Autoset: Any point in manually changing pressure?

[HomerJ]

Hi all, new here, be gentle!

I've been using my CPAP since January, on and off at first, more regularly now.  I keep having the feeling it's hard to breath through my mask.  I feel I need to concentrate so much on my breathing that I'm having problems sleeping!

I know this can mean 2 things, either too much air, or not enough.  In my case I definitely feel like it's not enough air.  I thought it might be the pressure, but looking at my numbers in SleepyHead, the pressure settings seem to be ok for my 95% value and mean value.  I also have an "autoset" CPAP machine, so am I right to believe as long as my min and max pressures are "wide" enough there is no need to tweak them?

I can't add my numbers as I'm a brand new member :-(

[PaulaO2]

Perhaps the lower pressure is too low. Once you are asleep, how often do you go that low?

Being too wide open can be a problem. The machine has too much room to wander through, trying to fix you. If it decides "apnea events settled, lets go to the low pressure" but then you have an event once it is there, it has to climb back up again. So if there's not that much of a space between the two, reaction time is quicker.

Do you have ramp on? If so, turn it off.

Have you tried to sit and watch tv with the mask and machine on? Take it to the living room, set it all up, turn it on, and just do something else. This will give you the chance to get used to the pressure.

Do you have EPR turned on? Some people feel they breathe better with it on. Some with it off. If it is on, try another setting. Or turn it off.

[HomerJ]

I had ramp on yes, but turned it off ealier today.  EPR is on too, I can try it off tonight.

I frequently read for about 30 minutes with the machine on, and it's not that bad when I'm awake.

I think I managed to shrink my numbers enough to attach them here.

[quiescence at last]

if these were mine, I would change the RAMP start pressure to 6, or turn the ramp off.  Since you did turn the ramp off, there is little reason to make any other changes.

I would not have changed the EPR to off, just leave at EPR of 3.

I would run the settings for a few days, and then re-post a chart.

QAL

[PaulaO2]

Just make one change at a time. Or you'll never know what does it.

If it is fine while you are in bed and reading (which is bad sleep hygiene, btw), it could be just sheer "I hear myself breathing, all I can feel and hear is myself breathing" semi-panic mode going on. We all experience it. White noise will help with that. Or music. Or turning it into a meditation as you fall asleep.

Turn off the ramp. Observe for a few nights or more.

Take a look at each night's Median pressure (in your image, it 9.94). If it rarely drops below 9 or stays that high, increase your minimum pressure. If your other nights are similar to that one, then my suggestion is to increase the minimum to 9 or even 9.5 or 10. Observe for a bit.

[HomerJ]

Thanks for the tips everyone.  

I know I shouldn't do anything other than sleep in bed (and well... uh... "that").  In my case, I have a "sunset lamp" that I use to help me fall asleep.  I set it to 30 minutes, and it slowly dims to darkness.  Most nights, I can't even last the 30 minutes before I pass out.

I'll go without ramp for a few nights and readjust if need be.  My median rarely drops below 9 so I might increase the min pressure to 9 in a week or so.

[PaulaO2]

Good. Please let us know how it works out! We love knowing what works and what doesn't.

[ajack]

The suggestion of 9 works for me too. As Paul said, It might need 10 later, but wait and see. You will be in the fine tuning range then. I would use the EPR if you like it, your 'new user' CA numbers are good.

[Sleeprider]

Based on your chart, your median pressure is 10/7 considering EPR. I would certainly struggle with that, and you are showing quite a bit of flow limitation in the chart. So your MEDIAN pressure is 10. What does that tell you about your starting pressure of 8.0 with EPR 3? If you said too low, you win! You need a minimum pressure closer to your median, and I don't see any reason to change the maximum pressure. I think you will find this much more comfortable, effective and you won't see quite so wide of pressure changes during the night. Keep EPR the same, minimum pressure to 10, max at 16.

[HomerJ]

Last night charts would agree with your suggestion to bump up the min pressure if I understand things correctly.  

I felt a lot better with ramp off from the start, and woke up this morning much more refreshed than yesterday (which is odd because my graph looks much worse!).  Looking at the chart, there were a lot of OAs, that all seem to appear when pressure has dropped close to the MIN of 8.  I'll go ahead and bump up the MIN to 9 for a few nights, aiming for 10 if things improve.