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Hoping for thoughts & advice
#1
Hoping for thoughts & advice
Hello everyone,

I'm new to the sleep apnea world.  I was diagnosed with OSA, so I went down the road of getting a machine and then found this board.  Struggling to get a full night's rest still at this point, so I would love to get some thoughts on my data to better tune my machine and hopefully get me through the night.  When laying on my back, I feel like i have a pretty good mask fit, but if I roll to either side (my preferred way to sleep before therapy), it slightly loses it's seal.

I'm pretty much running the machine as provided - except for a few minor adjustments to the ramp and starting pressure.  The leak rate looks horrible, but the Philips app says 100% fit, and i do feel like it is sealed on my face?  So clearly I'm missing something here.

Thank you!


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#2
RE: Hoping for thoughts & advice
I have little knowledge with the dreamstation go. It is a travel machine and this is first I have seen. So let me say that your pressures seem to low. You have it set at 5 and on most machines that is a setting for a child not an adult. I would raise it to 8 and the max to 12. Try it and post tomorrow. Hopefully you will have a better night. And try to work on leaks. Fit the mask as you are lying down in your normal sleep position with the machine on.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar     Dealing w DME     Chart Organizing
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#3
RE: Hoping for thoughts & advice
Welcome to Apnea Board. stacey is right on pressure being too low. I'd bump it to 7 or 8. I would also turn off the Ramp, it is delaying therapy for the 30 minutes it's on. The Respironics app isn't accurate nor is it expected to be. It's just a cheerleader, trying to get you to use the PAP. OSCAR has far more data, and is much more accurate. I do hope you realize that in my opinion the travel PAP such as this doesn't typically do well as an everyday machine. They are for short term trip circumstances, and some of these travel machines can't do that right either. Of course that is my opinion, even so you'd have fared better buying a standard sized machine.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Hoping for thoughts & advice
Almost everyone has mask leak issues in the beginning. Since back sleepers and side sleepers have different mask stress points, you may have to try a few different masks to find one that works for you. Since you are a relatively new hose-head, you may wish to speak with your DME to try a few masks. If necessary, you can switch masks at replenishment time.

Best of luck.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#5
RE: Hoping for thoughts & advice
Thank you everyone for your time and advice.  Attached is last night.  The sudden drop of pressure at 02:07'ish is me unable to sleep at a pressure of 12 and resetting to the initial 7.5 pressure.

Also, thanks for pointing out the travel pap thoughts.  I do expect once we get to a post-Covid world, I may be on this machine 3-4 nights a week in some hotel, so felt like I should start and learn with my desired sized machine.  It appears that the ResMed Airsense 10 is a popular machine on this forum.  Are there any concerns mixing the two brands or should I stick to the regular DreamStation?


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#6
RE: Hoping for thoughts & advice
Take a look at your pressure chart and leak rate, notice that the pressure has gone up (to the max) when your leak rate increased. Your machine (any machine) can not work if the leaks are high - that is what the machine does - it provides pressure to keep open your air way. If the pressure is lost your air way collapses. So I don't know if more pressure really will help, you need to find a way to stop the leaks on your mask or get a different type. I assume you are a mouth breather? If not and you can sleep without opening your mouth - the type of mask that has the least leaks are nasal cushion masks. Basically the less area of skin the mask touches the less amount of leaks.

But what I am having a hard time understanding is at the bottom of your chart it says "time over leak readline 0%. So lets try to move up both min and max by 1 and see if that helps.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar     Dealing w DME     Chart Organizing
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#7
RE: Hoping for thoughts & advice
Yes, I am a mouth breather.

Perhaps you can clarify what that chart is representing. Is it volume of air being released via the existing the port holes on my mask (and top of my head connector) plus any release around the edges of the mask? It appears I have 2 lines on my run chart (Leak Rate & Total Leaks)...where I have seen other people's chart with a single line.
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#8
RE: Hoping for thoughts & advice
On yours the bottom leak rate is the normal leak rate (from the expiration holes) the top is the total leaked (from seal and expiration holes). Again it shows 0% large leaks but the leaks and pressures show the same thing that the leaks are raising you pressure. 

Have you put the correct mask type into the machine?  Another thing you can do to see what is happening- take your mouse and put it on the left side of the leak graph near the words. Right click and go down to “dotted line” then pick the last one (large leak limit).

That should show the largest leak your machine can give therapy.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar     Dealing w DME     Chart Organizing
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#9
RE: Hoping for thoughts & advice
Just touching on the question about ResMed AirSense 10 AutoSet, I am including the word AutoSet to specify what to look for in the future. You have the DreamStation Go, and it should be better for the travel you mention. You are not obligated to stick with one manufacturer. So yes, when it's time to get a regular version of CPAP, go for this AutoSet. I think it's the best Auto CPAP available. This assessment is backed by comments of users here and also by seeing the results on OSCAR. Don't let the fact you bought Respironics keep you from obtaining the AutoSet. Masks can be from most any manufacturer as well on regular machines, I think most models of travel machine are limited to certain masks however.

OK on the current therapy, with quite a lot of Hypopnea, which are roughly 50-80% strength apnea events, you'll need to increase pressure to allow the machine to have enough pressure to fight these events. Leaks are a hindrance as this releases the pressure if leaks are of a high enough value.

Deal with leaks first and then add in the pressure bump stacey mentions.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Hoping for thoughts & advice
Your leak rate would be bad if you were using a ResMed machine, but for a PR machine, the measurement works differently, and except where there's a Large Leak indication, you're doing fine on leaks.

The pressure increase last night came in response to the cluster of hypopneas. In general, you probably need a higher minimum pressure to head off more of your events. PR machines are OK, but they have a conservative algorithm that doesn't move the pressure up quickly after an obstructive event occurs. That means they tend not to prevent additional subsequent events.

I would also note that you have a fair number of RERAs (respiratory effort related arousals) and flow limitations. That's another reason to consider a higher minimum.

I'm going to bet you'd tolerate a minimum of 9 for starters, with a higher minimum possibly called for once we see what happens with 9.

You do have a fair sprinkling of CAs, which can't be treated with increased pressure. (A central apnea, or clear airway, event is one where you stop breathing for 10 seconds or more and no obstruction is present.) CAs often occur as part of a partial arousal or full wake-up, and where that's true, the real problem is the arousal, not the CA itself. So for now, I'd suggest not worrying about the CAs, keeping your focus on sleeping more smoothly.

When did you start using your machine?

If you have the ability to buy a machine yourself, or to trade this one in for another one, I'd warmly suggest you get a ResMed Airsense 10 Autoset for Her. (Second choice: not "for Her.") I think it would do a better job of addressing your hypopneas and flow limitations, maybe RERAs too.

And if by any chance you could swing it, and your doctor would write a prescription for it, you might consider getting a ResMed Aircurve VAuto. It can do everything the Airsense 10 Autoset can do, plus it has settings that allow more "pressure support," which can be helpful for flow limitations. But it probably makes more sense at this point to get the Airsense 10 Autset; you could always trade it in for a VAuto if it became apparent that would be a better choice for you.
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