New to CPAP — settings adjustment

[rjbutler]

I’m 11 days in with a CPAP.  I am apparently one of the lucky ones who had minimal trouble adapting.  I’ve been able to use it the whole night from day one and my AHI has been less than 1 9 out of 11 nights, and less than 4 the other two.  MyAir scores have been 98+ every night.

The issue I’m having is that I don’t feel like I get enough air sometimes — when first going to sleep and sometimes when switch sides (which causes me to fully wake).  Eventually it adjusts up.  According to Oscar, my median pressure is usually around 6.5, 95% between 9 and 10.  I turned off auto-ramp after a few days (it was set at 4, with a 5-15 pressure range) and then a couple of days later bumped up the minimum pressure to 5.6.   I have a P30i mask, with one sample N30i cushion.  I’ve used the nasal pillows most night with good results, I’ve used the cushion twice and both times had large leaks.  But I feel like I’m getting more air with the cushions.  Sometimes if I reposition the pillows I have an improvement, but i suspect I’m slightly breaking the seal and getting outside air when that happens.

I have my first followup with the RT a week from Monday, and my appointment with the doctor is mid-May.  I’m a little hesitant to bump the low end of the range more without approval from the doctor, especially with the low AHI I’m seeing.  I think I read that the RT won’t make those adjustments on their own, that the doctor would need to approve?  Will the RT make that happen or do I need to contact the doctor myself?

Any other suggestions?  Thanks for any help.

[JCinPA]

Hi, there, welcome to ApneaBoard!

I'm kinda new to really delving deeply into therapy analysis using OSCAR, but have been using CPAP for almost 6 years, and like you, I took to it the very first night, and never had any issues.

Most people here and on other CPAP boards who use OSCAR and begin to learn what settings affect what become comfortable making settings adjustments on their own. I understand your reluctance since you are relatively new to it, but as long as you are not making huge changes in settings, you are OK making minor adjustments on your own, you won't blow yourself up!

To get the most help from members here, learn how to post a screenshot of your Oscar data. I use the Alt-PrtSc to capture it, post it in Word, then click the image and save it as a jpeg, put in on imgur.com and then post it here. There may be an easier way, but here is an example from my Oscar data for last night.



I believe turning off the Ramp feature was a good move, if you have no discomfort and fall asleep easily. I never use it. You should be able to move your lower pressure limit from 5 to 6 with no ill effects, and that may alleviate the feeling of not getting enough air because, well, you'll be getting more air. The upper limit does not matter much as it self-limits with your machine.

Try the 6-15 pressure setting for a couple nights and see how you feel. None of this will matter to an insurance company, they only care that you use it a minimum number of hours each day, they could not care less what your settings are. And your doctor surely should not care that you changed from 5-15 with ramp to 6-15 with no ramp.

Come back and report how it works and post an Oscar screenshot and you'll get a ton of helpful advice from folks way more expert at it than I am. If you are not sure how to change the pressure settings, see here:

https://www.youtube.com/watch?v=sEDSvaVaTvs

Good luck!

Cheers,

John

[rjbutler]

Here are my last two nights.  I have SpO2 readings for last night, but not the night before.  I'm able to just copy/past the images into the message, maybe that's easier on a Mac?  I'll try 6 tonight and see how it goes.  I also wonder if the medium nasal pillow might be a touch too small for me, I think an additional 2-3 mm between the pillows would be a better fit.  But maybe the Large would be too big.

*** Moderator Note: Corrupted image removed. ***

Images can not be hosted from a personal computer.  Please upload them either to the Apnea Board server, for CPAP related images only, or use an image hosting service.  For help in attaching images, please review Attaching Images and Files on the Apnea Board.

[Jeff8356]

rjbutler,

As was noted in your previous post, you can't just copy/paste images into a forum post. Nobody can see them but you.

See the link in my signature for help with attaching images to a forum post.

[rjbutler]

Here are my last two nights.  I have SpO2 readings for last night, but not the night before.  I'll try 6 tonight and see how it goes.  I also wonder if the medium nasal pillow might be a touch too small for me, I think an additional 2-3 mm between the pillows would be a better fit.  But maybe the Large would be too big.
       

[JCinPA]

Try the large, see what happens. Part of this process is experimentation to see what works best for you. Leave it on min pressure 6 for two nights, it might help with that feeling of not getting enough air.

Not scientific sampling, by any means, but just from reading posts, I think most folks start at around 7-8 or above for the min. And most will have more issues with too little pressure than too much, and raising it should pose no health concerns for you. Your machine "auto titrates", meaning it adjusts to the pressure it thinks you need based on your breathing events. Your upper limit is 15 but you see you are getting nowhere near that with a 95% at 10 or below, you can leave that alone.

If 6 eliminates the feeling of not getting enough air, you are good to go, if you still feel a little bit like you're pulling for a breath, try 6.5 or 7 for a couple of nights.

Jeff835 has the easier process for posting attachments. I have to host mine elsewhere on another board, but you don't have to do that here, apparently.

[rjbutler]

I bumped up to 6 last night and it seemed much better.  I do have seasonal allergies though and have been slightly congested lately.  Last night I also did a saline rinse which cleared me out a bit, so maybe that helped too.  I'll try this level for a bit and see how I feel.  

Overall, I'm very happy with the results though.

   

[JCinPA]

Very nice numbers, and glad the min pressure of 6 makes you feel better! If you feel good, you can leave it there. The machine is pretty much keeping you between 6 and 8 (very short bump to almost 9), so I think you've nailed it if you like the way you're sleeping. Very few breathing incidents, so you don't need more pressure. If after several days you want to experiment at min 6.5 to see how it feels, that won't hurt anything, but if it ain't broke, don't fix it, as they say.

Your flow limitations are pretty low, as well. Looks wonderful. I found the CPAP machine was giving me allergies from time to time. Many don't clean their machine much, and extra cleaning machines or chemicals are not really needed, but I believe your tank should be emptied and dried out every day, and I'm not alone in that view.

My cleaning regimen is to let the machine do the cool down cycle while I shower and have breakfast, then I wash my nasal pillows with soapy hands, and disassemble the water chamber and wash the chamber and gasket with soapy fingers, then rinse and lay on a hand towel to dry. At night I reassemble and refill the humidifier chamber (tap water) and off to bed.

On Saturday or Sunday, I bring the humidifier parts and the mask and mask hose down to the kitchen and soak it all in hot dish soapy water. I then soak all of it in warm water and white vinegar (2-to-1) for a half hour or so, then give everything a good couple of rinses and hang up to dry. I only do the main tubing about once a month.

I found this cleaning routine keeps me from having any allergies from the CPAP. A lot of folks here leave the tank full and just top off and hardly clean at all, but if you are having allergies, I would bet you'd benefit from this routine, and it doesn't take much effort or time.

Good luck!

[Dormeo]

I think I'd go even one step further than what JCinPA has advised. Try raising your minimum to 7. That way you'll have your full EPR of 3 all night long. (The machine can't go lower than 4.)

Your RT may scold you or not, but all you need to do is explain that you felt somewhat air-starved and feel much more comfortable with a higher minimum. Your RT should be pleased with your excellent results and excellent compliance.

I want to underline something JCinPA said: there's experimentation involved in optimizing PAP therapy, and what works for one person may not work for another. You should feel free to try anything that won't hurt you, within the constraints of your budget.