Dialing in this Year

[DreamWeaver80]

Hello Paper People!

It's been several years since my last post, but I'm determined to get things dialed in this year. For the past 4+ years I've been using my AirSense 10 with a pressure range between 5&6 to 15 with no EPR while wearing the Philips DreamWear Nasal Cushions. Check out my statistics here: https://imgur.com/3lvPpTN

My AHI has never been that high (averaging under 2), but I have never felt like a spring chicken with the fully rested feeling I used to have. I chalked it up to me getting older, but recently I decided to look closer at what's happening. I should also note that I've been having some ED issues which I also attributed to me getting older and also not working out as much as I used to (lack of conditioning). Also, my wife has noticed air leakage and snoring for a long time, but we never really talked about it with any serious objective before (in other words we'd say, "that sticks," and move on).

So I decided to pay for a consultant to look at my data with me and they noticed (1) large amounts of leaks which got worse when entering REM and (2) my REM being constantly interrupted because of the leaks and several moments of arousal during the night. You can see an example of what this looks like here: https://imgur.com/yQUR3wg

The recommendation was to tape my mouth shut, switch to CPAP with a pressure setting of 8, turn off any ramp or EPR, and then give that 4 to 5 nights and then bump it up to level 9 for 4 to 5 nights. After that I would receive a follow-up consultation. I purchased the recommended tape (BSN Cover-Roll Stretch Tape) and observed my data: https://imgur.com/pqBNImu

To my surprise there were still issues with leaking, but not as bad IMO. I then purchased the Bleep DreamPort system and with the combination of the tape the leaks are much better. I've done that for a few nights and that's where I am today: https://imgur.com/jOd4APQ and https://imgur.com/Ny4JvUe

I'm not sure the Imgur quality is good so I attached my stats, the daily view before I started to tape, and last night. I'll take any advice or insight I can get. Thanks everyone!

[Dog Slobber]

I disagree with the advice to switch to fixed pressure.

Judging by graphs, the rhythm and intensity of your pressure increases and flow limitations is consistent with REM and your apnea is worse during REM.

You may want to take a peak at your Respirate Rate, with some people increases in RR consistant with REM is visibe. Look for an increase in RR for about 30 minutes every 90 minutes that aligns with your FL activity and pressure increases.

The problem with fixed pressure with those who are prone to worsened OA during REM is the fixed pressure is a compromise between what they need in non-rem vs what they need during REM. More than they need during non-REM and not enough during REM. There is no goldilocks zone.

I would switch back to APAP, and start increasing my minimum pressure. 

I would start at about 9, then gradually start increasing it by a few partial points every few days or so. Expect to see a flattening of the pressure line and drop in AHI.

[DreamWeaver80]

Thanks for offering assistance. My understanding of that decision was basically due to the Resmed's algorithm not being perfect and by allowing the APAP feature to work within too wide a band it can behave in unintentional or even negative ways. For example, if you look closely at my breathing and rhythm it was clear to even me that some issues being flagged were not really issues. I am by no means an expert, but that made sense to me.

I 100% agree that the issues are occurring most during REM and I'll look into the Respite Rate.

I'm curious about how wide of a band you'd recommend in an optimal situation. I think you're view is that the minimum pressure should be what you need unless an event occurs, and then let the machine ratchet up the pressure to as high as it thinks it needs to, but why wouldn't I just go from 9 to 100 in that case? Are we relying too heavily on the machine's interpretation?

Thanks again!

[Dog Slobber]

Yes, for myself, I like to set my machine to a tight minimum to where it wants to be, giving me a very flat almost fixed pressure trace. And then setting my max pressure to the machine maximum letting the the pressure go where it needs to go.

But I completely understand there are compelling reasons to set a maximum:

• Some are uncomfortable with the potential for high pressures
  
• Intolerance to high pressures
  
• New to CPAP
  
• Aerophagia
  
• Mask Leaks
  

Should a Max be set and the data show the device is always bumping up against it, it's easy to increase if desired.

[SarcasticDave94]

A few things I would consider if you...
Try APAP again, at 7-12, no Ramp, EPR 1 for now.

Keep an eye on the CA line, this means clear airway to the PAP but it's Central Apnea. You get some on occasion because in part all do. CA are consistently inconsistent meaning up and down frequently. I'm not saying you have a big issue with CA as I do, but with pressure ranges and EPR it may go up a little. That's why I'm introducing EPR at 1.

Note how comfortable you feel with this setup, note if you sleep better or not. Try it a night and see if it's better or not. If not, we'll revert back to static.