Marlow's Therapy

[Sleeprider]

Results are better, increase EPAP by 1-cm to 8.0. I want to see a reduced variation of pressure. I can't do much with the CA events using the Autoset, other than to stabilize pressure and deal with obstructive events.

[Marlow]

Results are better, increase EPAP by 1-cm to 8.0.  I want to see a reduced variation of pressure. I can't do much with the  CA events using the Autoset, other than to stabilize pressure and deal with obstructive events.

Thank you. Do you mean I should set the minimum pressure to 8.0 and keep maximum pressure at 12.0 and keep EPR at 2? I do not have a BiPAP machine so I'm not sure how to set EPAP.

[Marlow]

The guaranteed randomness of CA is having your AHI jump all over. So you may want to close your eyes to some aspects of your data for a bit. Leak rates are good.

Do you feel OK with the results of therapy? Try this, without looking at data for a second, tell us how you feel for the therapy. What's going good and what's not? We know it's going to look ugly sometimes due to CA.

That's a good question. I feel like my therapy could be more effective. 

What's going well:
- Since I started PAP therapy on July 29, I have been wearing my mask at all times while sleeping. I don't tear it off in the middle of the night or give up.
- My events average is much lower than before I started PAP therapy.
- Some days when I've had fewer events I feel more rested but that could be placebo from knowing I've had fewer events.

What's not:
- I still feel quite tired & unrested. I know it can take several months or a year to feel better though.
- Sometimes I am awakened by mask farts when the pressure is high, or just general discomfort from high pressure, feeling like I'm being pummeled by air. At those times, I usually turn the machine off and back on again so that the pressure goes back to the lower end of the range.
- I can't comfortably sleep on my side due to my F30i mask.
- In the past 4-5 days, I have developed pain in my neck at the base of my skull, I think from trying to lay in the correct positions to keep my mask from leaking air. I can't completely relax when sleeping on my side because I don't want the mask to be pushed out of position. Staying on my back causes back pain.
- Sometimes I wake up in the middle of the night and I can't breathe through my nose due to congestion.

I know some of the "what's not" things can be solved by me trying different masks & changing the pillow I sleep on, so I will try to experiment with those.

[Sleeprider]

Thank you. Do you mean I should set the minimum pressure to 8.0 and keep maximum pressure at 12.0 and keep EPR at 2? I do not have a BiPAP machine so I'm not sure how to set EPAP.

Yes. Since the Resmed Airsense 10 has EPR, we often refer to the pressures in bilevel terms of IPAP/EPAP.  I don't see a need for higher maximum pressure, but think you will benefit from an increase in minimum pressure.

[Marlow]

Yes. Since the Resmed Airsense 10 has EPR, we often refer to the pressures in bilevel terms of IPAP/EPAP.  I don't see a need for higher maximum pressure, but think you will benefit from an increase in minimum pressure.

Thank you, Sleeprider. Last night I did the new setting of min. 8.0, keeping max 12.0 and EPR 2 the same. I have attached a screenshot. I started the new settings at 4:00 where the vertical green line is. I wasn't able to fall asleep until 5:30ish, I think. Not due to the settings, just insomnia.

I have also posted a screenshot of a 10-minute zoom-in on my events. Gideon said on September 3 that posting a 10-min zoom may help determine the character of my centrals. Does this screenshot indicate anything in that regard?

Based on my results so far, do you all think an ASV is needed or do we need to do more nights of the new settings to determine that? Thank you very much!

[SarcasticDave94]

Sometimes, changing pillows to something like MyPillow or a buckwheat hull filled may help with the mask and side sleeping. Others say these can be shaped to suit your self and mask.

Always be aware on any mask that you do not tighten to induce pain or discomfort. If you feel you must do so to control leaks, change masks, either cushion size, to a different brand or model, or change type as in pillows or nasal. Lots of users make the mistake of over tightening. This will distort the mask cushion and create more leaks than it can solve.

Mask manufacturers make lots of different masks, in different sizes, and types because each face is different. You'll find mask selection to be the hardest choice of all things with PAP therapy.

[Marlow]

Sometimes, changing pillows to something like MyPillow or a buckwheat hull filled may help with the mask and side sleeping. Others say these can be shaped to suit your self and mask.

Always be aware on any mask that you do not tighten to induce pain or discomfort. If you feel you must do so to control leaks, change masks, either cushion size, to a different brand or model, or change type as in pillows or nasal. Lots of users make the mistake of over tightening. This will distort the mask cushion and create more leaks than it can solve.

Mask manufacturers make lots of different masks, in different sizes, and types because each face is different. You'll find mask selection to be the hardest choice of all things with PAP therapy.

Thank you, SarcasticDave! I will take these recommendations into account.

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Last night's screenshots. The trend of more clear airways after 12 noon continues. Some of those are probably Sleep Wake Junk.

[Marlow]

Last night I increased max pressure to 12.2 to see if that would help clear up the obstructive events. I don't think it made a difference because pressure didn't get up past 12. 

My main questions now
1. Are my results indicating I need an ASV?

• As a reminder, I started PAP therapy on July 29, 2021. My WatchPAT study on June 14 found 4.7 central events per hour. The majority of my events now are central. I don't know if they qualify as treatment-emergent.
  

2. Would a different type of mask reduce central events? Would anything else help reduce central apnea besides an ASV?

Thank you all for your help.