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[Pressure] TheWallofSleep's Therapy Thread - Printable Version

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TheWallofSleep's Therapy Thread - TheWallofsleep - 04-19-2021

Hello, I would like some help dialing in my APAP pressure. I have an AHI of ~33, and have been on and off of APAP for almost 3 years with very little significant change in my day to day life, I still  wake up throughout the night, while suffering from severe fatigue and mental fogginess everyday. I track my sleep nightly with fitbit, and it wasn't until recently when I started raising my minimum pressure from 4.0 to about 7.0 when I started to see an improvement in results. According to these graphs, would it be more beneficial to keep going higher on my minimum pressure, or even raise or lower my maximum? Any insight is much appreciated, my life has been on hold for far too long.

I have a climate controlled hose set to 22 C, humidifier set to 3, Ramp disabled, and EPR disabled for all three nights in the screenshots. On the first night, my minimum is set to 7.4, not 7.0
Thank you.

RE: Help Calibrating APAP Pressure - Melman - 04-19-2021

Welcome to the forum. Setting your minimum pressure to 8 or 9 (close to the median) will minimize pressure swings which may be disrupting your sleep. Use of EPR which reduces pressure when you exhale will not only be more comfortable but will also reduce flow limitations. I suggest you set it full time at 2. I would recommend 3 if it were not for your CA events. EPR may increase them. After trying these settings post your data again for our review.

RE: Help Calibrating APAP Pressure - multicast - 04-20-2021

The minimum pressure seems a little low; you may raise it to 9.4. FL are low, hence I see no need for EPR as it will increase CA. Leak rate is very good.

Only your tidal volume seems low, it corresponds to a weight around 120 lbs. Is that correct?

RE: Help Calibrating APAP Pressure - TheWallofsleep - 04-20-2021

I increased my minimum pressure to 9.0, and left EPR off for the first night. Overall, not a good night. Here is the screenshot of my Oscar data, however the time spent in sleep is about half of the previous nights.

I feel as if there is another variable besides pressure that could be affecting me here. I usually 'feel' better on 7.0, and for what its worth, I spend more time in rem according to my Fitbit on 7.0, yet the data from Oscar indicates that I should be going higher. I found another night that looked pretty good in Oscar from April 8th, where the pressure is at 7.0, and one from the 13th where it was set at 8.0, but only slept for 4 hours.
 As far as tidal volume is concerned, yes, I weigh 125 pounds.
This feels like a never ending rut, I appreciate any help I can get.

RE: Help Calibrating APAP Pressure - TheWallofsleep - 04-21-2021

I am unsure if I need to reply to the post individually for the thread to work, but I will do this separate post just in case. I feel like I do poorer on 9.0 cmH20. Originally I was suggested 6.0, but I have found that to be too low. Does it look possible that ~7.0 is the more optimum range and that my central apneas are just unavoidable (or perhaps pressure is not the primary problem here)? Or is the algorithm on the CPAP itself not very accurate and in order for my 9.0 to be more efficient, I should raise my maximum higher than 13.0?
Thank you.

RE: Help Calibrating APAP Pressure - Crimson Nape - 04-21-2021

I believe that your pressure may be driven by your flow limits, like Melman said. I would try his advice and set your EPR to 2 - Full time. This may help to reduce the flow limits and keep your pressure lower.

RE: Help Calibrating APAP Pressure - Gideon - 04-21-2021

Set your min pressure = 10
Max = 20. Your max is not running away so it doesn't matter too much, just giving room to auto increase.
Set EPR = 1, fulltime. Note this may increase your centrals somewhat, don't worry, if we need to we will lower it. It also will help with obstructive events.

RE: Help Calibrating APAP Pressure - TheWallofsleep - 04-23-2021

Hello, the last two nights I set my APAP to 10.0-20.0, and EPR=1 fulltime, here are the results.
I am unsure what to make of these.
Thank you.

RE: Help Calibrating APAP Pressure - SarcasticDave94 - 04-23-2021

Call me curious, do you have your detailed copy of your diagnostic sleep study? You need this for 2 reasons, 1 all Apnea patients should have it in their personal health file, and 2 to satisfy my curiosity regarding Centrals. They jumped on that last chart.

Post a redacted version of that diagnostic. Central Apnea have a notorious habit of being consistently inconsistent as in up and down continually. Your test result would help identify these CA. I'm on the fence on whether you've used the PAP over those 3 years to get past a treatment emergent stage or just maybe the reason you keep quitting PAP is the Centrals indicating an ongoing issue and maybe misdiagnosed predominently Central events.

RE: Help Calibrating APAP Pressure - Gideon - 04-23-2021

As Dave said, "Central Apnea have a notorious habit of being consistently inconsistent".
We like to see consistent behavior on our charts, and for central apnea the consistent behavior is to behave inconsistently.