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Dialing in first-time therapy
#11
RE: Dialing in first-time therapy
So I raised pressure to 10.0, EPR set to off. Was pretty uncomfortable exhaling against the pressure after having EPR on for the entirety of the time I've been on CPAP, but I eventually fell asleep. Since ResMed splits sessions at 12 noon, I've attached two screenshots.

   

   

The large leak frequency in the second screenshot is something I've seen for the very first time - I remember waking up in my sleep to notice that I could hear snoring, and that I was breathing through my mouth. This hasn't happened before, perhaps it's a response to the increased effort of exhaling against the pressure?

I do normally have a habit of mouth breathing without CPAP, but didn't have any events for the past month or so of using just a nasal pillow mask, no tape or cervical collar, with a pressure of 9 and EPR set to 1. I wouldn't have cottonmouth when I woke up, either.

As you've both remarked, though, it might just be very early on in my therapy, and I might just have to ride the centrals out if they're treatment-emergent.
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#12
RE: Dialing in first-time therapy
OK so as a preliminary, it looks like perhaps turning the EPR off actually worsened the flow limits in the second chart AND your centrals are up a little too, as well as the hypopneas. My initial feeling from that snapshot would be that the EPR maybe wasn't the cause of the centrals. The increase in pressure, however, seems to have worsened things all around.

The trouble is, centrals are SO contrary. The only thing they are consistently is inconsistent. One night I might have a CAI of 9 or 10, and the next night, I might be having a CAI of 30+ (damn, I want an ASV soon). It could, potentially, be that this is normal variation for you, or it could be that the increased pressure has caused the increased centrals too.

How are you feeling in yourself today? If you are feeling drastically worse, then it might be preferable to return to your previous settings, otherwise, maybe try them for a second night at least, and see how it goes with the centrals particularly.

I'm guessing that those big leaks were all mouth leaks rather than from the nasal pillows? It's possible that the higher pressure was just enough to pop your mouth open, which would then make the CPAP ineffective. And that was probably why you were snoring along. That alone would tempt me to drop down again to 9 unless you see some very clear improvements soon at these settings.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#13
RE: Dialing in first-time therapy
Took your advice and dialed down the pressure. I did, actually, wake up with some sleep inertia and a mild headache with the pressure set to 10 and EPR off. It seems like your hypothesis about the increased pressure popping my mouth open and contributing to the large leak and snoring was correct, although I must note that one night is hardly a representative sample.

Set pressure to 9.4, EPR set to 1 and had a nice nap this afternoon, shown in the screenshot below, but then took my mask off and slept for another 1.5 hours after my alarm. Woke up feeling refreshed afterwards, however. That's something I do from time to time; I'd like to know if there's anything I can do to stop taking my mask off and having another kip.

   

Otherwise, any feedback on the results? Really appreciate the advice and analysis. My current plan is to try these settings out for a week or more and see if the CA/H events show up again, in which case I might increase pressure one click at a time (9.4 -> 9.6 -> 9.8 -> 10.0) and keep my EPR set to 1. I understand it works as a very low-level BiPAP, but I find exhaling against the reduced pressure very comfortable, even if it does potentially decrease the bearing life of the blower from ramping up and down all night - at least I'm maintaining upper airway patency with an EPAP of >=8.4. My PSG noted "moderate, intermittent snoring" at a fixed pressure (IPAP=EPAP) of 8.0 cmH₂O, which is why I'm assuming my consulting doctor gave me an Rx of 8.0 - 9.0 cmH₂O.
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#14
RE: Dialing in first-time therapy
Honestly, that looks pretty good to me. You've found a pressure that seems to be comfortable with minimal events, so yes, stay where you are for a while and see how you feel. A week is a good plan, especially as centrals can be so tricksy.

As for stopping taking your mask off - if it's a case of you taking your mask off while you're conscious of it, but then immediately falling asleep again, then I would suggest changing your habits. Make sure you sit up and on the edge of the bed or whatnot to make sure that you're physically awake before you stop the machine and take your mask off. That might give you enough time for your sleepy brain to treat it as a "this is time to move" rather than "this is just a quick thing and then back to sleep".

If you're taking it off while you're not consciously aware of it or mostly asleep and you don't always realise you've done so, then there are ways. You can make it more difficult to turn the machine off (maybe put it out of reach or in a drawer or somewhere you can't reach from bed). If you still take the mask off even with the machine running, you can do things to make it more tricky to get the mask off. Some people use bobby pins to help keep the straps against their hair, or using safety pins to make it harder to take off straps. Basically, anything that would mean you can't just slip it off easily. It's a little harder with the magnetic clasps but if you made it difficult enough, it might just wake you enough to put it back on again, even if it doesn't stop you trying to take it off completely.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#15
RE: Dialing in first-time therapy
I have heard of a few tape the mask to their face, for the reason of preventing mask removal not leak control. Others wear mittens, again to attempt preventing grabbing and taking masks off.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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