dgilluly Intro and APAP Settings Thread

[dgilluly]

Hello all,

I decided to make a post introducing myself and curious about a few things with my APAP's (Resmed Airsense 10 Autoset) settings.

I'm new to the various communities revolving around sleep apnea, and to treating my sleep apnea. I was diagnosed with sleep apnea on June 22nd 2021, following a sleep study on the 16th. In the test I only slept for 3 hours on my stomach and recorded an AHI of 6.8 if I remember correctly. One thing that my sleep specialists and I noticed is my AHI numbers are sometimes higher (I think part of the reason, is I'm using a full face mask due to sinus issues, and that forces me to sleep on my side), so my sleep specialists ordered a titration study in order to dial in the settings more. That's not until the very end of this month.

Symptoms before treatment were excessive daytime drowsiness, dry throat especially in mornings, sometimes would get a morning headache, waking mid-gasp occasionally, and nightmares involving being choked or drowning at least twice or three times a week. Those have gone away since starting CPAP, except for a little bit of daytime drowsiness depending on how well the CPAP worked the night prior. So my issues are more about consistency instead of general effectiveness.

I did make one little change so far, the original prescription was for 4-20cm, I lowered it to 4-12cm because anything higher was immediately waking me up, but I may put it back now that I'm more used to the machine. I haven't touched any other settings so far, and left the EPR set to 2.

For the past couple of nights I had an SD card in my machine, and logged some data. I'm wondering if there's some adjustments that can be made without getting me into too much trouble (to be fair, they never told me not to change settings on the machine). I have a bit of a non-medical technical background, but with the research I've been doing I'm thinking it might not hurt to try a pressure setting from 7-14cm to see if that helps for now.

If the information is needed for recommendations, I'm a 5'7" male, at around 140 lbs.

Thanks all in advanced.

[SarcasticDave94]

About EPR, this stands for Exhale Pressure Relief. The math for it to work fully is to subtract the EPR setting from your minimum pressure. It cannot be less than 4 or EPR is not benefiting until pressures rise. EPR 1 needs minimum pressures of 5, EPR 2 needs a minimum of 6, EPR 3 needs a minimum of 7.

Other news, you're getting frequent Central Apnea. This may be treatment emergent. You had a sleep study in June, from there how long have you been on PAP? Up to 3 months is an acceptable time for treatment emergent CA to diminish.

Did you get your detailed diagnostic sleep study data from your doctor? Best to get one for your own files. HIPAA law permits you to request and receive it. And you could post redacted copies here. I'm fishing for the event breakdown of events mainly, so we can classify the CA.

[dgilluly]

I haven't gotten a copy of my sleep study results yet, maybe I can request one through my patient portal.

I picked up my CPAP on July 1st and have been using it every night since except for one night mid-July due to having a cold.

[staceyburke]

welcome to the board - lots of good people can and will help you.

We see this all of the time, and I just don't understand how or why they send people out with a setting of Min=4 and EPR set at 1, 2 or 3.  It makes NO sense at all.

Let me try to explain what the settings do.

min=4 this is the inhale pressure and it can also be the exhale pressure

Max=12 (or any number up to 20) is the pressure the machine will go up to but not over to relieve obstructive apnea.

EPR= 1, 2 or 3 this is exhale relief pressure and reduces the exhale (min) pressure to allow easier breathing - it also helps with Flow Limits.  Flow limits are also obstructive apnea but they are less obstruction and are not timed. (see my signature for classification of apnea.)

Ok now we know what each does - the problem is the absolute lowest pressure the machine can go is 4.

So your min  =4 so the EPR can not do anything.  Your min needs to be at 7 or more for it to work.

I would suggest you set the min to 7

2nd problem you have is you have what is known as positional apnea.  Positional apnea is when you sleep in a position that cuts off your own airway.  It is also known as chin tucking when your chin drops to your sternum and cuts off your air.  NO PRESSURE will help this, you have to find a way to stay out of that position.  It could be as simple as not sleeping on your back or getting a flatter pillow.  But if those things don't work you will need a collar.  PLEASE see my link for a collar in my signature.  Many, many people have found it works and the link shows people with and the same people without the collar.

[dgilluly]

I usually sleep on my side most of the time with the CPAP mask. But maybe I'll have to try a collar.

I'm thinking my sleep doctor's concern for the first month or two was getting me used to the machine before pouring too much effort into the settings, so that could be the reason for the lowest minimum.

Part of me was wondering if it's actually the steep ramp ups that are awakening me (moreso at the beginning, but happens once every 3-5 nights lately) moreso than the max pressure itself, after seeing that chart.

I had a sneaking suspicion of that being how the EPR interacts with the min setting, which now that has been confirmed by two different people on here.