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First time, needing advice
#1
First time, needing advice
Hello

I have an AHI of 31.5, from an at-home sleep study / respiratory analysis. Doctor has prescribed a CPAP with a pressure of 7 cm H2O, and I have been using a Resmed Airsense11 for the last 2 weeks.

TLDR - should I change my minimum pressure to be higher than 4? Should I change my EPR level?

I have not managed to keep the mask on for more than 2 hours each night, so I haven't really started therapy yet, it's fair to say. I need some advice, hopefully someone can point me in the right direction - I'm committed to getting this to work, because I know my sleep quality is bad.

My main concern is that 1-2 hours after putting on the mask I start to feel breathless; I feel like I'm rebreathing spent air and not getting fresh air. I suspect this happens when I'm starting to fall asleep and my breathing rhythm slows down and breaths get a bit shallower.

Here's a question - when you exhale, where does the exhaled breath go? It goes into the mask (full face) and tube. So as I start to inhale, I can tell the initial air I'm getting is not "fresh". then I get fresh air and can breath normally. But to repeat, as my breath gets shallower, each breath takes longer to get that fresh air. Eventually, I feel like I have to take a deep breath in, and that's like an arousal that stops me from getting to sleep, so I take the mask off and quit.

I'm in the US, so the machine is provided by a company that's selected by the doctor. I have to call the respiratory therapist for help with the machine. I called 3 times last week to explain the breathlessness. They never answer, I leave a voicemail and so far they have not called back. So I'm very disappointed I'm not getting help for my condition, I've complained to the doctor about that.

I'm comfortable with the mask and headgear and I think I could sleep if I figure this out. Here are the settings on the machine, I have to assume that something here needs to be adjusted, if not then I don't know how CPAP is going to help me...

I have the Oscar software on my laptop, but until I spend a full night on therapy I'm not sure it's worth including any data, but correct me if I'm wrong about that.

I notice during the time I am wearing the mask, the pressure is changing; sometimes it's 5, I've seen 11 on the display. The only 2 things I can imagine might help me is adjusting the minimum pressure higher than 4, and/or changing the EPR level. I'm comfortable with everything else, humidity, temperature, etc.


Therapy mode is Autoset
Pressure range is 4-20 cm H2O
Autoset response is standard
Ramp time is Off - the therapist changed that when I told them the mask was leaking at the end of the ramp. I want to fit the mask at the maximum pressure. 
EPR is on
EPR type is Full time
EPR level is 3
Humidity level is 3
Mask setting is full face
Tube is Slimline
B/V filter is off
PatientView - advanced
SmartStart - off
SmartStop - off
Care CheckIn - on
Reminders - off


Many thanks in advance
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#2
RE: First time, needing advice
It would be worth posting OSCAR graphs even for just the partial use during a night. Seeing how the machine perceives your breathing while awake and drifting to sleep can be very informative.

As for rebreathing, you really aren't. The mask vents air quickly. Maybe you are feeling the heat from the tube and assuming that's your own breath? For a lot of people a pressure of 4 will also make them feel breathless. Raising your minimum pressure is likely a good idea but please post the OSCAR graphs so we can see details.
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#3
RE: First time, needing advice
Depending on the therapy, the type and size of mask, and the fit, there is always at least a small amount of 'rebreathing'.  Some therapy uses a significant rebreathing effect to control central apneas...if you have them.  However, the previous responder is correct: the fan blows lots of air through the hose constantly.  It quickly assumes its full flow against your exposed, inside-mask, face as you stop exhaling and commence to inhale.

Your AHI is in the 'severe' range according to established conventions in medicine and in the insurance industry.  The therapy you have might be a bit under-aggressive, which could explain why you're having so much trouble keeping your mask in place.  If you're removing it under duress, that would account for your experience to date.  I think you're going to need more inspiratory pressure, perhaps up to near 12 cm, and you might need a maintenance pressure during exhalation to keep flow limits in check...maybe as much as 6-7 cm at the low end.

We can't tell what is going on until, and unless, we see veridical data.  We also need at least three separate data sets, so three nights' worth of sleep performance and what your machine recorded, and then did, for you.
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#4
RE: First time, needing advice
Your minimum pressure setting is too low.  Most adults need at least 7.  Change just that one setting, and I bet you will feel better.  You can continue raising your pressure until you feel like your breathing is normal.
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#5
RE: First time, needing advice
Thank you all so much. 

Here is my first report from Oscar. I actually did well last night; mask on for 4 hours and I think I fell asleep. Only when the pressure increased and the mask started leaking did I stop - but that's a different issue from breathlessness, which I did not actually experience last night

   

will post more screenshots this week

D

p.s. can you estimate from the charts when I was asleep?
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#6
RE: First time, needing advice
I also agree that your base pressure, currently set to 4 if your bio information is correct at left, and if the chart you just posted is correct (I am sure it is), is too low.  You should set it tonight, prior to bed, to about 6, maybe 7, and see if we can't get control of some of the noise we see in 'events'.  All those clusters of events, especially that massive cluster in the middle of your night, suggests sleep position might be a problem.  Whether you're on your back or on your side, your chin is tucking down toward your chest.  This happens mostly on one's back.  

You might need to use a soft foam 'cervical collar' available at large box stores and medical supplies stores.  They help to keep your chin from falling too far toward your chest, folding over your airway and permitting 'flow limitations'.
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#7
RE: First time, needing advice
Did you have any central apnea during your sleep tests? Is the central apnea something that has been happening?

The Central apnea may be false since it appears in the cluster along with clustered central events.

Can you post a couple of zoomed views showing what is happening before and after the central apnea , a couple of 3 minute views and a 20 minute view of the overall cluster so we can get a feel for what is going on.
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#8
RE: First time, needing advice
Yes, "severe" central apnea was reported on my respiratory analysis from the sleep study; "significant  proportion of the events being of obstructive origin".

for the extra screenshots zoomed in, where exactly are you talking about? Can you give me a time window from the first screenshot, and I can post after work? (3pm in AZ right now).
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#9
RE: First time, needing advice
2308- 2335 please
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#10
RE: First time, needing advice
   
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