Not feeling great after 2.5 month APAP

[felipao11]

    Hi,

I've been using ResMed Airsense 10, autoramp with pressure 5-15 and EPR of 3, humidifier level 5.  It's been 2.5 months since I started and some days are better than others but I still don't feel fully active and mentally focused as before. My AHI was 15.2 during my evaluation and it has been below 1 every night since I started with my APAP.

I'm wondering if I have a Flow Limitations issue, would you say they look like a lot to disrupt my sleep?

Or maybe it's not been enough time and I just need to keep on using it for a couple more months in order to feel better?

   

   

[staceyburke]

I have a couple of things... first you have your Chart set up so we can not see things we need to see. first get rid of the pie chart - it takes up space that important information can be seen. (f3 or goto view at the top and go down to pie chart and turn it off). Next look at my post at the bottom on organization of charts. Most of that can be done by going again to view and reset graphs standard. Now we can see more of the information we need.

I think most of your problem is with flow limits. Flow limits are Apnea also they are just not large enough to be classified as OA or H. But if you have many of them, and you do, it stops you from having a restful night or even wakes you up. So how do you reduce them? Through the use of EPR. But you have your min so low the epr is not doing anything. 4 is as low as the machine can go and you are at 5 so the epr (which lowers the exhale pressure) can only go down 1.

Your pressure chart is hard to read because it is to small, changing what I put down in the 1st paragraph will fix that. Without being able to see what is really going on I would move the min to 7 and the EPR to 3 if it is not there all ready. Again, I can't see what those are because of how you have your graphs set up. (1st paragraph)

I think if you make those 2 changes you will feel better - it will take a couple of days but I have no doubt that it will help.

[felipao11]

Thanks for your help, I'm attaching 3 graphs with the updated organized charts.

I will increase my min level to 7 and keep EPR = 3, I'm wondering if I should decrease my max to 9 as it seems my pressure increases due to flow limitations and maybe that is disrupting my sleep. I think I want to reduce it from 15 to 9, in my statistics summary 95% of my pressure is below 9

   

   

   

[staceyburke]

Keeping it high is usually not a problem because the pressure will not go up higher than needed. If you want to take it down to around 12 would be fine but I would not go lower than that. What will help with the flow limits is raising the lower number not the top.

[multicast]

You may also set mode to "soft" to make the machine's reaction less "aggressive".

[Dormeo]

If the pressures are being driven up by flow limitations, and the pressure changes are a bother, then it can make good sense to lower the maximum, because the higher pressures rarely resolve the FLs. In your case, felipao, that makes particularly good sense given how few obstructive events you're having.

So my recommendation would be to set the minimum to 8 and the maximum to 8 and see how that goes. (Leave the EPR at 3.)

I'm struck by how many hours you clock on the machine each night and by how many interruptions to treatment you are having per night. Could you say a little about both of those aspects of your night-times?

[felipao11]

You may also set mode to "soft" to make the machine's reaction less "aggressive".

Thanks I will try that tonight

[felipao11]

If the pressures are being driven up by flow limitations, and the pressure changes are a bother, then it can make good sense to lower the maximum, because the higher pressures rarely resolve the FLs.  In your case, felipao, that makes particularly good sense given how few obstructive events you're having.

So my recommendation would be to set the minimum to 8 and the maximum to 8 and see how that goes.  (Leave the EPR at 3.)

I'm struck by how many hours you clock on the machine each night and by how many interruptions to treatment you are having per night.  Could you say a little about both of those aspects of your night-times?

Thank you!  Makes sense I will set those values, I tried with 6.6 min 9max tonight and I think I slept much better than with my previous settings, here is a screenshot of that.  I was afraid to go to 8 or 7 and not be able to sleep well so I decided 6.6 min, but will try 8 tonight 

The reason you see lots of hours is because I've been trying to sleep as much as I can to see if I that would make me feel better but has not been the case, some days it is but other not so much. I wake up a lot during the night that's why you see the interruptions, sometimes the high pressure wakes me up, others I need to go to the bathroom but it usually could take about 1 hr to fall back asleep that's another reason you see the  long hours clocked.

   

[Dormeo]

I'm glad that you slept better with a narrower pressure range.

If you're worried about 8, try 7 for min and max. You're experimenting, and you may find that 7 is too low to prevent events, but that's no disaster -- you'll have learned something.

One additional suggestion: turn off the ramp. You don't really need it with these lowish pressures, and the pressure rise is just one more potential disruption.

[CentralApneaUser909]

If the pressures are being driven up by flow limitations, and the pressure changes are a bother, then it can make good sense to lower the maximum, because the higher pressures rarely resolve the FLs.  In your case, felipao, that makes particularly good sense given how few obstructive events you're having.

So my recommendation would be to set the minimum to 8 and the maximum to 8 and see how that goes.  (Leave the EPR at 3.)

I'm struck by how many hours you clock on the machine each night and by how many interruptions to treatment you are having per night.  Could you say a little about both of those aspects of your night-times?

I thought higher pressure is the best way to resolve FLs? How else should they be resolved?