Help. New using CPAP with no positive results

[rogelio]

I am new to using a machine. I have been using a cpap for the last 2 weeks with no positive results, my AHI is about 4.7 average. Despite using the machine for about 7 hours, I wake up tired almost every day. I would like to see if I can get some advice. I have downloaded Oscar to see the statistics, which I am attaching to this message. I would appreciate enormously any advice from you.

[Pugsy]

Your minimum pressure is too low. It can't get to where it needs to be in a timely manner to better prevent the airway from collapsing.
Why have you limited the maximum pressure? Any special reason?

Remove the mask pressure graph and instead include the flow limitations graph.

Turn off the Pie Chart (Preferences/appearance tab/remove the show pie chart check mark.
Hide the Calendar.

How many times do you think you wake up during the night?
Do you take any medications of any kind? If so, what?

Exactly what symptoms are you having that you wished were gone? Is it fatigue or excessive sleepiness during the day or something else?

[rogelio]

Hi Pugsy. Thank you very much for responding so promptly. Here you can find the new graph with the changes you have suggested.
Also, let me answer your questions.
Q. Why have you limited the maximum pressure? Any special reason?
A. The doctor decided to set up the machine to those minimum and maximum pressures.
Q. How many times do you think you wake up during the night?
A. I believe I wake up around 5 or 6 times during the night
Q. Do you take any medications of any kind? If so, what?
A. No, I don't take any medication besides Advil when I have to deal with pain.
Q. Exactly what symptoms are you having that you wished were gone? Is it fatigue or excessive sleepiness during the day or something else?
A. It is mainly extreme fatigue.

Thank you very much for your help.

[Pugsy]

Are you having much, if any, nasal congestion?

No need to redo this image but we don't need respiration rate and the regular pressure graph is more useful than the mask pressure graph so any future images....
These graphs...
Events
Flow Rate
Pressure
Leak rate
Flow Limitations
Snores only if it shows very many snores.

[rogelio]

I am not having any nasal congestion. I use the Philips Respironics Dreamwear nasal pillows and I tape my mouth in order to prevent the air come out through my mouth. At the beginning I had this problem, the flow of air was coming out of my mouth when my jaw relaxed. I tried to use a chinstrap, but it didn't prevent the air to escape through my mouth. I tried taping and that worked much better; however, I wake up when my chics are extended by the air trying to search for a scape venue. When I tried to use a full mask, it did not work due to the fact that it is impossible to feet the contours of my face and, therefore, the mask leaks profusely.

Any suggestions regarding adjusting the settings of the machine? I learned how to adjust the clinical settings by myself.

Attached you can find the graphs you have suggested me to post.

Thank you very much for your help.

[palerider]

I am new to using a machine. I have been using a cpap for the last 2 weeks with no positive results, my AHI is about 4.7 average. Despite using the machine for about 7 hours, I wake up tired almost every day. I would like to see if I can get some advice. I have downloaded Oscar to see the statistics, which I am attaching to this message. I would appreciate enormously any advice from you.

Given your bad ahi caused by your wrong settings, I'm not surprised

[palerider]

Any suggestions regarding adjusting the settings of the machine? I learned how to adjust the clinical settings by myself.

Min 12, max 20.

[Pugsy]

Your flow limitation graph is a bit ugly. Sometimes it's ugly because of nasal congestion but apparently not in your case.
I ask because more pressure is what is needed with an ugly FL graph that we can't blame on nasal congestion.

Flow limitations are airway reductions in air flow that don't meet criteria for an OA or hyponea flag. The machine will try to increase the pressure to kill FLs as well as OAs and hyponeas. FLs can disturb sleep.

Look at your FL graph and look at mine below. Now I don't know that your FLs are a factor in not feeling so great but they sure could be.


I am a little more conservative with my estimates on minimum pressure just because I tend to start cautiously and work my way up to things. It's easier to adjust to more minimum when taken in small increments and sometimes we get lucky and don't need as much as I might first think.

