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[Diagnosis] New User
New User
Hi great site! 

I've been using APAP for a few weeks & would like some help and/or suggestions (pressure change/ramp etc.) based on the screen shots below. The results has been pretty consistent & last night's data is representative. Original sleep study results indicated ~60 events an hour so big improvement from those levels.


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RE: New User
Welcome to the forum.

Your obstructive events are well managed.
Min pressure should be 7 (Min = 4 (machine min + EPR (3) =7 or 6 min for an adult as a min, it can be higher We will leave it at 6 because we will be reducing EPR to 1

Reduce EPR to 1 to see if Central Apneas reduce. We may suggest turning off EPR depending on your results. EPR or PS / pressure support can play a big roll in flushing CO2 out of the system which can trigger central apneas when CO2 falls below your apneic threshold. We will not know until we try.

It would help a lot if you could post redacted copies of your sleep studies. Those will give us a lot of insight. Right now it is to determine if your central apnea is treatment-emergent per the mechanism above.

Also always critically state how you feel.
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RE: New User
Thanks for responding!

I lowered EPR to 1 last night & AHI decreased to 6.21 - is that possibly direct co-relation? I didn't realize how much I had been fighting the machine - last night breathed clear & easy.

Also, I've attached my sleep study.

Since starting treatment, I had noticed I felt less tired & in less need of naps/coffee, but not a massive improvement - however I feel very well rested this morning. Hopefully its a trend!

Any advice is greatly appreciated.

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RE: New User
Yes it is. Turn EPR off tonight. And turn Ramp off, your pressures are low so you shouldn't need it. Most of the senior people here do not use the ramp.
Work on getting those sleep studies, you want them in your personal possession
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RE: New User
Hi Bonjour, RMac did provide the sleep study, which shows hypopneas predominating, plus a lot of snoring and tossing/turning. Hypopnea index was 61.7; CAI, .04. So it looks as though the CAs are treatment-emergent and the low pressures are enough to prevent most hypopneas and all snoring. Nice!

RMac, you are in very good hands with Bonjour. Do follow his advice. I will be interested to see how you do with 0 EPR.
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RE: New User
Thanks Bonjour & Dormeo! 

- will turn off EPR & Ramp.
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RE: New User
Hi - its been a few months since last post & feeling positive benefits - as is evidenced by the data. But leak rate seems to be high - should that be a concern given reduction in AHI? Any suggestions to possibly improve?

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RE: New User
Leaks are the next assignment to work on. If I recall accurately, you show mouth breathing leaks and mask leaks, seen as big slightly rounded to flat top leaks for mouth leaking and the peaked, pointy ones typical of mask leaks. Consider adjusting the mask as follows: lie on the bed and PAP is on therapy pressures, hold mask to face as if wearing for the night but do not strap on just hold in place, note the tension to hold there relatively leak free, now add straps and adjust to same tension as finger tight a moment ago. For mouth leaks, consider a chin strap like a Knightsbridge Dual Band or you may have to tape over mouth.

Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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RE: New User
I would suggest 3 things, and I would do them one at a time and see how each helps. First raise the min by 2. Next reduce the epr 1 a day until centrals go down and last turn off the ramp. The ramp will not change apnea reported. While you are using the ramp you are NOT getting therapy, the pressure is to low to help. Ramp is used to help you get asleep but most people do better just leaving it off.
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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RE: New User
Hi stacey burke, the OP has both ramp and EPR off.

RMac, is it possible you are opening your mouth more these days -- perhaps sleeping more deeply? If so, you have a couple of options.

1. Tongue position. Try putting the tip of your tongue behind your upper front teeth. Then position the main part of your tongue up against your upper palate. Finally, give a little suck or swallow to create a bit of suction. You should now be able to open your mouth while breathing entirely through your nose. Practice this during the day, and see if you can get it grooved in deeply enough to help while you are asleep at night. For some people, this is really all it takes to avoid mouth leaks.

2. Collar. If your jaw tends to drop down during the night, pulling your mouth open, then a soft cervical collar, or a firmer snore collar, can be a big boon. More here:
3. Although chin straps tend to pull the jaw back, which is not helpful, the Knightsbridge Dual Band strap has a design that pulls the jaw straight up, which makes it a possible alternative to a cervical collar.

4. Tape. Some people (including me) rely on tape to keep the lips from opening. (I can't rely entirely on the tongue thing.) When the lips open, all too often that eventually leads to a noisy and disruptive mouth leak. To see whether tape would be feasible for you, I recommend that you invest in a box of Somnifix strips. They are very gentle on the skin but hold very well. Be sure to curl your lips inward per instructions before placing the strip. If these work for you, then you can experiment with lower-cost options.

Note about tape: Some people avoid it, for two reasons. (1) If you suddenly need to vomit in the night, the tape could lead to your aspirating some vomitus, which would be bad. However, you can sacrifice one strip to see for yourself how well you can pull you mouth open in an emergency using only your jaw muscles. (2) If there is a power failure and your machine goes off while you're sleeping, you won't be able to do the natural thing and open your mouth to breathe. As for that, out of an abundance of caution, I've put a circuit alarm in a plug on the same circuit as my machine. It will wake me up immediately if I lose power to the machine.
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