Help On Dreamstation settings

[Jgknsc]

I started therapy in January 2018 using a Respironics Dreamstation.  I did not have any problems for the first year and adapted from the very first night with no major issues until late January of this year.  I use a nasal cushion, size small with a medium frame.  I originally started with a medium cushion, but it seemed a bit too big as only the tip of my nose barely touched the medium on the sizing chart, so I moved to a small.  I try a medium every now and then, it does seem to provide a little more air flow, but after a while it leaks unless i really cinch it down and then it hurts the bottom of my nose.  My initial settings were 5-20.  After about two months that was changed to 7-20 and remain there.  Humidity was set at 3 in adaptive mode.  After the first year I began to get sinus congestion, not a lot of mucus or drainage just feeling dry and swollen which was making it harder t breath through my nose. My AHI was always pretty good usually below 2.  Since I have been fighting this issue my AHI had been less consistent.  On good nights it is the two range, on bad nights in the 5-6 range.  On a bad night I'm usually awakened with it being tough to breath.  I get up remove the mask and things come back to normal quickly.  I put the mask back on fiddle with the humidity and go back to sleep.  I know my AHI will not be good and I'll have 1 % or less of periodic breathing from fighting the issue.  This has also caused me to move to more mouth breathing which was not an issue for the first year.  I got a heated hose which helped at first.  I began with setting of 3 and 3.  Since then I have moved the humidity setting to 5 and the hose to 1.  I did this because the 5 was going to give me the highest humidity and the 1 the least heat in the hose, I don't like the warmer air.  I'm in arizona so it is pretty warm and dry already.  I do not have any sinus issue throughout the day.  So.... given where I am I know using CPAP can at times be a challenge, I don't want to stop it, so I'm wondering if I tweak my settings if things will go back to where I was when I started.  I am currently at 7-20, 1 on flex.  With heated hose use I run 5 on humidity and 1 on hose temperature.  If I go to non-heated hose I run at 3-4 on fixed.  At times I may get a little rainout on 4, that's why I got the heated hose. I have tried the dreamwear full face mask, size medium, leaks pretty bad and no improvement in mouth breathing.  I'm also thinking moving the humidity to lower numbers.  I was doing really well for better than a year so before I make any wholesale changes I have attached some charts with some good and bad nights to see if anyone has any suggestions on my settings.  -- Thanks in advance, John

[Sleeprider]

With pressure from 7-20, flow limitations, hypopnea and obstructive apnea figure prominently in your results suggesting a need for higher minimum pressure. I think your best course is to increase the minimum pressure to 8.0 and observe results, but I think you might end up at 9.0 based on 95% results. The sad fact is Philips Auto machines need to be set with a minimum pressure very close to what we'd choose for fixed CPAP because they don't respond fast enough to flow limits to prevent the obstructive events. I don't know your AFlex setting, but keep it at 1 or 2, but not 3.

[Jgknsc]

Sleeprider-  Thanks for the input, I will make the pressure adjustments and monitor.  You asked about my A-flex, it is set to 1.  As I noted in my post I was thinking of reducing the humidity.  I read a few threads on humidity settings and found that often times less is better.   I started that last night and set the humidity to 1 and the hose temp to 1.  This made a huge difference, no stuffy nose and no dryness which surprises me, but I'll take it.  Perhaps I was over analyzing things, probably should have done this sooner.  There are so many variables, its hard to know where to start. DME's are not a lot of help. Attached is a screen shot from last evening showing the result.

[Sleeprider]

Your humidity setting resulted in an improvement in obstructive events across the board with fewer OA, H and FL. Glad this was also comfortable. I still think you'd benefit from the higher minimum pressure, but this is a more comfortable looking night. The therapy that is comfortable and restful to you is normally the best, and you did a good job figuring out the humidity issue.