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New to forum, got some questions about results
#1
New to forum, got some questions about results
First a little background.  I’m not new to CPAP therapy, having used a machine from about 1998 until about 2002.  I’ve never had symptoms that could be attributed to sleep apnea, other than snoring -  which is why a sleep study was originally done.  I absolutely hated using the machine and tried various things to eliminate the need, including UPPP surgery (removal of the uvula) and losing 60 pounds.  After the weight loss, subsequent studies were within normal limits so I stopped CPAP therapy.  Recently, my snoring has become worse (so I’m told), so I had another sleep study.  Unfortunately, the results showed a return of the apnea (AHI 49).  Disheartening, as I still have no daytime symptoms and I still hate being tethered to a machine.

I was assured by everyone that this time would be different because of advances in comfort and noise reduction.  So, I am beginning my 3rd week of therapy with a Resmed Airsense 11 Autoset, and it is definitely an improved (but still not enjoyable) experience.  The machine was set up for me, but I have been tweaking the settings and mask(s) to find what works best for me.  The pressure range that was preset was 5-20 (highest actual pressure observed was 18), and I noticed that as the pressure increased, so did certain events (CA, US, H).   OA’s have been virtually nonexistent since the beginning.  Many, but not all of these increased events also seemed to occur in conjunction with leaks.

I tried reducing the max pressure to 10, and the AHI dropped from 4.68 to 2.1, nearly all H-events.  The next night, I increased the max pressure to 11, and the AHI increased to 5.22, with events split between H & CA.  The next night, I reduced the max to 10 again, and the AHI dropped to 1.76 with only two CA events (grouped together, following a mask leak). I have used a pressure range of 5-10 for the past 6 days, with AHI ranging from .84 to 2.34, nearly all H-events.  Until last night.  After 5 hours of sleep, I got up to use the bathroom.  I checked the screen of the machine and it showed very few events up to that time.  I put the mask back on and started up the machine, and for the first time, I was unable to tolerate the pressure for about 30 minutes.  I laid awake, alternating between trying to acclimate to the pressure and breathing deeply through my mouth in order to get enough air in my lungs.  I should have just taken off the mask and finished sleeping without it, but I am motivated to continue so that I can maintain a good MyAir score - which in retrospect is probably not wise.  So, I guess my question is this - is this an unusual experience, and if not, how can it be improved.  I’ve already eliminated the ramp-up because it seemed overly difficult to breath when it was ramping up.  Also, I assume that the extreme number of events during that time can be ignored and attributed to the constant mouth breathing and mask removal/adjustments that were happening at the time.  All that said, my “MyAir” score for last night was a 98 (losing two points for mask seal), which I think highlights the weakness of such a dumbed down summary of the entire night, and doesn’t take into account everything that occurred.

Regarding the mask & leaks, I had an old Respironics nasal pillow mask from about 10 years ago that had never been used, so I tried it for a couple of nights.  Although I did not notice any leaks while using it, my Oscar results showed otherwise.  Is it possible that an old mask design is not as efficient and is leaking around the connections and not necessarily around my nostrils?  I’m trying to decide whether to switch to a Resmed P30i, but not if it will leak as much as the old one that I tried.

Thanks for taking the time to read this and review my results.  I look forward to seeing your responses.

       
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#2
RE: New to forum, got some questions about results
Anyone?
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#3
RE: New to forum, got some questions about results
Based on your flow limitations, I would suggest turning EPR up 3 and full time. The ResMed algorithm responds to FL by rasing the pressure, but more EPR helps to reduce the FL. In addition, most adults feel air starved at a starting minimum of 4 cm H2O, and for EPR of 3 to work most effectively, it needs a minimum pressure of 7 during inhalation, which will drop to 4 during the exhale.

SO, minimum pressure of 7 and EPR Full Time at 3.

There is a possibility of more CA with EPR 3, so check back with a screenshot after two or three days for a review.
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#4
RE: New to forum, got some questions about results
Appreciate for the response.  I had thought about trying EPR, but I read a post on the MyApnea board that scared me from trying it, saying that it was potentially dangerous and not to use it unless a sleep study verified that it would be safe.  Is that a valid fear, or is there an alternate opinion on its use?  Also, if I use it, do I also need to increase the upper end of the pressure range from 10 to 13?

Thanks again.
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#5
RE: New to forum, got some questions about results
There are lots of alternate opinions Big Grin

ResMed advertises it as a 'Comfort Feature' - use it if it makes you feel better.

Most veteran ResMed users here think of it as a 'Baby Bi-level' - restricted in range and adjustment increment, but a good therapeutic addition. If EPR was dangerous, nobody would make a true Bi-level machine, with its extended pressure support.

Using it as a bi-level, it can reduce or eliminate hypopneas and flow limitations. At the same time, the increased ventilation sometimes upsets the O2/CO2 balance, which leads to Central Apneas, which isn't good, but it's not dangerous. You watch for it using OSCAR, and back off the EPR level if necessary.

CAs are not dangerous in themselves; it's what causes them and how frequent they are that disturbs your sleep. You can cause a CA by shifting from one side to the other - holding your breath as you turn over.

In short, try it; if you get better results, use it. If you get more CA, back off on the EPR until they settle down. Some CA are 'treatment emergent' and go away as your body gets used to better breathing.
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#6
RE: New to forum, got some questions about results
Just my 0.02cm H2O: Turn ramp off, minimum pressure 8, maximum pressure 12, change to "For Her" mode. And work on your leaks.

And don't change the settings every night: just stay for them a week or so before changing them again.

Mike
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#7
RE: New to forum, got some questions about results
(07-02-2022, 05:41 AM)multicast Wrote: Just my 0.02cm H2O: Turn ramp off, minimum pressure 8, maximum pressure 12, change to "For Her" mode.  And work on your leaks.  

And don't change the settings every night: just stay for them a week or so before changing them again.

Mike

My ramp has been turned off for two weeks - I found it hard to breath with it on.  From 3 weeks of experimenting, it seems that I have more events with higher pressures.  Last night I reduced my pressure range to 5-9, tightened up my mask, and used a chin strap to help with mouth breathing.  I seem to have had my best night so far, according to what I see in the Oscar results.  What I don't know (because I'm still learning to read the charts) is if the lower pressure might be causing other issues (affecting O2 saturation, for example).  I would assume that if there are few events, that I am getting enough air into my lungs, but do things like Tidal Volume, Minute Ventilation, & Flow Limitations tell a different story?

Thanks!
   
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#8
RE: New to forum, got some questions about results
I ordered a pulse oximeter today which should arrive in a few days.  I suppose that will give me some reassurance of CPAP effectiveness.
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