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[Pressure] Right pressure to reduce CA and easier breathing
#1
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Right pressure to reduce CA and easier breathing
Hi, I've been using my CPAP for about a month and treatment seems to be getting mildly harder in terms of comfort. I haven't changed my settings very much, but I wake up about 3-4 times a night and find my breathing to be shallow and like my breath rate is higher than normal. I feel somewhat anxious when I wake up and try to breathe slowly, but find that this is hard using my CPAP. I am wondering if there is anything in my settings that I should try to adjust. My Oura ring consistently tells me that my heart rate takes a long time to go lower and I can see that it doesn't really ever dip that much. This feels on par with how tired I feel in the morning. 

I have tried different EPR settings, such as 7 and 2 EPR and even 8 and 3 EPR, but I find that the higher EPR and pressure settings feel too much and I find it hard to take a deep breath in. Exhales feel okay, it's just the breath in feels cut off at the tail end and that causes me anxiety. 

Is there anything someone can see obviously in my chart that I can try? Thank you!
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#2
RE: Right pressure to reduce CA and easier breathing
Welcome! A few observations. You had cluster of CAs at the beginning of the night and right after the break in therapy. These appear to have occurred before you were asleep, so you should bracket them when you think about how things went by the numbers. Once you do that, by the numbers things are going well.

So the question is how to make your sleep more restful and refreshing, with breathing that feels natural. I see that you are using the "for her" mode and the soft response setting. If you can hack it, I'd suggestion the following series of experiments:

1. Start with a few nights of max = min = 7 and EPR of 3. Don't change anything else. This will give us a base line.

2. Turn of the "for her" mode and use the regular APAP mode. Try that for a few nights.

3. Also turn off the "soft response" setting and try that for a few nights.

The reason I'm suggesting max = min = 7 with EPR of 3 for all three experiments is that you aren't having obstructive events at low pressures, but your pressures are moving around in response to flow limitations. It's *possible* the pressure fluctuations bother you, so it might be useful to eliminate them from the picture. Also, 7 is the lowest you can go while still getting the benefits of EPR of 3. (The machine can't go lower than 4.)

About those flow limitations: do you have a stuffy nose?
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#3
RE: Right pressure to reduce CA and easier breathing
Hey, thanks for this! I notice that one of my nostrils is typically plugged up at night, but the other one is working fine. I've wondered if not having good flow through both nostrils could be contributing to my issues.

Just to confirm, you are suggesting I try setting a fixed pressure of 7 with an EPR of 3?

Could you elaborate a little bit on why the "for her" mode or the "soft response" mode might be helpful to try turning off?

Thank you so much for all of your help!!
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#4
RE: Right pressure to reduce CA and easier breathing
It's possible that having one nostril closed up gives you the feeling that you can't breathe enough. Is it always the same nostril? Does it feel closed up during the day? Are you doing anything to try unclogging your nose?

Yes, I'm suggesting setting your min to 7 and your max to 7. That's effectively a constant pressure, though without going into CPAP mode, which in some machines can limit the data that are reported.

You report a specific sensation of getting your breath cut off before you finish inhaling, and that makes me wonder whether the subtle effects produced by the For Her and/or soft response algorithms are bothering you.
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#5
RE: Right pressure to reduce CA and easier breathing
Hi, thanks for your response! It is not clogged during the day, I think it's sinus congestion due to lying on my back. I typically do a neti pot, wear a nasal dilator. I don't think it's my congestion causing the feeling because I typically feel the resistance at the tail end of breathing in and feel the mask suctioning in a little bit. 

Last night, I kept it at a constant pressure of 7 with EPR 2 and that was really difficult. This has been my worst AHI to date. I had nightmares a couple of times. In one, I was trying to breathe through my nose, but couldn't no matter how hard I breathed in and woke up inhaling hard through my nose. My nose was actually not clogged and I could breathe. I guess I was having a CA event. I am beginning to see a correlation with my nightmare/anxiety dreams with having apnea. This setting seemed to reduce my flow limits, but something dramatically increased my CA's. Do you have any idea, based off my chart, why this happened? Attached screenshot here. 

