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Sierra

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

My thoughts are to keep expectations in check. I've worn glasses since I was about 10 years old or so. When I first get a new pair they are perfect, but slowly regress as time goes by. New pair is like seeing the light again. But, now as I get older, I know what to expect.

If we skip forward to CPAP, my expectations were low. In fact I was hoping I would get diagnosed with not having apnea. Not the case, so now I use one. Did I ever expect it would lower my blood pressure, lower my cholesterol, prevent heart disease, reverse my diabetes, and keep my pants from wearing, tearing, or sagging at the knees? No, I did not. It does reduce my apnea, or so my machine tells me. Better sleep? Perhaps slightly. I do sleep through the night now about 50-70% of the time. Never did before. Is it worth it. Probably. Was it easy? No, but I figured it out. Good thing my expectations were low...

Then I start to realize that I do not hear so well. In a restaurant I can't hear the conversation at the table. So then come the hearing aids. They are going to cure everything? Right? Well they don't. This time I expected more but got less. That is my current project -- lowering expectations to reality.

Next the vision issue comes back. I notice that I can see well with one eye, but not the other. Go for a check, and it is not a simple pair of a new prescription. The optometrist tells me I have a cataract. So, now we research IOL options. My vision is going to be made perfect again? I hope so, but I'm starting to learn. Lower those expectations again...

Bottom line. There is a price to getting older, and there is a benefit in keeping expectations in check! Age happens!

I also take an ACE inhibitor (perindopril), but I don't suspect it is a problem.

One of the things you might want to think about is pressure. Over the months I reduced the maximum pressure and increased the minimum pressure until I only had about 1 cm difference. My theory based on a detailed review of the events recorded in SleepyHead is that the ResMed machine is chasing hypopnea events with more pressure. And, it is designed to do that, as it assumes a hypopnea event is caused by an obstructive flow restriction that does not go to a full obstructive apnea.

The problem is that the hypopnea event can also be caused by a reduced effort to breath, which is really central hypopnea. For these reasons I think it is of benefit to me to restrict the maximum pressure that the machine can go to, as increased pressure, at least in me, causes more central apnea. With this theory, I finally got to the point of trying a single fixed pressure (CPAP mode). It actually achieved a better AHI than even a narrow 1 cm pressure range in APAP mode. It does however takes long trial periods at different pressures to find the ideal. It would seem that one would just have to reduce pressure until obstructive apnea becomes a problem. I found it is not that simple. It seems even a single short obstructive apnea event can start a minute ventilation cycle which can result in multiple central apnea events. More pressure can cause centrals, and at some point less pressure can also cause centrals. So there is no sharp clear cut pressure which is obviously ideal. It just takes trial and error and a long time at a pressure to see how good or bad it is. As a check I also use total time in apnea as a measure. To me that is even more important than AHI.

I was running a pressure up to 15 cm in Auto mode, but now I use a single fixed pressure of 11 cm and get better results.

Hope that helps some,