[CPAP] Setting [what to set for better sleep]

[Sleeprider]

Your are currently using a pressure range of 8-12 with EPR 3 resulting in an AHI of 1.1. Those are good results, but your sleep is not restful. Earlier in this thread, you used this same pressure range with EPR off and got over 6-hours of sleep. Perhaps, you could try 7-11 with EPR 1 and see if that works a bit better.

Your therapy results are fine, and you should focus on comfort.

[ajack]

Dear Friends,

For the last few days I am having a disturbed sleep. I have not changed any setting. I feel like my lungs are full with air and I do not have a feeling of inhale and exhale, feel suffocated and get up.

I am attaching a ResScan report for the last few days.

Thanks and regards

RK Dutta

just to make sure the machine is ok. Take your mask off the hose and remove the filter on the back of your machine, turn it on and see how much air blows out, you should hear the motor rev fast. then put the filter back on and try again, you should get a similar airflow. put the mask on, there should be air coming out holes in it.

Feeling that you aren't breathing out can happen when you start, don't try and breathe out, just let it happen. You really are getting enough air. The min pressure setting is keeping a little air in your lung, it really is nothing to worry about. the first thing is to have your mask on when you lay down, sit up to take it off, never lay down without it. It only makes it harder to get use to cpap. you really do need to keep it on all night.

take the suggestion of downloading sleepyhead seriously.

[RK Dutta]

Dear Friends,

I have followed suggestions given by all concerned friends and following are the results of the therapy over a period of one month.

Max. Pressure :   11.0
Min. Pressure  :    7.0
Ramp             :   Off
EPR                :  Fulltime
EPR Level        :   1

Report

Days used       :  30/30
Average use    :   5.9 Hrs
Used Hrs.        :  178.6 Hrs.
Pressure          :    10.6
AHI                 :    0.9

It looks alright though. But my discomfort still persists. The sleep is not continuous, I wake now and than, four to five times every night. I can not sleep on my left side, only on my right. I sit on my bed, put on my mask, start the machine. I can feel the air pushing through my nostrils and I am breathing normally. As I lie down, I start feeling that the air supply has reduced and I am slowly kind of breathless. I rearrange my pillows and after I am in half sitting position, keep adjusting my neck to find a position where I can feel some air going into my nostrils and fall into sleep till I shift my position during sleep and wake up with breathlessness.

I am not able to fathom whether it is some medical condition or psychological. I would normally take an hour's nap in the afternoon. But these days it is not possible. I try to go for a nap without using the machine. I cannot do it. I wake up gasping within five to ten minutes. So I have given up having a nap resulting in drowsiness, which I  keep on fighting till about four in the afternoon. At my age, one needs sleep a little more then whatever I am able to get.

Please share your thoughts.

Thanks and regards

R K Dutta

[OpalRose]

I am not able to fathom whether it is some medical condition or psychological. I would normally take an hour's nap in the afternoon. But these days it is not possible. I try to go for a nap without using the machine. I cannot do it. I wake up gasping within five to ten minutes. So I have given up having a nap resulting in drowsiness, which I  keep on fighting till about four in the afternoon. At my age, one needs sleep a little more then whatever I am able to get.

Please share your thoughts.

Thanks and regards

R K Dutta

Hi RK Dutta,
I think at this point you have to do whatever it takes to be comfortable with your sleep. Waking several times in a night is certainly not restful. When you wake at night, try not to get out of bed or turn machine off. Just try to get comfy and concentrate on breathing in and out slowly.

It could be that you are sensitive to pressure changes. Has anyone recommended that you try putting your machine in Cpap mode and use a straight pressure? Something like 8cm minimum, EPR off.

If you want to use EPR, then set it to 1, but then you may need to raise the minimum setting to 9cm to offset.

Give it a few days, and see how that goes.

As far as taking naps...who says you can’t? Take your nap with your mask on and machine running. I never nap without my machine. The few times a tried it, I was jolted awake several times. This is not good on the heart.

Take your naps if needed, but with the machine. Good luck. Would like to see you get more restful sleep.

