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New APAP/CPAP User - Help with optimizing treatment
#1
Hi, I've been recently diagnosed with apnea, AHI of 88. They started me on CPAP treatment. At first it was on auto, but after examining my data, they changed it to fixed CPAP at 17.6 pressure. I'm using nose pillow along with a chin strap. Recently I've been waking up a few times a night gasping with my mouth, but then I fall right back asleep.

Attached are lots of screenshots, from when I was on auto as well as when they changed it to fixed CPAP.

Days 1-5

   
   
   
   
   
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#2
Days 6-10

   
   
   
   
   

Days 11-15

   
   
   
   
   
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#3
The pressure settings have not made much difference. It looks like you occasionally exhale through your mouth. You can see it where the flow rate graphs have no lower-half. Flow limits are kind of high. You responded well to the increase of EPR from 0 to 1 with a reduction in the hypopnea you originally had. I think you can benefit further from increasing EPR to 3 and returning to Autoset mode at 12 minimum to 18 maximum pressure.

I might take away your chin strap and try a soft cervical collar. It will apply light pressure on the back of the jaw to encourage you to keep your mouth closed, while the chin strap often pulls your jaw back increasing obstruction. In addition, I think it will avoid the occasional obstructive apnea that you have as a result of sleep position or chin-tucking. I think between using the soft cervical collar and increasing EPR, you will experience much better results at lower pressures.
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#4
So I got a cervical collar and tried the settings suggested. Here are the last few days.


   

   

   

   
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#5
That is some pretty stubborn obstruction with a lot of snores. You are struggling to keep AHI below 5 even with pressure to 20. If things don't turn around, you appear to be a bilevel candidate. I think as far as settings, you can set the maximum pressure back to 20 and keep the EPR. At least with the lower pressure 12-18 EPR 3, events did not increase, and this is encouraging in the event you need to move to BiPAP/VPAP. It would help to hear your impressions of the therapy and comfort. This is pretty darn high pressure. Have you found the cervical collar prevents your airway from collapsing?
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#6
(05-21-2018, 08:44 AM)Sleeprider Wrote: That is some pretty stubborn obstruction with a lot of snores.  You are struggling to keep AHI below 5 even with pressure to 20.  If things don't turn around, you appear to be a bilevel candidate.  I think as far as settings, you can set the maximum pressure back to 20 and keep the EPR. At least with the lower pressure 12-18 EPR 3, events did not increase, and this is encouraging in the event you need to move to BiPAP/VPAP.   It would help to hear your impressions of the therapy and comfort.  This is pretty darn high pressure.  Have you found the cervical collar prevents your airway from collapsing?

I do find myself not waking and needing to open my mouth (either to exhale or breathe in) like before. Not sure if that's the lower pressure, the collar, EPR, or all of the above.

When I first lay down to sleep is when it is least comfortable. It's not as bad as when the min pressure were set at 4 and I felt like I was suffocating, but not as comfortable as when the pressure were manually set at 17. It's not terribly uncomfortable, just feel short of breath and want to open my mouth to take in more air.

I'll try increasing the max to 20 and will report back in a few days.
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#7
Bilevel therapy is used for people that can't achieve efficacy within the limits of CPAP at 20 cm, and provides more pressure support and pressures to 25 or 30 cm. It is often used for those that don't "tolerate" CPAP and find the comfort of greater pressure support helpful. Just keep it in mind as a contingency if you need it. There are plenty of members on the forum that need the little extra bilevel can provide.
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#8
Here's the last week:

   

   

   

   

   

   

   

   
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#9
your still getting a lot of clusters. If your still using the collar make sure it fits under the chin were it won't allow your chin to slip into it.
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#10
You are exhaling through your mouth. If you find the exhale pressure too high to comfortably exhale, you should discuss getting a BiPAP/VPAP bilevel machine that can give you the pressure you need, but relief exhale pressure, or consider changing to a full face mask. Whenever you see all of the respiratory flow is above the zero line and just a few breaths below, that is oral exhaling, and it basically results in a loss of exhale pressure control. Most obstruction is still in clusters, so as Walla points out, there is room for improvement with the c-collar, but the leak rate is mostly an oral exhale.

[Image: attachment.php?aid=6256]
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