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New user questions about "auto" function
#1
New user questions about "auto" function
I was diagnosed with mild sleep apnea after a sleep study to determine whether that was a factor in the atrial fibrillation I developed earlier this year. The AHI on my test was 11, with virtually all of the events occurring while sleeping on my back (I mostly sleep on my side, but followed the instructions for the study & made a point of going to sleep on my back a couple of times).  The sleep doctor said that I should be okay if I use the "wear something lumpy on your back at night" approach, but the cardiologist recommends going the CPAP route, so that's what I've been doing. So far - it's going not that well: I've had the machine for 3 weeks, have had a few good nights but mostly end up lying in bed for well over an hour before I fall asleep. The source of the problem for me is the effort required on exhalation: it leaves me feeling exhausted, even when I use the CPAP while awake & sitting in a chair reading (recommended by the sleep clinic to help get used to it). 

What I don't understand is why the Autoset algorithm is increasing pressure while I'm just sitting reading & breathing as normally as I can considering that (even with EPR at maximum) breathing out against the pressure requires some effort. Today the pressure went up to maximum (from 5 to 10) during the first 5 minutes of sitting with my tablet browsing websites).I've talked to my regular doctor about experiencing shortness of breath during the day over the past few months, she thinks the CPAP could relieve that & if it doesn't (after a few weeks) she will send me for pulmonary function tests. 

Also the last time I tried to sleep with the CPAP (for 3 hours, with a break between the first 2 and the last 1) the machine reported an AHI of 10.4, Total AI 9.5, Central AI 9.2. This really sounded bizarre to me, especially since I was indeed awake the entire time (and lying on my side). And yes, I am certain I was awake, no sleeping at all during those 3 hours & no time when I wasn't breathing slowly & deeply: a meditation practice focused on breathing has been part of my life for over 35 years & I'm a classically-trained singer, so if there's one thing I can do, it'd be aware of my breathing. I finally gave up & stopped for the night: it feels like the CPAP is causing problems instead of solving them. Another small weird thing is that I've tried to use the autoramp setting, and the pressure increases while I'm still awake.

There are a couple of questions that come to my mind - first is whether whatever is making me feel short of breath during the day is being interpreted by the CPAP's algorithm as apnea, so maybe the pulmonary function tests should happen now rather than later? Second is whether the algorithm is thrown off by a slower respiration rate (I know that when I'm trying to relax & go to sleep it's under 10, more like 6 - 8).

I'll be trying to get some guidance from the sleep clinic tomorrow, but that can be its own challenge. Any thoughts from this community would be appreciated!
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#2
RE: New user questions about "auto" function
first, get a copy of the oscar software from the black banner across the top of this page. post some charts after a few nights to get some informed analyses of the efficacy of your therapy. much depends on the breakdown of event types and what else is shown in the various statistics and graphs oscar reports from machine data.

second, don't sweat anything you see from the machine while awake. even among apneacs our breathing is much more regular while asleep. obviously the machine doesn't know if we're awake or asleep. talking, yawning, clearing your throat, shifting about, etc. can cause flagged 'events'. unless you are masked up while reading in bed to become better acclimated to the experience, it might be less stressful to avoid it. sleep hygiene proponents tell us to limit bed to sleep and sex only.

personally I wouldn't think cpap has much of a bearing on your daytime breathing concern. otoh, intuitively it seems possible that if something is messing with your daytime breathing, it could also affect night breathing and how the machine responds. oscar charts would help ferret this (and other things) out.

i've never used ramp so I can't speak to that. most cpap veterans don't bother with it.

as for exhaling, if epr 3 isn't enough of a break from higher inhale pressure, you may need a bilevel machine that will provide more of a difference between inhale/exhale in the form of pressure support. otoh, 7 cmw (max 10 - epr 3) isn't much pressure. as much as we hate to hear "you'll get used to it" from the sleep med establishment, it's early days for you and it might become a lot more tolerable in time.

finally, why not try a lumpy thing on your back along with cpap?

I'm sure others' will be along with additional thoughts.
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