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Is more better? EPR, Pressure, Humidity
#1
As I look at everyone's settings, I think mine are too generic. I only had an in home study and so the Dr. prescribed the auto PAP and had the pressure set from 4 to 16, the EPR off, and the humidity at 4. After 2 months, I have discovered many things and each time I learn something new, I have more questions.

I am on therapy 7 to 9 hours every night and my sleep, or lack of sleep is divided into 2 distinct sessions. The first 4 hours I get good sleep (so to speak). And the next 4 hours are pure hell with very little sleep. I feel like I am in a battle with the machine. I have looked at the SleepyHead reports and something is happening but nothing obvious from the report.

I changed the EPR from off to 1, and upped the min pressure from 4 to 5 and this made a world of difference. Min pressure at 4 is actually uncomfortable. Feel like I am struggling to get air in. Min at 5 was much better. Hence, the question "Is more better?"

Also I noticed my pressure (on average) rises throughout the night. I changed the humidity from 4 to 6. Can too much humidity (besides the obvious) gum up the mask vent and cause the pressure to rise?

I don't think changing the min pressure will hurt anything like the max pressure will but it will change the high/low range of my therapy.
Dont-know  I am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
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#2
First off, humidity and EPR are "comfort settings" and should be adjusted purely on your preference. For me, 4 was too low and dried me out. I'm now regularly using humidity at 5 with my heated hose maxed out at 86 deg F, and I find that is the best happy medium for me. If I raise the humidity any further, I get excessive condensation in the hose and mask (i.e. rainout), which causes a lot of problems in the A10 (machine shutoffs, inaccurate data, etc.). I sleep in a cool room (60-66 deg F usually), which makes my setup especially susceptible to rainout.

To address your question about humidity "gumming up" the mask - as long as the humidity isn't condensing, it's not a problem, but as soon as condensation starts building up, it can indeed block the P10 vents, which prevents the exhaust and exchange of air that is necessary to keep carbon dioxide levels down and oxygen levels up. If the relative concentration of those gases gets out of balance, you'll wake up feeling like you're suffocating or at best have a headache the next day.

Pressure, on the other hand, is NOT a comfort setting. It is obviously the most critical setting in your therapy, and it appears that your pressure range is too broad. In particular your starting pressure is probably too low, especially if you're using EPR, which essentially subtracts x cm H2O (where x = EPR setting) from your pressure setting on exhale to make exhale easier. You were correct to raise it from 4 to 5, but I bet you would get better results from an even higher minimum.

To optimize pressure, you will need to carefully analyze your data in Sleepyhead. Look at long-term trends, not just one day or even week - are you regularly hitting your maximum pressure (if not, lower it), does pressure quickly rise from your minimum pressure as soon as you fall asleep and start having apnea events (if so, then raise it), where is your pressure for most of the night, does there appear to be a sweet spot or range?

You didn't mention what your AHI's have been, but if they are under control, these will just be tweaks. I imagine with a relatively high max pressure, you don't have them once your therapy gets going, but you might have them earlier in the night since you're starting so low. Again, this is information you can extract from your Sleepyhead data.

If you would like more specific guidance, consider posting your data.
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#3
I see that you're using SleepyHead. What is it telling you about your settings? Playing with your settings won't hurt you. If you set your pressure too high, everybody will know it the next day. . . Can you spell "aerophagia"?

Most people don't feel comfortable with a pressure generally below 7. . . Again, it's a subjective call.

Too much humidity can cause "Rainout" which is nothing more than condensation forming in the hose and mask. It's not dangerous, just annoying. You hear/feel it gurgling and trickling in your nose.

Hang in there and enjoy the therapy!
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#4
Rcgop,
You ask if more EPR, Pressure, Humidity is better....my answer is not necessarily.

EPR is a comfort setting to help you breath out against pressure. It can help you or not.
The only way is to try it. Set it midway to 2, see how you feel with it...you can always lower it or raise it. Some folk report an increase in Clear Airways if set at 3, so again you need to watch your results.

Humidity is another comfort feature. Some like it, and some don't. Again, try the different settings. Too much humidity can cause congestion, as too little humidity can cause you to feel dry.

I've left your pressure question for last, because this is "not" a comfort setting.
One thing, you've not told us your AHI breakdown and if it is controlled. Pressure changes should be made in accordance with what you are seeing on your SleepyHead reports, not by what others set their APAP's to.

I agree with raising your minimum pressure. A start pressure of 4 can make you feel starved for air.
Your start pressure should ideally be set 1 to 2cm below your 90% pressure number, and your max pressure should be set to 1 or 2cm above that 90% number.

Again, a lot depends on what type of apnea events you are having. Let us know your AHI numbers, and the breakdown. (Hypopnea's, Obstructive, Clear Airways)
OpalRose
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#5
(05-13-2016, 11:55 AM)OpalRose Wrote: I agree with raising your minimum pressure. A start pressure of 4 can make you feel starved for air.
Your start pressure should ideally be set 1 to 2cm below your 90% pressure number, and your max pressure should be set to 1 or 2cm above that 90% number.

Hi OpalRose,

Start Pressure usually refers specifically to the Ramp starting pressure.

Regarding the Start Pressure versus Min Pressure, I think you meant Min Pressure.

Always good to read your posts, which are always filled with good advice.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#6
(05-14-2016, 04:55 PM)vsheline Wrote:
(05-13-2016, 11:55 AM)OpalRose Wrote: I agree with raising your minimum pressure. A start pressure of 4 can make you feel starved for air.
Your start pressure should ideally be set 1 to 2cm below your 90% pressure number, and your max pressure should be set to 1 or 2cm above that 90% number.

Hi OpalRose,

Start Pressure usually refers specifically to the Ramp starting pressure.

Regarding the Start Pressure versus Min Pressure, I think you meant Min Pressure.

Always good to read your posts, always filled with good advice.

vsheline, thanks for clarifying,
Yes, I meant minimum pressure. Smile
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

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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