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New Member / First month on CPAP
New Member / First month on CPAP
Hi All.  Following a home sleep study, I was diagnosed with mild sleep apnea with an AHI of 12. Because of COVID restrictions, I have largely been managing the treatment myself over the last four weeks following the excellent guidance on this board. Although I have insurance, I quickly determined that it was more cost effective to buy equipment and supplies on-line rather than paying rental and co-pays to the approved DME. I ordered the board recommended Resmed machine and guessed on a nasal mask from the pictures (N30).  It took me a couple of weeks to get used to the therapy and understand the machine settings but I am now starting to get acclimated. The good news is that my AHI down to less than 2 most nights. I am sleeping better - no morning headaches and less fatigue. My BP is also down appreciably. Still fussing with the mask to prevent leaks when I sleep on my side. A couple of concerns: OSCAR shows that my pressure is typically 12-13. Is that a high pressure for"mild" sleep apnea?  Also, there is a lot of activity on the flow limit chart. Is that normal?

Lastly, I am planning to take the family up to Flagstaff next month (8000 ft elevation) for vacation. I will be taking my new travel machine, the Dreamstation Go. I appreciate that the Phillips algorithms are different. Should my settings remain the same? Should I use AFLEX or CFLEX as substitute for EPR-2? Will the the elevation change anything in my therapy?

Thanks for your thoughts.
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RE: New Member / First month on CPAP
mild is simply a reflection of the number of apnea per hour. nothing to do with the pressure it takes to overcome obstruction, which needs vary according to our physical makeup.
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RE: New Member / First month on CPAP
Sheepless has it.  The number of events per hour, averaged over each defined sleep cycle, gives us the range that the experts and insurance industries have agreed delineate the three categories, mild, moderate, and severe.  What it takes to get your numbers down under 5 is strictly between you and your device.

It is highly likely that you will have to make adjustments at altitude.  The air will be drier, for one thing, and it will be measurably rarer...meaning you won't be getting as much oxygen as you would normally.  The machine will adjust itself for fan speed as it has a sensor for pressure, and it will speed up the fan until it generates that pressure in the lighter air.

I don't know that you'll gain much by doing more than regulating the humidity the device delivers, and certainly taking pains to keep your tube warm so that you don't get condensation and rain-out.  I would see how the first couple of nights go, and then try some experimentation...light experimentation, no big adjustments.
Serial Tapist
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RE: New Member / First month on CPAP
Welcome to the forum.
Your numbers are very good,  your pressure has more fluctuation than I'd like to see, your Flow Limits are high but we shouldn't do a lot for them unless you have issues.
CFlex and AFlex are 'equivalent' on paper to EPR, though not in reality. They are PR features, not ResMed.

High pressure, low pressure, and the severeness of your apnea have minimal to no correlation.
Mild Apnea of 12 AHI means that you were getting figuratively an elbow in the ribs every 5 minutes on average, all night long.

I will suggest 2 changes

1. Set EPR = 3 full time, this is to help with the flow limits, it should also help with comfort.
2. Decrease your max pressure to 13 to minimize pressure fluctuation.  This is done for comfort.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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RE: New Member / First month on CPAP
All, thanks for the feedback!!  Glad to hear the the high pressure is not an issue and that the elevation should not effect my therapy. I will take the advice to lower my maximum pressure from 16 to 13 and raise the EPR level to 3 to see if fluctuation and flow limits can be moderated. I will report back this weekend.
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RE: New Member / First month on CPAP
On Thursday night I made the changes suggested by Bonjour (max pressure 13 / EPR 3). My AHI stayed low and I was more comfortable. Are the fluctuation and flow limits better controlled?
On Friday, I received a new N20 mask in the mail. I was hoping that this "less minimal" nasal mask would reduce the annoying leaks I have had with the N30 when I sleep on my side.  It did! Otherwise, the graphs seems similar. One thing I did notice-- I seem to be frequently bumping up against the new max pressure setting of 13. Given that the AHI seems well controlled does that matter?

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RE: New Member / First month on CPAP
Good to hear that your AHI is staying low and your comfort increasing. I hope you'll keep people posted on your experience. When you do, could you fit the following into one screen shot:

Flow rate
Flow limitations

The way to make these graphs fit is to scrunch them a little by grabbing the gray horizontal bars that separate them and moving them up a bit.

Different people have different reactions to high altitude, both in general and in sleep. It may not be a problem for you at all, but I'll report that I've gotten a lot more sensitive to altitude over the years. Half a glass of wine does me in; I get headaches and feel spacey; and at night my tidal volume goes down, my respiration rate goes up, and my minute ventilation goes down. Translation: I move less air per breath, breathe faster to try to make up for that, and yet move less air per minute than normal. My events didn't go up, but I felt very unrested.

You might want to ask your doctor whether you should have any medication for altitude sickness on hand, especially if you'll be staying for a while.
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