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can't breathe well toward end of night
#1
I'm having some sort of issue getting a screenshot to show up in my screenshot folder this morning, for whatever reason, and I don't have time to mess with it, but you can probably get an idea of what's going on with just a description of the problem. I've been on cpapa for about a month now, and for the past few mornings, at about 0230 or 0300, I've gotten up to get a drink of water, as usual, and when I come back to bed and try to get settled in again, my tidal volume, minute vent and flow rate all increase dramatically. tidal volume varies from 1050 to as high as 2100, averages about 1200. Minute vent hovers around 12. I feel like I can't ever get a good breath and after about 15 minutes have had to take my nasal pillows off and just quit the cpap for the rest of the night. Any thoughts as to why this has just recently started and what I can do about it?

When I have more time I'll try to resolve the screenshot issue, but for now any thoughts are appreciated.  Thanks!

PS, I's sure there are already threads on this but I don't have time to search them out right now.
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#2
Raise your minimum pressure to the median pressure you have for most nights. Your description sounds like anxiety upon restarting therapy, and of course your machine is at a very low pressure. You start hyperventilating and this cascades into a failure as the machine can't meet your demand at 5 cm. You've been doing this long enough, you don't need that low pressure any more.
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#3
I agree. A starting pressure of 6 or more, and quitting the ramp, helped me be able to stop experiencing what you've described.
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#4
Ditto to what Hydrangea and Sleeprider said. I too had problems breathing with my orginal DME settings of 5-17. Once I made some modifications by bumping up the IPAP (min pressure) especially, those problems went away.
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#5
I have had the same issue (feeling like Im not getting enough air) and still feel it some at min pressure of 8, but also experience some aerophagia at times so I am reluctant to raise pressures much. Any ideas?
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#6
Thanks very much to all three of you. I appreciate the information very much and have already changed the settings on my machine. Specifically, I moved the minimum pressure to 6.2 and turned off the ramp.
I appreciate this group very much. Lots of help readily available. The people at my sleep center don't seem all that knowledgeable, to tell the truth. I would hope that my doctor would know all of this, but I've been disappointed in them before, too. (Especially my epileptologist, but that's another story.) In any case, I won't have an appointment with her for almost a month, and this was a problem that really needed to be solved. I imagine there will be others along the way as well.
Thanks again!
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#7
(03-23-2017, 02:35 PM)Mark71 Wrote: I have had the same issue (feeling like Im not getting enough air) and still feel it some at min pressure of 8, but also experience some aerophagia at times so I am reluctant to raise pressures much.  Any ideas?

It could be that you have Ramp enabled to start at a very low setting. Disable ramp is my advice.  Also check out your EPR setting to see what setting it is at. I use a setting of 1 generally myself but have used 2 as well before.  I also found turning down the humidity to a manual setting of 2 or 3 helped me.
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#8
(03-23-2017, 02:55 PM)Marillion Wrote:
(03-23-2017, 02:35 PM)Mark71 Wrote: I have had the same issue (feeling like Im not getting enough air) and still feel it some at min pressure of 8, but also experience some aerophagia at times so I am reluctant to raise pressures much.  Any ideas?

It could be that you have Ramp enabled to start at a very low setting.  Disable ramp is my advice.  Also check out your EPR setting to see what setting it is at.  I use a setting of 1 generally myself but have used 2 as well before.  I also found turning down the humidity to a manual setting of 2 or 3 helped me.

I don't really understand what the EPR is. The sleep guy at the center where I had my study said I should turn it from 3 to 2, which I did. Didn't really make much difference that I could tell. What does the EPR do, and do you think 1 would be better than 2 for me? How would I decide?
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#9
EPR = Exhale Pressure Relief. It drops the pressure by 1-3 when you exhale but also reduces the minimum pressure you have by whatever number you set it at. So right now, if your minimum pressure setting is at 5, if you set EPR at 3 or 2 your minimum pressure at exhale will be 4 since that is the lowest it can go to. Even if you set your EPR at 1 your exhale pressure will be at 4 as well. Too low!

I am of the firm conviction that you need to bump up your minimum pressure to try 6 to start, and try an EPR setting of 1 or turn it off entirely. Perhaps wait till Sleeprider confirms this though. I am pretty new to this myself. But that is based on my own experiences and what I have been reading here so far. Also, try switching your P10 nasal pillow size to a Large. That made a big difference for me as well.
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#10
EPR acts a lot like bilevel (BiPAP/VPAP). To really understand its impact on therapy, you need to understand bilevel titration, where EPAP is used to resolve obstructive apnea, and pressure support (IPAP) can be used to manage flow limitation, hypopnea and RERA. My concern with EPR is that for patients with a CPAP titration based on fixed pressure, it actually can undermine the prescription, unless the CPAP pressure (IPAP) is increased.

For example, let's say you are titrated at 8 cm H2O pressure for CPAP. You get your new Resmed machine and dial in EPR at 3, and now instead of fixed pressure at 8.0, you now have bilevel pressure at 8/5. Well 5.0 cm EPAP pressure allows obstructive apnea to occur, so you find out you need a pressure of 11/8 and so you wonder why the clinic got it wrong. Happens all the time.

Compared to CFlex and AFlex used by Respironics, EPR is a true bilevel variable that is allowed as a "comfort feature". Flex is only a temporary pressure reduction at the beginning of exhale or inhale and is actually a comfort feature, and pressure returns to the CPAP level before exhale begins; but EPR is bilevel, and keep the pressure low until inhale begins, unless the airway collapses and then the pressure stays low until the apnea ends.

This is all more than you wanted to know, but the point is bilevel therapy is much more comfortable than CPAP, and if you use EPR, it helps to understand how it might affect therapy.
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