Help with my settings

[kboy1983]

Hi,

I'm looking for some help with my cpap settings.

Background: Was diagnosed with severe sleep apnoea at just over 50 events per hour.

Got my machine in March & have struggled with mask fitting & finding the most effective settings.

The machine (Lowenstein Prisma Smart) was set up with pressure range 4-15 on standard apap mode.

This was far too low of a starting pressure, so changed to 9 with dynamic apap.

From studying my charts I changed my min to 12.5 & increased max to 16.

I never get any AHI below 5 & see many hypopnea despite the changes.

I've also struggled with my masks & can't use a full face as my mouth relaxes & get massive leaks. 

Resorted to mouth tape & a nasal pillow which has completely wiped out any leaks.

I've attached a screenshot of one of my better nights & was hoping for some help.

I sleep on my side 100% & the clusters early on are when I'm awake trying to get to sleep.

[Jay51]

Do you have softpap enabled?  Using softpap may help.  

Here is some comprehensive reading from our wiki on the Lowenstein PrismaLine machines:

1OSCAR Optimisation for Lowenstein

[Deborah K.]

I don't know much about Lowenstein machines, but you need to raise your upper pressure limit to 20, as you are frequently bumping against the 16 you are using.

[kboy1983]

Hello!!

I raised my max pressure to 20 & also turned on soft pap (reduces epap by 2) & had a terrible night.

I've attached last night's chart & it's not good reading 

Any ideas what is happening?

[Jay51]

Sorry about that.  

Sometimes experiments fail.  

You can go backwards to your original settings in the 1st chart and we can give suggestions from there again.

[Jay51]

Raising epap pressure is what usually helps (like Deborah suggested).  But it didn't work here in your case. 

Also, softpap should have helped decrease H's, flow limitations, etc.  But that didn't seem to work either.  

You have a cluster of OA's just as you are falling asleep.  Some things like lowering pillow height, side sleeping (which you are doing) with something like a pillow between your chin and chest to stop chin tucking, and even trying a soft cervical collar to prevent chin tucking.  

Here is some reading from our wiki on Positional Apnea (these techniques may help your therapy improve):

• 5.3Positional Apnea
  

[kboy1983]

Hello again,

Tried something a bit different last night:

• Reduced my max to 14.5
  
• Changed to standard APAP from dynamic
  
• Turned softpap off
  

Other than a few leaks due to mouth tape coming unstuck it doesn't look too bad.

I notice that a lot of my OA's happen at 12.5, so wondering if I should increase my minimum to 13.

What do you think?

Thanks for your help so far.

[Jay51]

Great job.  

You can try that change to see what happens. 

In looking at your first original OSCAR chart that you posted, it looks a little better, but you are on the right track experimenting now.  

You may never get your AHI down to O.O every single night, but when/if you get it low enough for your own personal satisfaction, and you feel decently well rested in the morning when you wake up after sleep, the goal would be to consistently start getting nights like that for the long term.  

And anytime in the future you learn something new that may help (there is a ton of great knowledge and hacks here at ApneaBoard) you can try that change to see if it further increases your sleep quality.

[kboy1983]

Hello again,

I raised my minimum to 13 & my results are attached.

My OSA has reduced from 2.05 to 0.84 which I think is a significant improvement, but hypopneas are still fairly high at 4.74.

I'm thinking of increasing minimum again by .5 to see how that works.

Do you think that's the best course of action?

Thanks again for your help.

[Jay51]

You can try that change as well to see how it affects your therapy. 

In theory, softpap should help decrease H's.  I think you tried it at level 3.  You may want to try a night with it at just level one and see if that negatively affects you like the softpap 3 did previously. 

No hurry with all the changes.  Take it one change at a time to see exactly how it affects you.  Then you can try another experiment if you want to as well.