I don't know why but EPR just doesn't seem to work for me. Everytime I go above 1 (using min 6 or above), I have a worse night of sleep. Not sure what I'm doing wrong. It really messes up my inhale (can't breathe in deeply and slowly, feels cut off at the end). Perhaps it is the "For Her" or the "Soft" setting. 

I'm looking back at my data and it looks like my lowest AHI (1.08 CA) was at Pressure 6 and EPR 1. Added that screenshot here. Tonight I will reduce the range to 6-10 and keep the EPR at 1 and try turning off "Auto for Her", but leave the "Soft" setting and see how that feels. 

Looking forward to hearing your thoughts. Thank you so much! Thanks
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#6
RE: Right pressure to reduce CA and easier breathing
Oh, I'm so sorry that part of the experiment was a bust. It looks like you had a bunch of sleep/wake transition CAs, toward the beginning of each of the first two treatment segments. Sometimes the neurochemical handoff between waking and sleeping controls for breathing glitch a little, resulting in CAs.

I agree with what you propose to try next. And you can just turn EPR off if you think that might help.
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#7
RE: Right pressure to reduce CA and easier breathing
Last night I reverted back to my previous settings and for some reason I had an even worse AHI than the previous night. I hardly ever have any OA's, but have a lot of CA's. Do you have an idea of what could be going on?
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#8
RE: Right pressure to reduce CA and easier breathing
Are you able to post screenshots of your detailed diagnostic sleep study report? Specifically I mean the doctor comments about the recommendation and the event table with the type and count. Fishing for the cause of those Central Apnea flags.
Mask Primer

Positional Apnea

Attach OSCAR, etc.

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#9
RE: Right pressure to reduce CA and easier breathing
Great ask, Dave.

Also, I've just noticed that the 95% and 99% values for inspiration time are quite high. Textureofthings, could you find a place where your inspiration time is high and zoom in to create a 1-2 minute snippet showing the usual graphs plus the inspiration-time graph?

And if you don't mind, could you also produce a roughly 10-minute snippet from that last chart just before midnight, when you were having one of those barrages of CAs?
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#10
RE: Right pressure to reduce CA and easier breathing
Hi both, thanks so much for your reply. 

I did a sleep study 3 years ago where I was right up to the threshold for apnea, but did not cross, so the doctor said I didn't have it. My symptoms have exponentially increased over the last couple of months, so I got my sleep medicine doc to prescribe me CPAP (I was miserable), but my sleep study is scheduled for the end of this month (polysomnogram). I've been seeing that a lot of people recommend WatchPat over Polysomnogram (I did WatchPat last time) because of questionable accuracy of polysomnography sensors and apparently the measures from WatchPat are more useful (https://www.youtube.com/watch?v=yIBifmwoF9A). 

Dormeo, I added both screenshots you asked for. Could you explain what the inspiration times are and what to look for here?

I spoke to someone about my CA's and he went through each CA and told me that the clusters that are at the beginning of each session, may be where I am actually awake and that the single CA events actually look more like a light arousal due to flow limits in the preceding breaths, where I take a recovery breath and then pause due to the large breath. He said that these were likely not true CA's. He recommended I increase my setting to address my flow limits in general. Last night, I increased my setting from min 6 to min 7, EPR 3 and it was better than the previous night. I will try this setting again tonight. Any additional feedback re-settings?

One thing with the higher EPR is that I'm noticing that the duration of inspiration feels weird, like the machine can't tell I'm still breathing in, so it drops the pressure too early. This makes me feel like I am breathing quite shallow all night. I can see via my Oura that my heart rate doesn't ever really drop all night, or takes a very long time to drop. Perhaps this is the limitation of the Airsense 11 and I need to look into a true bi-level? Has anyone experienced this and fixed the settings so the breath rate feels more natural?

Thanks all for your help ~
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