[CPAP] snewmy - Therapy Help

[snewmy]

Hello all, I am 25, and have been using the CPAP for about 5 years or so. I am just having really crappy sleeps and it feels like I have never gotten it right. The machine does not report many apneas but when I look into the flow rates, there is many spikes it seems like. Would anybody be able to offer some insights? I have some pictures at different settings i'd like to share.

Mask: resmed airfit p30i nasal pillows. I use mouth tape every night.
pictures are in order as follows:

Pressure: 8-11, EPR 3 full time:

Pressure constant 11, EPR OFF:

[Phaleronic]

Welcome to the forum snewmy

You are having CA events on both charts-were you diagnosed with with CSA/OSA mixed or straight OSA? Do you feel a difference between the modes regarding your sleep? I personally sleep the best (deepest) using cpap.

Are you sleeping on your sides on a flat pillow?

I would suggest using cpap mode but turn up the pressure to 13cm and turn EPR on @ 1, try it tonight for 30 minutes or so before bed to see what you feel at that pressure.

[snewmy]

Welcome to the forum snewmy

You are having CA events on both charts-were you diagnosed with with CSA/OSA mixed or straight OSA?  Do you feel a difference between the modes regarding your sleep?  I personally sleep the best (deepest) using cpap.  

Are you sleeping on your sides on a flat pillow?  

I would suggest using cpap mode but turn up the pressure to 13cm and turn EPR on @ 1, try it tonight for 30 minutes or so before bed to see what you feel at that pressure.

Hello! Thanks a lot for your reply. I was just told that i "had sleep apnea" and was given a APAP with a setting of 5-20 pressure x.x.

I tried what you suggested last night. My AHI is much higher now, but i "think" i feel more rested today. i'm not decided yet though, haha.

[Phaleronic]

Hello! Thanks a lot for your reply. I was just told that i "had sleep apnea" and was given a APAP with a setting of 5-20 pressure x.x.

I tried what you suggested last night. My AHI is much higher now, but i "think" i feel more rested today. i'm not decided yet though, haha.

Okay

Let's give it a few more nights at this pressure, you're still having CA events lined up some clustered, are you sleeping on your sides as much as possible, and not propped up?

[snewmy]

Hello, I have been under treatment for probably about 7 years now on cpap. They started me on 5-20 APAP but i later changed that after learning more, the sleep specialist basically saw my AHI was low and sent me on my way lol. 

Anyway, I have always had trouble with having a good nights sleep and have been kind of lazy with posting and getting it fixed. Here is my other post https://www.apneaboard.com/forums/Thread...appy-sleep

I had been using EPR 3 full time, but I think this actually made me have more centrals. Since then the last two weeks I have turned EPR off.

It was recommended to try a pressure of 13, and I even had help from the LankyLefty who said I was under pressure and should try 13, 14, 15. Those pressures made me wake up so much and my sleep felt way worse. He unfortunately stopped replying to my emails so I am unable to get more help.

Attached to this post are some snapshots of different settings i've done.
In Order: Last night, 10cmh2o EPR off | 10cmh20 EPR 3 fulltime | 13cmh20 EPR 3 fulltime (note; first part was me awake, trying to get used to the pressure. then also later in the night i switched it down to 10 because i was feeling bad).

also I use nasal pillows and i mouth tape every night. 

Here are some close ups of these spikes in my flow rate from last night. (you will probably have to zoom in on imgur sorry)
https ://i.imgur.com/vq6t9cs.png
https ://i.imgur.com/tuC8a0m.png
https ://i.imgur.com/tV1h1Wf.png

I think I have pretty good sleep hygiene. I have generally consistent bed times, I sleep without lights on, and I use a white noise machine. I put blue light filters on all devices and tvs within a few hours of bedtime.

Any help would be greatly appreciated!

[DaveSkvn]

Hi snewmy,

I see your respiratory rate is a bit variable. Could you post a screenshot including your respiratory rate graph? It should be a flat line - shouldn't go above 20. If it is patchy with periods higher than others then you are in the UARS/flow limitation zone.

[snewmy]

Hi Dave,
Thanks a lot for your reply. Here are the same nights i posted above but with scrolled down to view the respiratory rate graph.

[DaveSkvn]

Yes, its definitely something you might benefit from looking into.

An introduction to UARS (often referred to on here as flow limitations)

https://www.youtube.com/watch?v=sa9zNYpTWlM

With OSA, airflow stops and your blood oxygen level drops. Both of which can easily be detected. The AHI tells you if you have a OSA problem.

With UARS airflow continues (but disrupted) and blood oxygen level remains normal. There is no equivalent of the AHI. It is not visible in the AHI.

Personally I think its very common to have both to some extent - they both involve blockages in the upper airway - but the first is far easier to spot and manage.

You want your breathing to be like the top trace here. Inspiration is above the line. Expiration below. Yours is probably like the middle one most of the time - it indicates something is getting in the way. As you can see in the bottom trace the flow goes from inspiration to expiration frequently. This is when the measured respiratory rate starts to climb. If you zoom in on your own flow rate trace when the respiratory rate has a bump you'll probably see this kind of thing starting to appear (not this bad). 
 
   

You might want to have a read through this

https://www.apneaboard.com/forums/Thread...#pid547311

and maybe have a go with the flow limitation index thing yourself.

[snewmy]

Dave,
Thanks a lot for your reply. I learned some more about this thanks to you! I ran two nights through your site. One with 10cm and epr off, and one with 10cm and epr 3. I attached below. They seem pretty similiar to me.

i do use mouth tape as I said earlier, with nasal pillows. I don't think my nostrils are really stuffy at night. it is normal for one side to be slightly stuffy right? and it switches? i believe.

[DaveSkvn]

As you say the traces are pretty similar. I'd say 7 Feb was the ERP3 and 17 Feb was ERP 0. For me that results in the index shifting about 1.0 - for you about 0.2. It kind of indicates that you might not get too much benefit from bi level - it only goes up to the equivalent of EPR 5 or so. You might want to do a few more nights on each setting to confirm.

The key issue is the variability. You also seem to have a lot of the black lines in the bottom line - that's where the inhalation volume is more than 20% different to the exhalation volume - i.e. it all goes to pot. Its certainly not stable breathing.

Quite what you do now, I don't know. There is clearly a problem but EPR does not seem to help you much. The trace is pretty uniform so its probably not positional. I have found pressure level makes little difference. You seem to be finding the same. Have you tried a soft foam surgical collar? It made a big difference to me. I'm afraid I'm a full face mask user so can't say much about nasal pillows.