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What fixed pressure I should try?
#1
Hello apneaboard community,

I need your expertise. I'm on APAP for almost 3 months now and I'm comfortable with my mask and the machine by itself.

The problem is I still don't feel the benefits of my therapy even if my numbers are pretty good with an AHI below 0.5 most of the time.

From what I understand I maybe need to go on fixed pressure CPAP.

But what fixed pressure I should start with???

See a screenshot of a typical night for me:

[Image: screenshot-20160415-184858_zpsl1g8xvsd.png]

Also you need to know that I have a problem of swallowing air (aerophagia). My EPR is full time with a 2 cm H²O.

Hope somebody will be able to help me out.

I see my doctor in two weeks but I will like to try fixed pressure for the weekend Unsure

Your feedback will be really appreciate Big Grin
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#2
You don't have an issue with Centrals, so you could try an EPR of 3. Setting your pressure to a straight pressure that would keep the bogies at bay would likely increase aerophagia. If EPR of 3 helps, but not enough, you may wish to talk to your doc about bilevel with a higher pressure support.

There are some other things with high pressure - such as need for enough humidity - that can make a big diff. Dunno about you, but if my eyes are puffy I feel yuck! too much or too little humidity, sinus inflammation, anddddd water retention can all contribute here, and cpap exacerbates all of those. EPR and Bilevel would help with both aerophagia and retention.

if it is sinus issues, nasal sprays are your friend and I highly recommend the ones with xylitol (such as xlear) as they are more soothing to the tissues than plain saline, and have a nice antibacterial effect also.
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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#3
(04-15-2016, 05:54 PM)Rousseau21 Wrote: Hello apneaboard community,

I need your expertise. I'm on APAP for almost 3 months now and I'm comfortable with my mask and the machine by itself.

The problem is I still don't feel the benefits of my therapy even if my numbers are pretty good with an AHI below 0.5 most of the time.
Can you be a bit more specific about what you mean by you "still don't feel the benefits" of your therapy?

Are you still experiencing some of your pre-CPAP symptoms of OSA? If so, which symptoms?

How would you describe the subjective quality of your current sleep? Do you get to sleep at the beginning of the night with little or no problem? Are you waking up a lot during the night? Or are you just not feeling much different than before you started CPAP?



Quote:From what I understand I maybe need to go on fixed pressure CPAP.

But what fixed pressure I should start with???
Some people do sleep better with fixed pressure CPAP than APAP. On the one night of data that you posted, your 95% pressure level was 13.54. If that's pretty close to what your 95% pressure level runs most days, then starting with a fixed pressure of around 13 or 14 is a good guess. If you switch to fixed pressure I'd keep EPR = 2 at least for a few nights. It's best to only change one variable at a time.

But if you don't want to give up on APAP just yet, it is worth considering changing EPR from 2 to 3 and leaving the machine in APAP using your current settings at least for a few nights.

Quote:Also you need to know that I have a problem of swallowing air (aerophagia). My EPR is full time with a 2 cm H²O.
Switching to CPAP may or may not help with the aerophagia. I think you'll know whether switching to CPAP helps or hurts the aerophagia issue within 1-3 nights.

I will add that when I was on fixed CPAP pressure I had a lot more trouble with aerophagia than I had on APAP. But even with APAP, I still had enough aerophagia and other problems leading to sleep disruption that the sleep doc finally suggested a switch to bilevel. Auto bilevel is what finally brought my aerophagia under control.

So you might want to talk with the sleep doc's office. Mention that you've been doing this for 3 months with good numbers on paper, but that you still feel lousy and that you are still experiencing a lot of aerophagia. Ask whether it's worth being switched to a bilevel machine to see if that helps with the aerophagia.

Questions about SleepyHead?
See my Guide to SleepyHead
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#4
As far as you AHI goes, you would be considered "done"-as was I. I still could not get good sleep and my Doctor had to play some games to get me on a BiLevel. I needed an EPR of 4 and that requires BiLevel. each step I took was "better". BiLevel (Resmed Aircurve 10 VPAP) is for patient tolerance, the next level up machine is for centrals and complex (which you don't have). The VPAP comes with more settings to play with and I have been adjusting T1 max (how long it will let you breathe in before it withdraws the support pressure) it turns out that I inhale slowly and it gets slower through the night, default is 2 seconds and just recently I changed from 3.4-3.7-4.0 seconds. I also changed how sensitive it was in detecting the start of my inhale. This "may" be what I have been looking for as the last two nights have been epic.

I suggest that something besides the treatment pressure is keeping you from sound sleep and you need to play around with the settings and see if you can isolate what it is.

