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First Time Posting
#1
First Time Posting
he subject says this is my first post to the board as I want to be sure I am getting the most effective treatment possible.

Diagnosis
A couple years ago I noticed that I was constantly tired and needing more sleep.  I was also snoring a lot and my wife noticed that it was getting worse. Originally I thought it might be stress related, but over time it became clear that it was something else.  I eventually was approved for an in-home sleep study by my insurance company which came back with a mild case of sleep apnea (AHI 6) and a blend of unclassified (2), obstructive (1) and central (2) apneas.  That study was done on June 7, 2016.

My pulmonologist prescribed me an oral appliance which at first did the trick of giving me more relief.  Over the past year I've been advancing the jaw forward since my sleep quality was diminishing.  Finally, about  a month ago, I realized I needed another study.  The doctor gave me another in-home study and instructed me to use it with the oral appliance.  The result was an AHI of 6.3 on June 22, 2017.  We discussed PAP therapy since advancing the oral appliance further would just result in jaw issues and with my dad and cousin having sleep apnea it is probably only going to get worse.

Treatment
Last night was my second night using the ResMed 10 AutoSet plus Philips Dreamwear Nasal Pillows.  The doctor set to a pressure range of 4 to 20 which I suspect is a default "I have no idea what settings are optimal" setting.  The first night was a learning experience and I didn't have an SD card to record data -- I slept with it for just over 4 hours before switching to my oral appliance.  Last night I got used to it a bit more and slept for about 7 hours 20 minutes and feel pretty good, however, I still need to get used to the resistance I feel when I exhale and my chest feels a bit tight which I've read is normal for new users.

Data
I don't know enough to analyze the data right now so I was wondering if someone could help guide me.  I am trying to optimize my treatment since I'm probably going to be in this for the long haul!  Thanks in advance! Link here: http://imgur.com/a/DNzZA
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#2
RE: First Time Posting
Welcome to the forum,  I'm sure that you will find that this is the right place.
I know you posted a 'verbal' summary of your sleep study, but if you could post an image of your sleep study it would help.  Most of your events in your chart are CA and that makes your sleep study important.  CA is Central Apnea or Clear Airway (non-obstructed) events and this makes it important to view this data.

Thank you for the nightly chart.

Your numbers are great, under 5, and that is considered treated.  Most of us here are not satisfied with that.  It does mean that changes need to be small and slow as you tweak the settings in.  Because of the possibility of CA we also need to be cautious.  Frequently those diminish over time.  

Do you know how to change your settings?  (Press and hold the home button (below the display) and the round knob at the same time for 3-5 seconds.)

Most adults have trouble (resistance) with a pressure of 4.  Normally I would say go to 6cm H2O but because of your CA only go to 5cm Min Pressure for now and maybe 6cm later.

Typically you raise pressure to handle obstructive events, but raising pressure also tends to increase CA events if you are susceptible and you may be.   You seem to have more CA events now than in your study, but a single night's chart does not make that definitive.  On a CPAP/APAP machine you typically reduce pressure to eliminate CA events.  

You are currently not using EPR, please do not use EPR until we see where the CA goes, and that may take some time.  A different more expensive class of machine is typically used to treat CA.

Finally, read the content of the links in my signature,  They will inform you of apnea, including Central and Complex Apnea, its treatment, mask usage, and other important information

Again your numbers are great, especially for starting out.

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#3
RE: First Time Posting
Dreamweaver, your first night looks pretty good. Your events were mostly central and I think we can help. First, some CA events are normal in new users, however you are using EPR at the highest setting of 3, with a pressure range that starts at 4 cm. That combination is not going to work well for you. If you feel like you were getting plenty of air and were comfortable, you can keep the 4-20 setting, however I'd like you to turn EPR down to 1 or OFF. With EPR, your exhale pressure (EPAP) which controls obstructive apnea never gets above 4 cm. Turning the EPR down to 1 or off will let the machine be more responsive, and less EPR will result is lots fewer CA events...I guarantee it.

