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[Treatment] Need some tuning I think
#1
Need some tuning I think
I'm new here and new to the world of Sleep Apnea. I've attached my at home sleep study. Lots of snoring, lots of gasping for breath, low oxygen levels and a very unhappy but understanding wife. I've trialed a CPAP machine for a month and it's made quite a difference in all those aspects, so I did purchase one in the hopes that I would continue to see improvements in my sleep. And I have noticed some improvements. I'm still tired during the day, but it is not as debilitating as it was. I no longer fall asleep at my computer while reading, I don't fall asleep after dinner watching TV. 

So my concern now after seeing the Oscar report is the number of RERA events. I've read through a bunch of threads with peoples logs, and my RERA events look a lot higher than most that I've seen. What does it mean? Do I need to be concerned? Can I tweak some settings to counter them? The sleep clinic I visited only mentioned the number of events of OA while I was trialing their machine in relation to what the sleep study showed. And to be clear, I'm not unhappy with the clinic. They've already made a huge improvement in my sleep. I'm just ready to take it to the next level.

I've added my Oscar charts for last night for comparison to the sleep study and to help with any possible tweaks I might make.

Thanks


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#2
RE: Need some tuning I think
How did you end up with the current setting of CPAP mode with a fixed pressure of 10? Doctor recommended or trial and error?

Without more information I am not quite sure about the machines flagging those events as RERA’s. I suggest focusing on the hypopnoea and obstructive events.

My opinion is the settings you currently use are not optimal for your therapy. I suggest a reset back to a baseline we can work from. If you are willing, give the following settings a go.

Mode APAP
Min pressure 8
Max pressure 15
EPR 3 full-time
No ramp

One thing of note is you have quite a few flow limitations. It is possible that your current machine will not be able to resolve them sufficiently and you may need to move to a bilevel e.g. ResMed AirCurve 10 Vauto. We can try and resolve them as best we can with the available settings, but you just may need more pressure support than the Autoset can provide.

Another thought is make sure you are using the flattest pillow you comfortably can use. Everything you can do to help keep your neck properly aligned will help.

Give those a try for a few days and report back. We can work with it from there.
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#3
RE: Need some tuning I think
Those RERA are just getting flagged left and right wherever you get any kind of normal breath during that period with the excessive FL. Mine does the same when that happens, it's just the way the machine is programmed. EPR may help knock them down, but there might need to be additional interventions like bilevel as PL&P mentioned, or other methods to improve nasal breathing and reduce airway resistance. Sometimes the partial blockages come from something that's not easy for a little bit of air pressure to push out of the way, often within the nose itself.
Look, I'm an engineer, not a doctor! Please don't take my opinion as a substitute for medical advice.
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#4
RE: Need some tuning I think
hey tim,

the idea is to normalize breathing in the flowrate graph; that's the endpoint we're aiming for. These RERAs can be conceptualized as subtler breathing events that share the same nature as apneas and hypopneas. You have a lot of flow limitation, in addition. You need more pressure, preferably in the form of pressure support. Your machine, I take it, only has EPR, so you should give that a shot at 3cm (simultaneously increase min pressure by 1cm). If that's not enough, then I second the opinion of peaceloveandpizza in trialing a bilevel. It's more appropriate for your needs. That said, you could try increasing the pressure until it's intolerably uncomfortable as well, as there's a chance the increased pressure can resolve these too.
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#5
RE: Need some tuning I think
           
Thanks for the reply.

The sleep clinic set my rates at the end of my 30 day trial, based on what he was seeing for the OA's. He never mentioned any other problems with my sleeping.
Before your reply and after reading lots and watching countless videos, I did increase  my rate to 11 and put EPR to 3. I noticed a significant decrease in both Hypopnea and RERA.
I shall shall change to your suggested settings, and see what happens from there.
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#6
RE: Need some tuning I think
I'm struggling with the correct temp and humidity right now. I got woken up unable to breath due to the swollen membranes in my nose the other night. I had the sleep tech turn both down as the trial machine felt a little too warm. I'm closing in on max humidity now on the ResMed, and increasing heat setting slowly as well. I'm almost positive that this is part of my problem here. Things swelling and making it harder to breath.

Thanks Pete!
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#7
RE: Need some tuning I think
(03-22-2024, 09:41 PM)PeaceLoveAndPizza Wrote: Give those a try for a few days and report back. We can work with it from there.

Here are the last 3 nights with your suggested settings.
As an FYI, I have been  using the ResMed N30i then switched it out for the P30i last night. My thoughts on switching masks was to better facilitate my preference for side sleeping. I found I was having leaks due to my movements at night and I can feel my airway collapse while on my back. Now just to get used to the pillows.


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