[Sleeprider]

RK, you have the misfortune of owning a machine that does not record useful therapeutic data. Without information from the machine, it is very difficult to troubleshoot, verify or fix. The machine is reporting a 0.9 AHI which is good, but your sleep is disrupted due to a feeling you do not have enough air. Since you seem to be comfortable with the pressure, I can think of two things that might contribute to your feeling of air-starvation. First, you may be using a nasal pillow size too small for good flow. Get the next larger size and give it a try. Also, consider the Resmed Airfit P10 mask which is quieter and lighter than your current Swift FX. The second option is to use a higher minimum pressure and maximum pressure. You might try 8.0 to 12.0 and see if that relieves your symptoms. Your machine is reporting a pressure of 10.6 which is very close to your current maximum pressure. It appears you may benefit from higher starting pressure, and higher maximum pressure.

[RK Dutta]

Dear Friends,

Thanks for your support. Let me try your recommendations.

Thanks and regards

RK Dutta

[Ron AKA]

I read through all the posts, and here are my thoughts on what you have tried and where you are. Your AHI numbers are very good, and I think you just need to focus on getting the comfort level better.

1. I would suggest a Max 12 and Min 8 pressure setting, and then try each EPR setting starting with 1 for a few days at each setting up to 3. In theory the maximum EPR setting will provide the easiest exhale, and easiest inhale, and most air flow. But everyone is different so you need to just try it.

2. I also would suggest you try the ResMed AirFit P10 nasal pillow mask. I am not far behind you in age at 69, and was skeptical when that mask was suggested. However I am liking it much better than I thought. Perhaps partly marketing hype, but ResMed claims to have done a study where users of the P10 got nearly an extra hour of sleep compared to those using the Swift FX.

3. You have the ResMed S9 Escape machine which has some limitations on what data it collects and in turn limits determining how to best set it up. Have you considered replacing it with a used ResMed S9 AutoSet which does not have these limitations? I suspect you only need to replace the CPAP part of the machine as the H5i humidifier that you have will likely fit it. Perahaps there are used machines around that would not be too costly.

Hope that helps some

[RK Dutta]

Dear Friends,

I am using Resmed S9 Escape auto. I was earlier using Swift Nasal Pillows, now I am using, BMC's Fealite, Nasal Pillows System after Swift pillows's tube was broken. 

Since July 2019 I have been hospitalized for couple of times for COPD. My treatment for COPD is still continuing. These  days I am facing problem breathing even with the machine.

Could any one please suggest a remedy.

thanks and regards


RK Dutta

[RK Dutta]

Dear Friends,

I have been going through a tough time. Since July 2019 I have had three attacks of COPD, the last being March of 2020. I am on regular medication for heart(having a triple bypass on March 2000). since March 2020 I am regularly on medication and nebulizers. during this covid 19 period my regular walks have been affected and I have breathing issues. My lung tests carried out during the 1st week of September showed a function of 57%. I find it difficult to breath with machine on. Every few minutes I get up gasping for breath. The only position I am able to sleep little bit is sitting on a chair with machine on.

I have changed settings on my S9 escape auto several times so that I could get a comfortable sleep, but I am unable to find a setting.

My current setting are

Mode             APAP
Humidity level  2.5
Max. Pressure  14
Min.     "         10
Ramp             off
EPR              Full
Level             3

Please help me find a setting which could give me a comfortable sleep. Please suggest at your earliest.

Thanks and regards

R K Dutta

[Sleeprider]

RK, it would be extremely helpful if we could get some flow limitation, tidal volume, respiratory rate and minute vent data. Your machine is not going to give it to us. With COPD you probably need a bilevel machine. Pressure support is what makes inspiration easier, and you are at the maximum EPR of 3 with your CPAP. In bilevel terms you are using EPAP min 7.0, PS 3 and max pressure 14 which gives a range of 10/7 to 14/11 (IPAP/EPAP).

Since you don't have more pressure support available, and we don't know what pressure you are actually getting based on data, you can start increasing the minimum pressure and maximum pressure limits in your settings. It's purely guesswork and you will have to go by how you feel. Start increasing minimum pressure by 1-cm at a time. By increasing minimum pressure to 11.0, your starting pressure becomes 11/8. If you go to 12.0, it becomes 12/9. Higher pressure may make your breathing easier, but the real answer is bilevel machine to treat COPD with pressure support. That is the way we do things in the good old U.S.A.