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Do I need fixed pressure rather than auto? Numbers attached.
#1
Do I need fixed pressure rather than auto? Numbers attached.
Hi there,

Hoping for a little advice from you good folk! Smile

My numbers seem really good, but I am waking up tired as I wake up mutlple times a night.

I seem to always wake up in REM having very intense full on dreams. Clearly there is a flow restriction at this time and the dreams are related, but I don't seem to be registering many OAs or Hs.

When the pressure goes up, it obviously helps with the Hs and OAs, but it also causes increased nasal congestion in my nose which doesn't help the flow limitation situation, so it's a bit of a balancing act in terms of my max pressure i've found. 

I can't work out whether I am waking up because of soft palate collapse, or nasal congestion, or probably both really. Or maybe leaks also? And if maybe having a fixed pressure might help straddle the line and alleviate my waking up during the night?

I was playing around with the pressures last night so just ignore my max in the screen shots, but generally I am set for around 6.4min and 9ish max.

All and any help/advice is greatly appreciated.

I wear a soft cervical collar and I also use a nasal dilator. I was taking CBD oil, but am taking a break. It definitely helps me sleep better through the night, and I'm certain this is because I don't go into proper REM during first cycle, but I often wake up tired anyway, so trying without it for a bit.

   
   
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#2
RE: Do I need fixed pressure rather than auto? Numbers attached.
You are doing great. Just keep an eye on it. If anything review your sleep Hygiene
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#3
RE: Do I need fixed pressure rather than auto? Numbers attached.
Thanks Gideon, I really appreciate your response. I have been using CPAP for nearly 10months and while things have gradually improved thanks to a few tweaks and getting used to things, I still generally wake up tired (and endlessly frustrated). My sleep hygiene is quite good I think. I was just hoping if anyone has any suggestions to avoid the continual waking at night, and if you can tell at all from the data what is nasal constriction and what is other upper airway restriction. Thanks so much.
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#4
RE: Do I need fixed pressure rather than auto? Numbers attached.
jamesdavis79,
  Do use any type of sleep tracker?  Smart watch, FiitBit, Garmin, etc?  You could compare your sleep stages to, say, see if the rise in pressure from your FL's is interfering with your sleep.  Might be worth a shot.

Have you changed your EPR settings lately?
Jeff8356

MacBook Air (2017, Intel) | macOS Monterey (12.7) | OSCAR v1.5.1 | VM = Win10/Win11 |
How to Links:
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Do I need fixed pressure rather than auto? Numbers attached.
Hi Jeff,
Thanks so much for your response. Yes, this is a good suggestion and I had literally ordered a fitbit the day before so that I can get as full a picture of my situation as possible. I am getting a fitbit inspire 3 which also has an SPO2 monitor, I'll report back on how well this works. I haven't changed any EPR settings lately. I decided to take CBD oil again last night as I was a complete wreck during the day and my daily tiredness and disturbed nights had been getting progressively worse since I had stopped taking CBD oil... I feel so much better this morning, I think CBD oil has some issues with it in that it messes with that first cycle of REM sleep, but overall it helps me actually have a fairly restful night of sleep. If I take CBD oil and have somewhere close to 10hours of sleep (perhaps the extra to make up for that first cycle), I can actually feel somewhat normal during the day. Often when I don't take it, I feel like I've been to war during the night. I'm really curious to explore this further and the fitbit will hopefully help me on this front. I will report back! 
Thanks again for your help.
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#6
RE: Do I need fixed pressure rather than auto? Numbers attached.
@OP -May I offer up an idea for your consideration? This may be a bit out in the weeds but may be worthwhile. Bear with me and I will explain.

You have been on PAP for 6+ months so CAs are not treatment-emergent.

AirSense 10 AutoSet is not built to deal with CAs. But this is not a case of "many" CAs of >5 per hour. And there are a couple of things that can be done with AutoSet machines to try and avoid CAs.

First, experiment with EPR. You could try 2 instead of 3 for a few nights and see if that helps with CAs WITHOUT creating Hs or increased flow limits.

Second, and this is the out-in-the-weeds part, there are some PAPers (not all, but some) who benefit from a tightly controlled band of pressures. You could experiment with fixed pressure (stay in AutoSet mode, just set min and max the same) with EPR of 3. Costs nothing to try it, use it for several nights, see how you feel. You can always go back to original settings if needed. This happened to work for me, so I am one of the few. May not work for you, but then again it may help.
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