Trying to set ResMed Autoset ??

[grumpygirl]

Hello to All- In trying to find some relief with my constant fatique and mild depression I have decided to try my machine in Auto mode to see if my pressure may be the problem. I was originally titrated at 12cm but that high pressure was totally wrong for me and caused serious aerophagia and constant wakings. At the time I was taking Zoloft and xanax and I think that influenced my titration-making it seem that I needed a higher pressure than I do now. I was also titrated using a FFM and now use the Opus mask and taping of my mouth.

I am currently setting my pressure at 10.2 in straight cpap mode and usually get very low AHI and leak rates, but I find that I am still waking up frequently and feeling horrible most days. I was taking Prozac for a few weeks lately but could not tolerate the side effects so stopped taking it just a few days ago. I am convinced that my mild depression stems from the poor quality of sleep I am getting. On days that I do sleep well I always feel much better and have a much better disposition. It is rare that I do wake up feeling that I rested well even when my stats are so good.

My question is this: at what range should I set my pressure?? Would 8-11 be workable?? Would that give me a wide enough range without causing too much aerophagia? Even on nights when I have set my machine to straight cpap mode and tried a pressure above 10.4 I get a lot of uncomfortable stomach pressure and gas. My stats are still usually very low except when I was on Prozac and then they shot up much higher-an AHI of 3 which is much higher than the usual 1.6 I normally get. I also felt like crap when the AHI rose that high. Like I felt pre-cpap days.

So what would be best to start with?? Any thoughts and suggestions would be greatly appreciated since I have been stuggling with this constant fatique for way too long now. BTW- I was wondering if for some reason that taping my mouth might be causing me to not get enough oxygen during the night. I tape heavily because I am a bad mouth breather and I tie my nasal pillows together with dental floss to avoid leaks, I coat my nostrils with lanolin cream to avoid irritation too. I usually use about 3 pieces to tape per night since I would pop my mouth open with out enough tape. I have tried several FFM and cannot get one to fit properly since I have a very narrow face and recessed chin-they always leak too much and are so uncomfortable that I end up taking them off during the night. Any thoughts would be so appreciated. Thanks-GG

[avi123]

Yes, I have some ideas for you.

1) Get rid of your mask and try a mask like my with a chinstrap, and don't tape your mouth.
2) Set your APAP's max pressure on your optimal pressure for CPAP and the min on 3 cm below it.
Use full Flexes or EPRs at all time. No ramp.
3) Don't pay attention to AHIs.
4) Take Rxs at min doses.
5) Enter an F under gender, and add your local and age.
6) Report back.

[sleepycarol]

There isn't any reason why you can't tape your mouth -- but it you are having to use quite a bit of tape, you might try a chin strap or a ace bandage. I have heard of members using the ace bandage like a chin strap and then others use it around the head covering the lips. It seems that they can get by with less tape and the ace bandage helps keeps the lips sealed without being to tight. I have not personally tried it but hopefully some of those members will chime in and report on that mod.

I would set it your suggested settings and see if it helps. Hopefully with time, if you see you need to increase your pressure you will be able to do so once your body becomes used to it if done slowly over a period of time. Go a week or so and increase pressure slightly. Get used to that pressure and do another slight increase, etc.

You do not need to list your location and age unless you want to. Same with gender identity it is a personal choice not a requirement that it be listed.

Good luck.

[Pugsy]

Sigh...Avi..quit telling people that their mask choice is why they feel awful and if they will use what you use that they will feel wonderful. What you use works for you and you alone. There is absolutely no way of knowing if it will work for someone else. It might, might not. And who cares about age, sex or location...I assume female...grumpyGIRL sort of is a pretty good clue. I wouldn't get any sleep at all with your mask, chin strap and 75 degree bedroom. I would have zero events because I wouldn't sleep...wouldn't help me much.

Grumpygirl....given your history of aerophagia...I wouldn't let the machine have much range above your normally titrated pressure since you already know that higher pressures cause worse aerophagia symptoms.
I think 8 to 11 is sure a good place to start.

Waking up frequently for whatever reason will sure make us feel awful the next day. If your awakenings are not due to mask issues or machine issues...going to APAP may not make much of a difference but sure worth trying. Never know..perhaps using a slightly lower pressure for some of the night will enable better quality sleep.

Also take a long hard look at any meds you might be taking (even OTC) to see if any of them have a side effect for causing insomnia or sleep disturbances. Even meds normally thought to promote drowsiness can cause sleep problems in some people. I take Ultram for pain...comes with a "may cause drowsiness" caution sticker but when I take it at night I am wired like I am on speed. In the fine print of the side effects is "insomnia". Meds often have both side effects but people don't think about the possibility. So look at the long list of potential side effects and not just the short list.
Need to figure out if we can what is causing the awakenings. Until you get those taken care of...feeling better is going to be very elusive.

[grumpygirl]

Don't really know what my optimal pressure is! What does my gender, local and age have to do with anything???? EPR gives me much higher AHI and I feel like I haven't slept at all when I use it!! GG

[LSAT]

avi might be right...if you were an 82 year old man.