If you feel like you were not getting quite enough air to be comfortable, you may safely turn the minimum pressure up to 5 or 6 cm. Again, turn EPR down to a setting of 1. Instructions on accessing your machine's settings can be found at the link at the top of the page for CPAP Setup Manuals. Welcome and good luck!
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#4
RE: First Time Posting
Hi DreamWeaver80,
WELCOME! to the forum.!
Good luck to you with CPAP therapy and also with getting it fine-tuned to meet your needs, hang in there for more responses to your post.
trish6hundred
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#5
RE: First Time Posting
Thanks for all the feedback so far -- I am just getting to this now after a few more nights of use.  After 2 nights I noticed a small red sore developing under my nose so I had to loosen the straps a bit.  I used that as a sort of excuse to revert back to my oral appliance one night and WOW what a difference!  I didn't even realize how much better I feel until then.

(07-05-2017, 10:44 AM)bonjour Wrote: I know you posted a 'verbal' summary of your sleep study, but if you could post an image of your sleep study it would help.  Most of your events in your chart are CA and that makes your sleep study important.  CA is Central Apnea or Clear Airway (non-obstructed) events and this makes it important to view this data.

Here is a link to both reports (from June 2016 and June 2017): http://imgur.com/a/4FvhI

(07-05-2017, 10:44 AM)bonjour Wrote: Most adults have trouble (resistance) with a pressure of 4.  Normally I would say go to 6cm H2O but because of your CA only go to 5cm Min Pressure for now and maybe 6cm later.

Typically you raise pressure to handle obstructive events, but raising pressure also tends to increase CA events if you are susceptible and you may be.   You seem to have more CA events now than in your study, but a single night's chart does not make that definitive.  On a CPAP/APAP machine you typically reduce pressure to eliminate CA events.

Can you explain this please?  I thought a pressure of 4 is less than 6cm H2O.

(07-05-2017, 02:48 PM)Sleeprider Wrote: First, some CA events are normal in new users, however you are using EPR at the highest setting of 3, with a pressure range that starts at 4 cm.  That combination is not going to work well for you.  If you feel like you were getting plenty of air and were comfortable, you can keep the 4-20 setting, however I'd like you to turn EPR down to 1 or OFF.  With EPR, your exhale pressure (EPAP) which controls obstructive apnea never gets above 4 cm.  Turning the EPR down to 1 or off will let the machine be more responsive, and less EPR will result is lots fewer CA events...I guarantee it.

Similar to the above, I am a bit confused here.  I turned the EPR to 3 since I thought it was the amount of 'drop in pressure' the machine allowed when I exhale.  I want to be able to exhale freely without resistance (since that seems more comfortable).  I thought my problem was the inhale of air being resisted.

(07-05-2017, 02:48 PM)Sleeprider Wrote: If you feel like you were not getting quite enough air to be comfortable, you may safely turn the minimum pressure up to 5 or 6 cm.  Again, turn EPR down to a setting of 1.  Instructions on accessing your machine's settings can be found at the link at the top of the page for CPAP Setup Manuals.  Welcome and good luck!

Taking both of your posts into account I am going to turn off the EPR and up the minimum pressure to 5 and give that a few nights.  I will post last night's results next.
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#6
RE: First Time Posting
A pressure of 4 cm is generally considered to be a pediatric pressure, there are of course exceptions. Most adults feel that at this pressure they cannot get enough air to breath. a pressure somewhere around 6-8 usually relieves this issue.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#7
RE: First Time Posting
Last night's results, as promised: http://imgur.com/V8OiTht

I am still having more Clear Airway events than anything else so hopefully turning off the EPR and changing the minimum cmH2O to 5 will help.  I am going to learn more about the settings and their meaning.
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#8
RE: First Time Posting
Looking at your chart. Your OAs are fine, a few H left, If it was my chart, I would go to min 6. max 7.5 with no epr for now. I'd even be tempted to try fixed pressure cpap 7 with no epr, till the Clear Airways settle
You didn't have a lot of centrals in your sleep study (1) . The odds are these Clear Airways are pressure induced and will settle down within a week to 3 months.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#9
RE: First Time Posting
Why does changing the max matter with an APAP setting?  Doesn't that just allow the machine to go higher if needed?
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#10
RE: First Time Posting
With some people with the pressure induced CA, the more pressure, the more CA. It's your body getting use to CPAP. EPR can make it worse too. I'd want to limit the max pressure to where the H was being treated. If it was my chart, I'd want to get the oa and h good, and not press too hard to make more CA. When the CA settle, it's a different story.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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