[Pressure] ResMed hypopnea need help tuning settings

[stevewea]

My doctor said I have hypopnea and has me on a ResMed AirSense 10 AutoSet. He set my machine to an initial pressure of 4, auto-ramp to max pressure 5, with a exhale relief of 3.

The 1st night: I had a very hard time exhaling out and found myself out of breath, so I stopped the machine for the night after only an hour.

The 2nd night: with help from this board I tried initial pressure 7, max pressure 7 to fix the exhale.  It worked great!  Exhaling was very easy!  But I woke up a couple of times the first hour scarily out of breath, so again I turned off the machine for the night.

The 3rd night: Tried starting pressure of 6 and max of 14.  I auto-ramped to 14 while still awake, and the high pressure was way too much.  I decreased the pressure a few times because my mouth kept blowing open, and finally turned off the machine at max pressure 10.

With so much trouble with the machine, I'd say I'm suffering from CPAPnea!

So I am hoping to get suggestions to:
1. keep my mouth from blowing open, and 
2. avoid waking up starved for oxygen.

I got my data into OSCAR today but I won't post it yet because my chart is a mess with all of the stopping/starting, changing pressures, and yanking the mask off.  One thing I was able to tell is the leak rate is 0 except when I was messing with the mask and pressures.

Unless I get a recommendation, I'm going to try min 6 max 9, with exhale relief at 3.  If I can keep it together tonight, I should have something to post tomorrow.

Thanks!
Steve

[staceyburke]

Your min is to low. The min is your inhale pressure and you need it raised to give you enough oxygen.

The absolute lowest any m machine will go is 4 and that is used for children not adults. I need at least 9 not to feel air starved and pulling off my mask

EPR is exhale relief meaning it subtracts ate EPR from the minimum to help you exhale. So for example if your min was 8 and your EPR was 3 - your inhale would be 8 and your exhale would be 5.

That would be my suggestion but if you still need more air raise the min.

Min=8
EPR=3
Max up to you set it 2 above your actual max recorded on OSCAR.

GET A GOOD NIGHTS SLEEP and post tomorrow.

[SarcasticDave94]

Yep, EPR 3 will only fully work with min pressure of 7.

You need your actual diagnosic study report, the detailed one. You need this for your personal health file and you can post it here in redacted form. And HIPAA law permits you to request and receive it. No from the doc's office isn't acceptable.

You'll also need OSCAR, the free and safe report tool. You need this to see your own therapy and to post screenshots as new attachments.

We're data and results driven.

You need the CPAP Setup Manual for your exact machine, in this case it's the ResMed AirSense 10 AutoSet. Look at the top banner. You need this to understand your PAP, how to access the Clinical Menu and to know what the settings are and what they do.

[Ratchick]

What all the others have said. If the pressure is causing a mouth leak, there are ways around that (either changing to a different mask or by using other methods to keep your jaw lifted/mouth sealed).

The shortness of breath is a sign you need MORE pressure not less, usually. Your minimum definitely needs to be higher, and if breathing out against it is harder, use the EPR, as stated above. Start with the minimum pressure at 8, set the maximum to 10 (or a level above that that you can tolerate and ideally isn't popping your mouth open), and then show us the chart from OSCAR.

[stevewea]

Thank you everyone for your responses, I really appreciate it!

Last night I went with min 8, max 9, EPR 3.  My mouth wasn't blowing open, just had some air bubbles running into my mouth sometimes, and I didn't find myself starved for air, so these are improvements!

Unfortunately, it was still very uncomfortable so I didn't sleep much - I turned it off after a couple of hours.  

I have attached:
- OSCAR charts from last night
- screenshots from my sleep study result from the Dr. (I assume this is the summary report, not the detail?)

Thank you!

[staceyburke]

Having centrals are hard to help - normal Cpap machines do NOT treat centrals. All we can do is try to lessen then thankfully most times the go away after getting use to therapy. 

Your sleep studies would list centrals you had or did not have without Cpap therapy. If you have them post without you personal info. 

As what we could change is to take away EPR AND make the min and max the same. That makes it like a normal Cpap without autoset. 

Min=8
Max=8
EPR=0 full time

[stevewea]

oh, I didn't notice my study result wasn't attached last time.  trying again

[staceyburke]

From what I see it is good news, you did not have centrals and if correct yours are coming from emergent centrals. Meaning that once your body gets use to Cpap therapy they will go away. It takes several weeks but if you can stick with it for whole nights they should go away. 

BTW everyone has some centrals during the night, the machine will record a central anytime you hold your breath for 10 seconds or longer. And many people hold their breath when turning over or pulling up covers. So you, like most people will have a few each night but that is not a problem.

[SarcasticDave94]

For now, go with straight PAP pressure somewhere between 8-9. These CA ought to be treatment emergent as they weren't on the study report. The goal for right now is to maximize comfort so you'll keep using your machine so that the body has time to get used to the therapy. Hopefully in short time, the CA diminish.

[stevewea]

Thank you for the help.

In my situation then, any EPR is not a good thing?

It sounds like for tonight I will change to:
Min=8
Max=8
EPR=0

…and I will try to go the full night.