Sierra

I suffer from some congestion, and use a ResMed P10 nasal pillow mask. I find if I can get my nose reasonably clear before I go to bed, I will stay clear all night. I do use a chin strap and tape on my mouth to ensure I breathe through my nose. I will occasionally use a decongestant like Otrivin in the more congested nostril occasionally but not as a matter of routine.

My experience with a full face mask (F20) was not so successful. I couldn't find the happy medium between a comfortable fit and no leaks. Also, it seemed to promote breathing through my mouth and I think that was causing a sore throat.

I find that for those who use SleepyHead and really look at what is going on, then improvements can usually be made by increasing minimum pressure and reducing maximum pressure, and quite often by increasing the minimum start pressure. Yes, people are different, but there is no way I would be comfortable with a minimum start pressure of 4 cm. It is just too low and I get a suffocating feeling.

An APAP is a reactive, not a predictive machine. There may be artificial intelligence predictive machines in development, but todays machine has to see an issue before it reacts. If you start every sleep session with 4 cm of pressure and you really need 10 cm for effective treatment, then you have to have enough apnea events in the early sleep to ratchet up the pressure to the effective level. By setting the minimum pressure at 10 cm you put your knowledge from viewing SleepyHead data into the machine. That makes the so called "automatic" method much more effective. The machine does not have to play trial and error on you every night. I think setting the minimum up in a Dreamstation is more important than with the ResMed. The Dreamstation algorithm seems to be slow to increase pressure and quick to reduce it, so it is going up and down all night, if you give it the freedom with a wide pressure range.

There is less treatment effectiveness to be gained by setting a lower maximum pressure, but some comfort can be gained. From viewing SleepyHead you can find times when the machine tends to become over responsive and push pressure up. Mild snoring and flow limitation can run it up even when apnea events are not occurring. If the individual is having issues with higher pressure such as leaks and waking up, it may be of benefit to tolerate a bit of snoring and flow limitation in exchange for lower pressure. And since apnea events are not increased, AHI stays low. My wife is in that category.

But if you set tight limits then you have to monitor your results more diligently.

What you need to know is the total apnea index (AI) compared to the central apnea index (Central AI). If you look at the sleep report on your machine these may be displayed right near the bottom of the report for the date range selected near the top of the report. What you need to figure out is if these jumps in AHI are due to obstructive apnea or central apnea. If obstructive apnea then your machine pressures may simply need to be adjusted. If it is caused by central apnea, then the solution is more complex. Some of the other parameters on the machine may need adjustment. Central apnea can be an indicator of other underlying medical conditions, such as heart issues, and you should have that aspect checked. If you are a suitable candidate, it may be necessary to move from an AirCurve 10 to the AirCurve 10 ASV model which provides breathing assistance. All things you should discuss with your sleep doctor and medical doctor.

If you are using low pressure settings, less than 7 cm, then the EPR is going to be limited in what it can do. The machine will not allow the pressure to go below 4 cm. Say for example your minimum pressure is set for 5 cm, even if you set EPR at 3, all it will do is give you 5 cm on inhale and 4 cm on exhale. If your minimum is 7 cm then an EPR of 3 will give you 7 cm on inhale and 4 cm on exhale. Many find that comfortable. Over time I have adjusted my Ramp Start pressure up from 7 cm to currently about 8.6 cm. My test to determine whether or not it is set right is to breathe normally when I first go to bed, and see if I can feel any restriction on inhale or exhale. It should almost feel as if there is no mask on your face at all. i.e. no restriction in air flow.

Unfortunately many machines are delivered to the user with the minimum at 4 cm, and the Ramp Start at 4 cm. That can easily result in a feeling of not enough air. EPR on or off when the minimum is set at 4 cm will make no difference, because it cannot do anything.

There are two basic types of apnea; obstructive and central. Obstructive is essentially when the airway collapses, and their can be many causes and aggravating contributors. The central apnea occurs when the body just decides to stop breathing. It is less well understood, and again there can be many contributing factors. A sleep study would certainly give you a very good idea whether or not you are actually having apnea, or if it is something totally different.

Anything below about 8 cm is low pressure in my opinion. The difference between 4 and 5 is pretty insignificant, and in fact both pressures are so low that it may feel like there is not enough air when you have the mask on. All machines should go as low as 4 cm, but it is not necessarily going to feel comfortable. Do you have any difficulty breathing? Does the mask feel like it is restricting air flow? It is possible you may need a little higher pressure.

First, if you already have not, you should read through the posts in this fairly recent thread.

https://myapnea.org/forum/not-understand-epr-setting

My thoughts on EPR are that it does provide some comfort benefits by reducing the pressure on the exhale. The disadvantage is it also reduces your treatment pressure on exhale and if you are susceptible to apnea during exhale (and many are), then turning it on when it was off, can reduce your treatment effectiveness. If you have an auto CPAP and the maximum pressure allows it, your machine will probably compensate for it by increasing your inhale pressure. When it increases, so does exhale pressure, so you kind of come full circle, and have not really accomplished anything. And with an increased inhale pressure you are likely to have more issues with mask leaks.

For these reasons, my preference is to use EPR but only during the Auto Ramp portion of the nightly cycle. With EPR set at 3 and the start pressure set at 7-8 cm, the pressure will cycle on inhale and exhale to provide maximum comfort while you are going to sleep. Then when you are asleep the EPR goes off and inhale/exhale pressure become the same. This maximizes treatment effectiveness, and results in a lower maximum pressure during treatment.

Flex is much the same as EPR but the pressure reduction is less than the nominal setting. It modifies the reduction based on flow and pressure, and the impact on treatment effectiveness probably is less. Not sure if you can set Flex to be used only during the ramp on a Dreamstation, but if you can, that is how I would use it.

Hope that helps some,

If you are talking about the sleep report displayed on the machine screen, the Pressure there is the average of the 95% pressure levels for each day in the window of time that is selected at the top of the report. The 95% means that 95% of the time pressures were at or below that value of 13.9 cm in your case.

I've not had the headache issue, but it may be just you adapting to the higher oxygen levels you should be getting with using a CPAP.

Is this the mask you are using? What is your maximum pressure? I'm on mask #5, and wondering if I should go for 6! It is all on my nickel, and this appears to be a fairly expensive option.

https://www.youtube.com/watch?v=BRgTBdNNlTU

In my opinion the airway is more likely to collapse when sleeping on your back, however I'm sure it can collapse when sleeping on your stomach as well. A sleep test is the way to find out.