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[CPAP] could use a little help
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Eddie702 Offline

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Posts: 20
Joined: Jul 2013

Machine: Res Med S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Res Med Mirage Quatro Medium
Humidifier: F & P
CPAP Pressure: Auto C-pap 4-20
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Massachusetts

Post: #1
could use a little help
my cpap experience is somewhat "inconsistent". sometimes it seams to work great, sometimes not, like now.

I have experimented with different pressures I guess not knowing the best way to set up the machine. I thought I had it figured it out but feeling very tired. The last 50 days June 8 until now my average readings for those 50 days are as follows:
AHI 0.9
Hypopnea 0.5
central 0'4
apnea index 0.4
obstructive 0.1
min pressure 4.0
max pressure 20.0
epr full time
epr level 3.0
pressure median 7.6
pressure 95th percent 14.3
max pressure 16.1
leak median 0.0
leak 95th percent 0.0
leak max 0.6

From what I am able to determine these # look good so I don't understand why I am so tired. using the ResScan software

Thank you for the help
07-28-2015 08:47 PM
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PollCat Offline
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Posts: 1,576
Joined: Feb 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: H5i Cleanable with ClimateLine
CPAP Pressure: 10 - 18
CPAP Software: SleepyHead

Other Comments: CPAP-ing since 1995; Type 2 Diabetes; Chronic Asthma; Gout

Sex: Male
Location: Westfield, IN

Post: #2
RE: could use a little help
Did you have a sleep study to determine what should be your settings? You shouldn't start changing your settings until you have been on the doc's settings for a while. Personally, I believe no newbie should touch their settings until they have been receiving the therapy for at least one year.

If, however you are self-medicating, so to speak, I'm not in a position to offer any meaningful assistance.


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07-28-2015 09:40 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #3
RE: could use a little help
How many hours you sleep and how many mask events shown on summary graphs
One of your earlier posts talk about stuffy nose, how is it now?
07-28-2015 09:53 PM
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Sleeprider Online
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Posts: 3,317
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #4
RE: could use a little help
The numbers are good, but you can still experience respiratory event related arousals (RERA) and other problems. You're running the machine wide open, and that is good to get an initial idea of your correct titration. I would raise the minimum APAP pressure to somewhere near your average pressure (7.5) with the expectation that most events would be headed off, and you would be better ventilated. If you were titrating for CPAP, you'd set it near 14 as a single pressure.

I self-titrated, and it is a common occurrence to have a diagnostic sleep study and be given an APAP machine. It will work best if you increase pressure to at least the average pressure you get "wide open". See if it helps, at least EPR will work at that pressure. It is not fully functional below a pressure of 7.

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07-28-2015 09:56 PM
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alby_c Offline

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Posts: 81
Joined: Aug 2013

Machine: resmed s9 autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed
CPAP Pressure: 6 - 12
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Brisbane, Australia

Post: #5
RE: could use a little help
I am a firm believer of owning your therapy.
I would endorse Sleeprider's comments - increase the min pressure. That alone should help - I feel like I am suffocating at 4 in my mask. I need at least a min 6. The nightly graphs should show you the pressure it likes to get to to keep most events away.
07-29-2015 12:03 AM
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trish6hundred Offline

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Posts: 6,430
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #6
RE: could use a little help
Hi Eddie702,
You might try raising your minimum pressure to 7.5 as Sleeprider suggested and see if that helps you.
Much success to you with getting your CPAP therapy fine tuned to get better sleep, good to hear from you again.

trish6hundred
07-29-2015 06:12 AM
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Eddie702 Offline

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Posts: 20
Joined: Jul 2013

Machine: Res Med S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Res Med Mirage Quatro Medium
Humidifier: F & P
CPAP Pressure: Auto C-pap 4-20
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Massachusetts

Post: #7
RE: could use a little help
Thank you for the replies. My last sleep study was 2 years ago. At that time I was using and had been using a "brick". All they told me was "moderate" sleep apnea and to run the pressure at 8. They said no real change from my original sleep study which was maybe 10 years ago. From my original sleep study up until 2 years ago I did not use cpap...couldn't tolerate it. I now bought an s9 autoset and a new mask and it seems to work well as far as tolerating it and I feel like I am sleeping ok but still tired...not getting good results consistantly right now although at times in the past it has seemed ok.

a few questions if you don't mind. I am using the RESSCAN software. I alwaws thought if the ahi was kept below 4-5 that things should be ok.