So my thoughts are at least 10 cm minimum and max of 20. You might need more minimum but jumping from 6.5 to 10 is a substantial jump and you might have some comfort issues with that big of a jump. Look at your pressure graph....the bulk of the time you are up there anyway and the FL graph is still ugly.

[rogelio]

Thank you for your help. I am going to adjust my setting following your suggestions.

Should I set the EPR on of off? I ask you about this because when using the original settings (5 to 15) I had the EPR on and the number of events was even higher than now. I am not sure if the recommendation is to have the EPR on when the pressure is higher in order to feel more comfortable. What do you think?

[rogelio]

Any suggestions regarding adjusting the settings of the machine? I learned how to adjust the clinical settings by myself.

Min 12, max 20.

Thank you for your answer! I will make adjustments tonight.

[rogelio]

Thank you for your help. I am going to adjust my setting following your suggestions.

Should I set the EPR on of off? I ask you about this because when using the original settings (5 to 15) I had the EPR on and the number of events was even higher than now. I am not sure if the recommendation is to have the EPR on when the pressure is higher in order to feel more comfortable. What do you think?

By EPR I mean IPAP and EPAP

[palerider]

Thank you for your help. I am going to adjust my setting following your suggestions.

Should I set the EPR on of off? I ask you about this because when using the original settings (5 to 15) I had the EPR on and the number of events was even higher than now. I am not sure if the recommendation is to have the EPR on when the pressure is higher in order to feel more comfortable. What do you think?

By EPR I mean IPAP and EPAP

I'm pretty sure those things don't mean what you think they do.

[rogelio]

So my thoughts are at least 10 cm minimum and max of 20. You might need more minimum but jumping from 6.5 to 10 is a substantial jump and you might have some comfort issues with that big of a jump. Look at your pressure graph....the bulk of the time you are up there anyway and the FL graph is still ugly.
[/quote]

Hi Pugsy,
Last night, I made the changes you suggested, the results were awful, the HAI almost triple. During the night, I was waking up a lot. After four hours of use, I decided to stop the machine and try to sleep without it. I really don't know what to do. I am attaching the graphs from Oscar.
Any suggestion? I am getting desperate not knowing if I should give up or continue with the treatment. I would appreciate any advice. Thanks.

[Pugsy]

Ahhh...more minimum pressure seems to have invited the aerophagia monster to come calling....time to back off the minimum pressure increases and go much slower with smaller increments.

wiki/index.php/Aerophagia

Bummer...Add in EPR...set to max of 3. This is the first thing we do to fight the aerophagia monster.

I suspect that the mess of events flagged from 2:00 to 3:00 were probably awake related flagged events because of the belly issues.
Watch the videos here.
http://freecpapadvice.com/sleepyhead-free-software
While it is talking about arousal/awake related centrals....there can be false positive OAs and hyponeas as well. It's not limited to just centrals.

Looks like you set it to a minimum of 11 and not 10. My suggestion is to back up to minimum of 9 cm and add in EPR set to 3 and see what happens.

[rogelio]

Ahhh...more minimum pressure seems to have invited the aerophagia monster to come calling....time to back off the minimum pressure increases and go much slower with smaller increments.

wiki/index.php/Aerophagia

Bummer...Add in EPR...set to max of 3. This is the first thing we do to fight the aerophagia monster.

I suspect that the mess of events flagged from 2:00 to 3:00 were probably awake related flagged events because of the belly issues.
Watch the videos here.
http://freecpapadvice.com/sleepyhead-free-software
While it is talking about arousal/awake related centrals....there can be false positive OAs and hyponeas as well. It's not limited to just centrals.

Looks like you set it to a minimum of 11 and not 10. My suggestion is to back up to minimum of 9 cm and add in EPR set to 3 and see what happens.

Thank you for your recommendation.

I just want to point out that haven't experienced aerophagia, not that I am aware. Probably, you came to that conclusion by looking at my graphs, is that right?

I will set up the minimum to 9 tonight and add EPR at 3. Should I also decrease the maximum from 20 to a lower number?

Again, I really apreciate the time you put in advicing me on this matter.