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[CPAP] Needing a little feedback to help me start the ride
#1
Needing a little feedback to help me start the ride
I am a new to CPAP user, slowly getting into it. I spent the past few days educating myself here and there, naturally ending up with more new questions than answers.

I was diagnosed with OSA (sleep study AHI of 72, both OA and CA), 44 years old male, far from overweight. In case it matters I also have a previous ADHD diagnostic, based on recent reads there is a little bit of a controversy around ADHD and OSA relationship. Any pointers to good resources on this subject would be greatly appreciated.

I have been prescribed APAP therapy, auto-mode <6;16> cm pressure range,  and got an Airsense 10. Doc didn't talk about EPR, the setting was off.

Unfortunately where I live the medical follow up is not very tight, I will have to largely count on myself for treatment tuning, thus trying to cover as much ground as I can before my next appointment in order to get the most of it. I installed OSCAR and now playing around to get a better understanding of my condition. In short I am probing EPR and pressure range settings while learning to interpret OSCAR data outputs.

I attached 3 OSCAR screen shots from the past few days and would be very grateful to have a little feedback about it. I am of course not asking for medical advice's, but I am confident that y'all well informed folks could help me get on the right tracks.

There are two points at the center of my current preoccupations:

- My flow limitations seems very high. Is it 'off the chart' level ? Should I concentrate on that?

- Almost every night I have occasional quite long events (around 50 seconds, mainly OA's) which are a little bit daunting. Should I worry about those ?

On a side note I am also struggling with large leaks, using a face mask because I tend to be a mouth breather. I had to tighten up the mask past comfortable level since leaks are a big issue when pressure rise during sleep. Although I am now having bruises, I decided to hold over and take care of it when my treatment set points are better defined.

Please feel free to ask for zoom-in's or additional info as necessary.

Thanks!

   
   
   
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#2
RE: Needing a little feedback to help me start the ride
Hi Minimax, welcome to the forum.

The first point I would like to make is that you have your mask too tight. If you are getting bruises, that's most definitely too tight. The headgear should be firm but not tight - too tight will crush the seal and cause worse leaks. You may need a different type of mask - every face is different, so you may need to try several masks to get one that's right for you.

On the Sunday night you had a huge cluster of apneas and hypopneas - this is often a sign that your sleeping position is causing problems. Most likely your head is falling forward with your chin to your chest, causing stress on the airway. This can be overcome by sleeping on your side, or by using a soft cervical collar to support your chin. You can also try an orthopedic pillow to support your neck and keep your spine straight.

Your machine is trying to go to a higher pressure - I would set the max to 20 and see how high it needs to go - it won't go any higher than it needs to. It probably wouldn't hurt to raise your minimum pressure as well - you can see that the machine spends very little time at the minimum.

Finally, please arrange your charts as follows: Calendar OFF. Graphs to display: Event flags; Flow rate; Pressure; Leak; Flow limitations.
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#3
RE: Needing a little feedback to help me start the ride
Welcome!

As Tony said, your mask is definitely too tight. 
Likely the wrong mask for your face.

Read the mask primer wiki:
http://www.apneaboard.com/wiki/index.php/Mask_Primer

It's helpful to browse through the wiki articles here for all sorts of good cpap information.

It depends on the company but your DME (business that supplied your cpap stuff) may allow one mask switch within 30 days free of charge. 
Many of the online suppliers offer 30 day returns as well. (Check out supplier list, link at top of main pages here)

Masks are very individual and a source of frustration for many. Lots of trial and error to reduce leaks and increase comfort.
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#4
RE: Needing a little feedback to help me start the ride
Thanks all for the help,

Based on your recommendations I made a few experiments last evening. Little strokes fell great oaks, as I was told.

- Already using an orthopedic pillow, considering to find a cervical collar and working on my sleeping position.

- I will likely have to find another mask, past 13cm pressure I cannot manage to keep the seal without 'strongly' tightening the headgear. Unfortunately I will probably have to stick with it for now. Would it be a good idea to try out a nasal pillow even if mouth breathing (chin strap or tape?) ?

- Past 15cm pressure it felt quite uncomfortable to exhale even with an EPR maxed at 3. Is this something we get used to, needing some practice ? I had the impression higher pressure would prevent me from breathing normally, so I did the reverse for the sake of investigation and caped last night pressure at <8:12>cm with EPR set to 3. No big changes, flow limitations are a tad better but not much although I had many longer OAs and my mean tidal volume was significantly lower.

- Still digging the wiki, there is a lot to digest, not finished yet ...

I didn't get any comment on my flow limitations and longish apneas, does it mean it is a little bit unusual?
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#5
RE: Needing a little feedback to help me start the ride
You might want to try nasal pillows and a chin strap (if you tend to be a mouth breather).
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. 
ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.
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