Obviously there is more to this than I thought. I will raise the minimum pressure and see what happens
07-29-2015 09:19 AM
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Shastzi Offline

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Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #8
RE: could use a little help
Hi Eddie,
Your numbers look good and I think you could follow the good advice above.
You may be turning in good AHI numbers but still not having that good a night's sleep.
At this point you need to tune your machine so it lets you sleep well but doesn't
wake you up while changing pressures, etc.

I'd say, from your numbers, set the high pressure to 16 and low to 12 ( 4 point spread )
Run it like that for a week or two without changing anything.
Keep an eye on the leaks and other things. (humidity / moisture / dry mouth )
See how that works & report back!
Wink

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

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07-29-2015 09:30 AM
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AndyB Offline

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Posts: 71
Joined: May 2015

Machine: ResMed AirSense 10 Autoset with RERA
Mask Type: Full face mask
Mask Make & Model: F&P Simplus, ResMed AirFit F10; PR Amara View
Humidifier: ResMed integrated heated
CPAP Pressure: 10.4-13.0
CPAP Software: SleepyHead

Other Comments: Diagnosed May 2015; EPR @ 1cmH2O; Ramp off; ResMed Climateline heated hose

Sex: Male
Location: SE Wisconsin

Post: #9
RE: could use a little help
(07-28-2015 09:56 PM)Sleeprider Wrote:  It will work best if you increase pressure to at least the average pressure you get "wide open". See if it helps, at least EPR will work at that pressure. It is not fully functional below a pressure of 7.

Sleeprider, what are your general thoughts on EPR? Your comment above suggests that you endorse it, at least in some circumstances.

I turned EPR and Ramp off very early in my new adventure with CPAP therapy, thinking they were promoting CAs, of which I had many early on, and still do frequently (my AHI is usually comprised 50-75% by CAs, with the balance being hypopneas).

I'm wondering whether I should turn EPR back on (it was set at 2cmH2O during my sleep study).
07-29-2015 12:13 PM
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Sleeprider Online
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Posts: 3,317
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #10
RE: could use a little help
(07-29-2015 12:13 PM)AndyB Wrote:  Sleeprider, what are your general thoughts on EPR? Your comment above suggests that you endorse it, at least in some circumstances.

I turned EPR and Ramp off very early in my new adventure with CPAP therapy, thinking they were promoting CAs, of which I had many early on, and still do frequently (my AHI is usually comprised 50-75% by CAs, with the balance being hypopneas).

I'm wondering whether I should turn EPR back on (it was set at 2cmH2O during my sleep study).

That's a good question, and since it seems to affect individuals differently, there is no right or wrong answer. When EPR makes you more comfortable, and makes exhalation easier, it is certainly a good thing. The problem with it is that it actually turns your CPAP into a limited BPAP (bilevel). The fundamental principle of BPAP titration is the EPAP/IPAP must be high enough to support the respiratory system and prevent OA. EPAP/IPAP are both from minimum pressure (usually 4.0/8.0) to eliminate OA. IPAP is then increased to relieve H, RERA and snores, and the PS can also be increased to optimize respiratory perfusion.

In CPAP and APAP, where EPR seems to have problems is when exhalation relief pressure falls below the threshold necessary to prevent OA and hypopnea from occlusion of the throat tissue. Because it is a subtraction from IPAP, you need to set the minimum IPAP at a level that you do not trigger OA and H at the reduced EPAP pressure. When it is set right, EPR provides exhalation comfort and still supports the respiratory system. However, EPR can have a real effect on apnea, if the IPAP is too low and EPR is too great. Since most patients are not titrated on EPR, there is a risk of that happening.

Changing pressure also seems to correlate with increased CA in some people. It could be due to micro arousals, CO2 washout, or the unstable airway at too low of an exhale pressure...I don't know, but it's common. CA events are not much of a concern unless they are clustered or abundant. Almost anyone can be induced to have CA by too much pressure support (pressure difference between EPAP/IPAP) which washes out too much CO2. I suspect that is why Resmed limits EPR to 3.0 cm, and Philips limits Aflex/Cflex to 2.0; that pressure difference is less than the minimum PS for most bilevel and should minimize that problem. A little bit of CA is not bad if the RDI is otherwise low, and that is the tradeoff I accept in my own therapy.

Sorry for the long answer.

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07-29-2015 02:40 PM
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