For your Doctors meeting I would just outright go for the next level BiLevel VPAP machine, get the extra settings and see what you can do. Get the manual and see what the settings are and what they do
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#5
(04-15-2016, 06:06 PM)DariaVader Wrote: You don't have an issue with Centrals, so you could try an EPR of 3. Setting your pressure to a straight pressure that would keep the bogies at bay would likely increase aerophagia. If EPR of 3 helps, but not enough, you may wish to talk to your doc about bilevel with a higher pressure support.

There are some other things with high pressure - such as need for enough humidity - that can make a big diff. Dunno about you, but if my eyes are puffy I feel yuck! too much or too little humidity, sinus inflammation, anddddd water retention can all contribute here, and cpap exacerbates all of those. EPR and Bilevel would help with both aerophagia and retention.

if it is sinus issues, nasal sprays are your friend and I highly recommend the ones with xylitol (such as xlear) as they are more soothing to the tissues than plain saline, and have a nice antibacterial effect also.


Thanks for the quick reply DariaVader Smile

Ok I will try to put my EPR to 3 cm H²O.

The humidity is maybe a problem I still search for the correct setting ...

I don't have sinus issues so far.

I'm still tired and lacking concentration that's why I said I don't see the benefits of the therapy ...
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#6
This helped me with my humidifier and hose temp settings: http://www.resmed.com/us/dam/documents/p...sa_eng.pdf
Just my personal opinion. My posts are not medical advice or a statement of fact. Please consult a qualified physician or other qualified medical personnel. Please comply with all applicable laws, codes, regulations, and protocols.
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#7
Thanks for the quick reply robysue Smile

Quote:Are you still experiencing some of your pre-CPAP symptoms of OSA? If so, which symptoms?

I'm still tired and I'm lacking concentration ...

Quote:How would you describe the subjective quality of your current sleep? Do you get to sleep at the beginning of the night with little or no problem? Are you waking up a lot during the night? Or are you just not feeling much different than before you started CPAP?

I'm falling asleep pretty easily and I do not usually waking up during the night. I feel worst now then before my therapy Sad


Quote:But if you don't want to give up on APAP just yet, it is worth considering changing EPR from 2 to 3 and leaving the machine in APAP using your current settings at least for a few nights.

I will put my EPR to 3 tonight to give it a try Smile

Quote:Also you need to know that I have a problem of swallowing air (aerophagia). My EPR is full time with a 2 cm H²O. Switching to CPAP may or may not help with the aerophagia. I think you'll know whether switching to CPAP helps or hurts the aerophagia issue within 1-3 nights.

I will add that when I was on fixed CPAP pressure I had a lot more trouble with aerophagia than I had on APAP. But even with APAP, I still had enough aerophagia and other problems leading to sleep disruption that the sleep doc finally suggested a switch to bilevel. Auto bilevel is what finally brought my aerophagia under control.

So you might want to talk with the sleep doc's office. Mention that you've been doing this for 3 months with good numbers on paper, but that you still feel lousy and that you are still experiencing a lot of aerophagia. Ask whether it's worth being switched to a bilevel machine to see if that helps with the aerophagia.

I hope I don't need a bilevel machine because I already buy the APAP machine and a BiLevel is more expensive ...

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#8
(04-15-2016, 06:34 PM)PoolQ Wrote: As far as you AHI goes, you would be considered "done"-as was I. I still could not get good sleep and my Doctor had to play some games to get me on a BiLevel. I needed an EPR of 4 and that requires BiLevel. each step I took was "better". BiLevel (Resmed Aircurve 10 VPAP) is for patient tolerance, the next level up machine is for centrals and complex (which you don't have). The VPAP comes with more settings to play with and I have been adjusting T1 max (how long it will let you breathe in before it withdraws the support pressure) it turns out that I inhale slowly and it gets slower through the night, default is 2 seconds and just recently I changed from 3.4-3.7-4.0 seconds. I also changed how sensitive it was in detecting the start of my inhale. This "may" be what I have been looking for as the last two nights have been epic.

I suggest that something besides the treatment pressure is keeping you from sound sleep and you need to play around with the settings and see if you can isolate what it is.

For your Doctors meeting I would just outright go for the next level BiLevel VPAP machine, get the extra settings and see what you can do. Get the manual and see what the settings are and what they do

Thanks for the quick reply PoolQ !

I hope that I won't need to go there because I already buy my APAP machine and I can't change from what I understand and it's more expensive Oh-jeez

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#9
(04-15-2016, 06:44 PM)sdb7802 Wrote: This helped me with my humidifier and hose temp settings: http://www.resmed.com/us/dam/documents/p...sa_eng.pdf

Thanks sdb7802 for this link !

I'm not really sure how to decide my setting ...

I know that we are not in the same environment and we are not the same type of person but can you tell me what are your settings sdb7802 ? Big Grin
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#10
you can go anywhere from max humidity and warmth down to a dry tank and 60 degrees F temperature. I usually use a dry tank or sometime a folded up damp paper towel with temp at 62 degrees. As you can guess I do not like humidity, others will have it set to its max
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