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[Treatment] Hitting the wall with self-titration
#1
Hitting the wall with self-titration
30M, tall and thin, I've had my resmed for several months and I can tolerate it fine but I'm having trouble making progress. Sometimes I have "good" nights but doesn't seem to be much rhyme or reason to it. I've settled around 10 for min pressure as I haven't noticed a meaningful difference from 8 (out of the box was 5) and my mouth is puffing up a bit more. I mouth tape and have a chin strap which seem to be keeping leaks down, and I turned off EPR as it seemed to meaningfully decrease centrals - it's been 3 months, mostly using EPR, and the only difference I notice is I have more centrals with EPR (which I understand isn't necessarily a problem) but my respiratory rate seems to trend slightly higher. I feel like I have a bit of trouble breathing through my nose but my ENT did an MRI and said it seemed clear and I don't need to open my mouth to breathe so we'll leave that there for now. Anyone have any ideas (other than general sleep hygiene)?

Over the last month, AHI was 1.79, CA index was 1.62, and Hypo Index was 0.13


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#2
RE: Hitting the wall with self-titration
Welcome to the forum sleeperton, you have some flow limits going on but numbers look pretty good overall. Do you sleep on a flat pillow? And do you find yourself on your sides or on your back mostly?

I would try CPAP mode (or set min/max both to 12cm) and turn on EPR to 1 for a few nights and see if you feel more rested-I know I did when I switched over to CPAP mode.
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#3
RE: Hitting the wall with self-titration
I would *like* to sleep on my back (good posture) but I understand with apnea I have to work with what I can handle. So I usually use a flat pillow under my head "normally" and have one I sort of lean my back on, with another I kinda hug use to try to keep my chin up. I do find myself going back and forth from one side to another several times a night (consciously). Side sleeping definitely was less obstructive for my in-lab test. I have a wedge pillow but it doesn't seem to make a huge difference vs just having a flat one at my back. Will do with the cpap at 12 + 1 EPR and report back.
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#4
RE: Hitting the wall with self-titration
Your pressure is jumping a lot. You can’t be getting very good sleep like that. 

To calm down those spikes of pressure set

EPR to full time
EPR 3

That should help.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#5
RE: Hitting the wall with self-titration
I did have Full time EPR = 3 set pretty much every night up until last week. It did not seem to matter much and I had more centrals, though again I know centrals may not be an actual issue.
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#6
RE: Hitting the wall with self-titration
Could you post a typical night EPR3 please.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#7
RE: Hitting the wall with self-titration
Here you go 3 EPR from like 3 weeks back. Last night I tried the CPAP at 12 with 1 EPR and I had a little burping but otherwise seemed fine? Only slept for 6-ish hours so we'll see how it goes tonight.


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#8
RE: Hitting the wall with self-titration
Take a look at your pressure graph with the EPR 3 and compare it to the one with no EPR...  Do you see the the difference of the 2.  The one with no EPR is spiking (mountains) all night and the one with EPR is much flatter.  Flatter is better, less sleep distubance and lower pressure - not as much leakage.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#9
RE: Hitting the wall with self-titration
Heard. When should I get concerned about the centrals? I understand it's just me "not" breathing, which is different from being unable to breathe, but I kinda thought they were supposed to go away after a few months as my body acclimated to the assisted CO2 removal. Also, I wasn't really feeling better with EPR on full either (which is why I turned it off)? I'll keep trying CPAP mode w/ and up the EPR to 3 now I guess, but not sure what the next step would be.
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#10
RE: Hitting the wall with self-titration
(05-22-2024, 07:47 PM)sleeper ton Wrote: Heard. When should I get concerned about the centrals? I understand it's just me "not" breathing, which is different from being unable to breathe, but I kinda thought they were supposed to go away after a few months as my body acclimated to the assisted CO2 removal. Also, I wasn't really feeling better with EPR on full either (which is why I turned it off)? I'll keep trying CPAP mode w/ and up the EPR to 3 now I guess, but not sure what the next step would be.

Sleeperton, Can you post a chart where you have used CPAP mode with EPR on please when you are able?
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