[CPAP] Alark - Therapy Issues

[Alark]

My AHI is 8, and my RDI is 16.

I’ve tried both APAP and CPAP, but APAP has always made things worse for me, so I stuck with CPAP.
With CPAP, I’ve experimented with multiple pressure settings and found that using EPR (exhalation pressure relief) ON works better for me than leaving it off. By making these adjustments, I’ve managed to get my AHI below 2 with some days at 1.
However, I feel like I might actually be more tired than before.

I’ve attached some results for reference. What are your thoughts on BiPAP? Could it be a better option for me? what do you think about trying pressures like 5 or 6?

link for more images: https://imgur.com/a/4TRpAxS

[G. Szabo]

You have inspiratory flow limitations and some disturbances during exhalation. Based on your Dec 24 APAP shot, your median pressure was 9.9, while your 95% was 11 cm.
Your attached  CPAP pressure is 8 cm, which is low. You should have it between 10 and 11 cm, including 11 cm. 
Your exhalation disturbance is worth investigating once you establish yourself under this higher pressure.

[Alark]

Update:

the last image is without EPR (pressures 10 - 11)


Please check https://imgur.com/a/HRdim1j



I also rented a lumis 150 vpap didn't use yet

[G. Szabo]

The only way to reduce your Hs is to increase your pressure to 11 cm because you are already on EPR=3.

[Alark]

This ones where 11 is it normal to still feel tired with low ahi?

[G. Szabo]

Your exhalation is superimposed with cardiogenic oscillations, which can also be seen in the inhalation period; hence, it is difficult to see the characteristic shapes corresponding to the inhalation flow limit, which is okay at 0.04 (95%). However, it can be even further reduced with a bi-level device, which might help with your symptoms. 
You can also try installing an oxygen saturation sensor to ensure that your oxygen level does not drop too low at night. 

Hence, you might want to experiment and invest in two steps (the sensor and then the bi-level) to determine whether your complaint is related to your sleep.      

 

[Alark]

first try bipap - s

ipap 12
epap 8


ti max 2.0
ti min 0.3
rise time = min
trigger = med
cycler = med

Should i stick with cpap 11 with epr 3?

[Jay51]

Does it feel like your inhalations are too short?  (Getting cut off too early by the 150 ST?)

Since these OSCAR charts are from using an s9 lumis 150 st, you may experiment with increasing your rise time from medium to high setting.  This may make your inhalations more smooth (the top of your waves).  It looks like a lot of them are pointed. 

Also, changing cycle setting from medium to low or even very low may help as well.  

Even increasing TI max from 2.0 to 3.0 could give you more time to inhale.  

Just a few thoughts based on these specific charts.

[Sleeprider]

Your therapy was better with the CPAP with EPR. Can you go back to that? The Lumis VPAP 150 ST does not have EasyBreathe available to make the IPAP/EPAP transitions more comfortable. It also has a backup rate that can trigger IPAP on a timed basis. Instead of EasyBreathe, we only have time of inspiration and rise-time controls. To help with this particular device, we really need to know all of the settings. Note this device is unlike the Vauto or VPAP S devices that lack backup rate but have Easybreathe and other controls.

[Alark]

"Does it feel like your inhalations are too short? (Getting cut off too early by the 150 ST?)"
No, I think 2 is fine. i feel like my inhalations at naturally short.. not sure..

However, regarding the inhalation, I do notice it feels quick and sharp.

The rise time starts at the MIN setting, then transitioning from 150ms to 900ms.