[needshelp]

Grumpy GIRL, Have you experimented with changing the EPR? I'm not clear if you have tried doing that. For me EPRs of 1 and 2 don't change the AHI much. But an EPR setting of 3 shoots the AHI up to 3 and higher. Suggest you determine an EPR number that gives you the lowest AHI and helps you feel better. Set your machine for that.
Since your sleep study number was 12 cm, suggest you think about bracketing that 12 with the APAP settings of 8 - 13cm and try that for a week to see what you get, AND how you feel! If your AHI is too high change the 8cm to a 9 and try that for a week. Why a week? Most people's sleep varies from night to night. You could get a better picture and better data on how you are doing. You could also keep a sleep diary....notes on how you feel and the AHI, AI, and CA numbers for that night. It could help you track what works and what doesn't. At least that helped me work through some issues and helped resolve them.
Hope this helps and wish you success!
Cindy

[avi123]

Don't really know what my optimal pressure is!

If so the Autoset will tell what it is. You should adjust the setting on your Autoset so that the pressure graph does not hug the max and min limits. See the top graph here:
(could you get it from your S8 Autoset?)




What does my gender, local and age have to do with anything????

About age, recent survey showed that young persons suffer more
from Residual Excessive Sleepiness during the daytime. And there are more details.

Gender could relate to how to stop your Nocturia.

EPR gives me much higher AHI and I feel like I haven't slept at all when I use it!! GG

I would not look at AHIs if they are below 20. Read the reference report in my signature line.


p.s. depression, is most likely the comorbide of the sleep apnea and not the other way around. It should be treated aggressively.

[grumpygirl]

Good Morning All- Set my ResMed to Auto last night and here are my morning results:
Pressure setting 8.4-11.0
Avg. Pressure- 10.0
Leak- .10
AHI- 1.5
AI-0.2
HI-1.3

I had a hard time falling asleep last night-took me maybe 45 min. to finally get to sleep, but after I did I seemed to sleep through the night until about 5:40 a.m. This morning I feel very "spacey" and not able to focus. I am tired and feel like I could go back to sleep and sleep ALL day!! Don't want to do that because I feel like it would waste the day.
I almost feel flu-like, or that I need a big jolt of caffeine!!! Would it be to my advantage to raise the minimum pressure up to maybe 9. I have the EPR set a 1 for ramp only for about 15 min.

I know those stats are very good-so why do I still feel like crap???!!!! Could it be that the slight pressure changes of the apap stir me out of sleep just enough that I am still not getting rested?? Why did my machine not raise the pressure enough to take care of the few apneas I experienced?? I always seem to suffer more from hypopneas(SP??) than apneas.
Why would that be? Is it because my pressure is not high enough? Even when I have my machine set on straight cpap I always have higher HI numbers.

I guess I am just grasping at straws now trying to find the perfect solution to my constant fatique and fogginess. I know that I suffer from mild depression but just do not tolerate medications very well and feel that if I could sleep better I would feel better mentally. As I said in my original post when I do rest well I feel so much better mentally and physically but those days are few and far between.

Any thoughts?? Thanks-GG Should I set my EPR of 1 to a fulltime setting??

[notyorz]

Good morning GG and yes, the numbers look good. You didn't max out on the pressures and the leak and AHI #'s are nice.

I am certain more experienced members will come around today to offer their well rounded knowledge, but I had a few questions for you..

How many hours sleep do you estimate you had last night? You say it took a while and you slept until 5:40am, but if you fell asleep at 1-2am and only got 4-5 hours tops, well you can see why this might be the reason you are foggy today...

I would give each change you make to your pressure settings a few days (at least! Perhaps a full week would be better to average the results). Changing after one night seems counterproductive and may leave you chasing something you didn't know you were *this close* to getting to.

It just might be a matter of time for you right now. Take time to let the therapy work and see if these numbers will remain consistent before changing pressures again.

Here's hoping you find relief soon!

[Pugsy]

S8 machines (any model S8) were notorious for having higher hyponea numbers. Discussed a lot in the past.
Seems like that people who had used the S8 machines that got a S9 machine reported much less hyponea numbers.
ResMed changed the algorithm with the S9.
For a S8 machine...your numbers (especially the hyponea) are really quite excellent.
You can't expect to kill every event and feel the "miracle". A perfect AHI of 0.0 doesn't guarantee the miracle unfortunately. It just doesn't work that way. I sure wish it did.

If you were using a regular bilevel machine (which using EPR sort of creates a bilevel environment in your machine) typically EPAP (exhale pressure) is evaluated for obstructive apneas and IPAP (inhale pressure) is evaluated for Hyponeas.
Are you getting your data off the LCD screen or do you have the software to see if your max was reached and maybe the IPAP needed to be higher? While I don't think your hyponea numbers are bad at all...maybe a little more IPAP but then you have aerophagia...so damned if you do and maybe damned if you don't. Maybe a little more pressure along with more EPR would give you a little more event destruction and the added EPR might help limit the aerophagia.

