn on aeroplane mode so i can put my min up to 11 (my rough median) and trial it out and see if i can bring my AHI down without raising suspicion that I'm messing with the settings?

Has anyone got any other ideas?

Also they were going on about higher min pressures and it can do you harm as you were not prescribed it etc etc. Will 11 min cause me any problems? i don't think it will and I'm almost certain it will have a positive effect!

Let me know what you think folks!

Regards

Buck

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[Sleeprider]

The events are obstructive, and higher minimum pressure is indicated. I don't know what background one must have to be a "consultant", but they must be really smart people to insist that you be treated poorly!

One other idea for you. The high number and clustering of events is shouting "soft cervical collar" to me. Your pressure does get high enough to address those events yet you're not responding. There may be some positional issues here.

[buckrogers76]

The events are obstructive, and higher minimum pressure is indicated.  I don't know what background one must have to be a "consultant", but they must be really smart people to insist that you be treated poorly!

One other idea for you.  The high number and clustering of events is shouting "soft cervical collar" to me.  Your pressure does get high enough to address those events yet you're not responding.   There may be some positional issues here.

Hey Sleeprider

Thanks for the response , i will try the soft collar tonight and see how i get on!

Regards

Buck

[buckrogers76]

Hi peeps

Followed sleepriders suggestion and last nights data looks a lot better. I do find the collar to be restrictive/disruptive to a degree , any tips?
Also whats going on with me waking up this morning with eyes that look like p*** holes in the snow , i feel worse with an AHI of 3.10 v 16.26!

So even considering below 5 is classed as treated , i'm still concerned that i had over 20 hypopnea last night. How is best to address those.
Could they be false readings like turning over which i do a sh*t load of every night!

Anyhow have a perusal of my stats and tell me your thoughts!

Regards

Buck

[Sleeprider]

The hypopnea are not a huge concern here because you have a great tidal volume at 660 mL. It is unlikely that the hypopnea are going to be a big problem for you in terms of not getting enough air. That said, the remaining hypopnea do line up with flow limitations, so we can conclude this remains an obstructive issue. I think how you feel, and perhaps your eye irritation may be related to leaks. It is quite high and this is either a bad fit or mouth leaks, and with the use of a FFM, I have to go with fit. So you might be getting a nice blast of air in your eyes through the night. Mask fit and leak reduction is really your next big task. I don't see a need for more pressure, and the positional therapy has helped a lot. Continue working with that strategy and try to get a more comfortable fit.

It's safe to say your machine is doing a lot of work to rise from a minimum pressure of 6.0 to its average of 13 and 95% pressure of 16.3. You will eventually find a steadier pressure is more comfortable. I recommend you start increasing minimum pressure towards a minimum of 12. Do this at a pace that is comfortable for you, but a minimum pressure of 6.0 is pretty pointless for you, and starting at a higher pressure may help you to get a better mask fit for when pressure goes higher...and it always will. I think your pressure is getting pretty high, so you may want to introduce EPR for comfort. You have not had any issues with central apnea, and EPR can help provided you also adequately increase minimum pressure.

[buckrogers76]

The hypopnea are not a huge concern here because you have a great tidal volume at 660 mL.  It is unlikely that the hypopnea are going to be a big problem for you in terms of not getting enough air.  That said, the remaining hypopnea do line up with flow limitations, so we can conclude this remains an obstructive issue.  I think how you feel, and perhaps your eye irritation may be related to leaks.  It is quite high and this is either a bad fit or mouth leaks, and with the use of a FFM, I have to go with fit.  So you might be getting a nice blast of air in your eyes through the night.  Mask fit and leak reduction is really your next big task.  I don't see a need for more pressure, and the positional therapy has helped a lot.  Continue working with that strategy and try to get a more comfortable fit.

It's safe to say your machine is doing a lot of work to rise from a minimum pressure of 6.0 to its average of 13 and 95% pressure of 16.3.  You will eventually find a steadier pressure is more comfortable.  I recommend you start increasing minimum pressure towards a minimum of 12.  Do this at a pace that is comfortable for you, but a minimum pressure of 6.0 is pretty pointless for you, and starting at a higher pressure may help you to get a better mask fit for when pressure goes higher...and it always will.  I think your pressure is getting pretty high, so you may want to introduce EPR for comfort.  You have not had any issues with central apnea, and EPR can help provided you also adequately increase minimum pressure.

Hi Sleeprider 


Thanks for the detailed response. I would love nothing more than to start raising my minimum pressure but I tried that before and the hospital whose outpatient care I'm under played hell. I have to call them to request any pressure changes and when I rang them yesterday a request to raise my min pressure was flat out denied.

That's why earlier in this thread I was asking what options I have to go rogue without detection i.e. Another memory card or aeroplane mode etc. 

On the subject of mask fit last night was effected by the introduction of the foam collar I think. I will refit it for tonight and see what happens. According to the resmed app prior to last night I was only at a 2 litres leak rate per min and that was for a few days.
Anyway tell me what you think ref the rogue stuff!

Regards

Buck
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[Sleeprider]

I forgot you're the one with the smart consultant that thinks one pressure works for all. Your pressure requirement is high enough that you might even qualify for bilevel in the U.S. Airplane mode will keep the meddlers from accessing your data, but you would eventually have to deal with them. I see our medical system following the U.K. model, and I hope we can pull it back from the brink for fully social medicine. Choice and individual rights matter.