Personally I don't think your lack of feeling the way you want is related to your AHI and I doubt that even an AHI of 0.0 would give you what you want. I think it is likely related to something else and that makes for a difficult task.
Been down that road myself.

You know your data looks good on paper. Will you feel better if you manage to reduce the events more? Unknown...it really can't get much better on paper anyway. I don't blame you for wanting to try though. I would do the same if I were in your shoes and in fact I have done it. I used APAP 10 minimum and 20 maximum for a long time (it gave me AHI numbers 1 to 2) but I still didn't feel as good as I wanted...better than pre cpap for sure but not what I wanted. I am lucky and aerophagia didn't limit my experiments....I worked my way up to 13 minimum with zero change in AHI and no change in how I felt. There comes a point when no matter what changes we make we can't kill all the events.
I finally had the "miracle" when I stumbled on to bilevel therapy. I had been using Respironics machine so I couldn't play with EPR like you can. Would it help you? I have no idea. Heck, I don't even know why it helps me. After all this time I sometimes wonder if I would have done just as well with a ResMed machine and using EPR of 3. With my bilevel machine I use a 4 cm difference between inhale and exhale. I might have done just as well with EPR of 3.

If you wanted to try EPR of 3..you would likely need a higher starting point and I don't know if the drop in exhale would offer enough relief to keep the aerophagia away. That for sure needs to be addressed.
Would it even help you feel better? No way to know because we don't really know why you don't feel so great.

And of course the standard speech for people who have very acceptable numbers and still don't feel like they want to.
Meds? Bed comfort? Pain? Other health issues...and that very long list of things that affect the quality of our sleep and thus the way we feel the next day that would be a factor even if we didn't have OSA.
The machine only fixes the OSA side of the problem. If there are other problems...the machine can't fix those.

[archangle]

Keep in mind that sometimes when you improve your apnea, you may feel screwy for a while because your body has adjusted to hypoxia and sleep disturbance and has to get your metabolism back into balance. Sometimes, even getting a good night's sleep when you usually don't can leave you feeling strange. (I do note you say you're waking up a lot.)

Do you have any idea why you're waking up? Pain, gas, dry throat, pressure, leaks, aliens?

What happens to your AHI and other problems if you lower your pressure?

[grumpygirl]

Pugsy- I do not have the software to enable me to get a more detailed reading. I am not sure I understand what it is that you are saying about the EPR ( maybe too much brain fog). In your post you spoke of inhale pressure and exhale pressure- in setting an EPR for my machine if I set it to 3 then that would mean I would technically have to raise my overall pressure to compensate or otherwise I would experience more apneas-correct?? In order to lower my hyponeas I should raise the overall pressure or the lower pressure?? I don't plan on moving the pressure for another couple of days but when I do ( if I need to) what do you think my range should be-9-12 cm,what would my EPR be?? When I have used an EPR setting in the past I have not felt any better in fact I felt more sluggish-but maybe I wasn't setting the machine to the correct settings in order to see improvement. I had little or no aerophagia this morning with my 8.4-11cm setting and that was a relief- I always get nervous changing settings and EPR etc. for fear that I will have horrible aerophagia the next day. As you said-damned if I do, damned if I don't, I never know what is the right thing to do. That is why I often just give up and stick with the straight cpap setting of 10.2 with no EPR and feel crappy anyway. Thanks-GG

[Pugsy]

In your post you spoke of inhale pressure and exhale pressure- in setting an EPR for my machine if I set it to 3 then that would mean I would technically have to raise my overall pressure to compensate or otherwise I would experience more apneas-correct?? In order to lower my hyponeas I should raise the overall pressure or the lower pressure??

Yes, it is possible that when someone uses much of a drop in exhale pressure by using EPR of 3..that the reduction might allow some events to sneak past the defenses. It doesn't always happen though. It depends on any number of things and is not set in stone. A maybe situation to be addressed should it come up..I don't believe in looking for trouble unless it pops up.

Right now with an EPR of only 1 you are only seeing a drop of 1 cm upon exhale.
If it were me...I would try EPR of 3 at current settings and work my way up (increase the minimum a little bit at a time) if the drop allowed some events to occur (more than I would accept). Even if you did have to increase the minimum a little bit...you might find that with EPR of 3 that the aerophagia wasn't so much of a problem. Heck, you might get lucky and not have any increase in events.

If your hyponea account was MUCH higher..yes treat them like we would with a bilevel machine and allow more IPAP but really you don't have that many. To have more IPAP with your machine you would need an increase in the minimum pressure. If that was what we were going to try to do.
I sure wouldn't make an abrupt change right now with the minimum pressure. I would only change EPR.
This is a situation where having the software would really benefit you...so you could see how much time was spent at the higher maximum limit. Evaluating pressure needs by looking at a 95% number really makes it more difficult.

[grumpygirl]

How can I get the software I need to really view what is happening during the night?? GG