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Need some help/advice - here's my symptoms and machine settings
#1
Need some help/advice - here's my symptoms and machine settings
Hello,

For the past several years, I have been unable to sleep very well throughout the night. Sometimes trouble falling asleep, but mainly I'd be waking up throughout the night 10+ times. I really wouldn't feel tired so much throughout the day I would just feel sluggish and like crap. Especially when I wake up, I would basically feel like death. Looking online, some of the symptoms of sleep apnea were you dose off in the couch during the day, need multiple naps, etc. That really wasn't me. I never have been able to take naps my whole life. I'm one of those people where everything needs to be perfect with fans, temp, etc. before I can even think about falling asleep. When I was younger, I could fall asleep and sleep for 12 straight hours if I wanted to. Now at age 35, a typical night for me was I go to sleep at 11, wake up at 1-2 am and then toss and turn the rest of the night dosing in and out of sleep. I decided to have a sleep study done. It wasn't an overnight place, just a thing you take home. I attached the summary of the study below in the images. It said I had an AHI of 10.6 per hour (mild sleep apnea) and recommended I do a CPAP Machine. I wasn't quite sure if I needed one or not but I knew I had to try something.

So about a month later I ended up with a Resmed Airsense 10 Autoset. I decided to go straight to a full face mask because my dad has sleep apnea and it works great for him. I also have enlarged turbonites in my nose so I think throughout the night I may breathe through my mouth some. Typically I fall asleep breathing through my nose. Regardless, to cover all bases I thought I'd stick with a full face mask. The first one I tried was the Resmed F20 and it was a disaster. Left a horrible mark on my nose and I'm a side sleeper that tosses and turns all night so it didn't work for me at all. I swapped it out for a F30i 5 days ago and it has worked a whole lot better. It feels good on the face and I do actually fall asleep fine with it on though obviously it still is a lot different for me than not having a mask at all.

So here's my question. I've slept 5 nights now with the F30i mask and a little over a week total with the machine and honestly I've noticed basically zero change. It's typically the same pattern, I can usually fall asleep pretty fast and maybe sleep for 2-3 hours but then I jolt up and the remaining 4-5 hours I feel like I'm just tossing and turning all night. The pressures were originally set between 4-20 so it would start at 4 when I turned it on. At 4 it felt like I was getting hardly any air so I went in to the admin settings and set the minimum to 6 (following recommendations of other posts on this board). Maybe that still isn't high enough? I've attached my charts from the previous night. My AHI was 5.29 with 7 obstructive events....so that wasn't terrible. What I'm confused about is I had 36 Clear Airway events. I'm not sure what Clear Airway really means.

My doctor isn't much help. It's basically yea your AHI is going down so that's good its working. Well it really isn't, I still sleep the exact same way I was before. So it makes me worry do I have some sort of another issue. I'm 35 years old and I think my health is decent otherwise. I'm 6/1 and weigh about 210 so maybe slightly overweight.

So I guess what I'm needing help with is #1 do you think this cpap machine is even gonna help? #2 could someone smarter than me look at the results from OSCAR that I've attached from last night and give some advice on maybe some tweaks I should make or what is happening to me throughout the night? It does seem with that particular mask I'm wearing I feel air hitting my mouth area but not so much going up my nose. My friend uses a nose mask so do you think I should possibly try a nose mask only (I think he uses a Dreamwisp). Was just worried it may not help if I switched. I don't know if I should feel strong air going up my nose or not because that isn't the case right now. I can breathe and all through the nose at pressures of 6 but if my airway closes I'm not sure its strong enough to open it. That said I really have no clue and that may not be the case at all. Just trying to think of reasons as to why I'm still not sleeping.

Thanks in advance for any help.


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#2
RE: Need some help/advice - here's my symptoms and machine settings
Welcome to the club,

I see two things that need attention to help you. Leak rate is consistently high, Max of 22.8 is just below the redline of 24. Your mask isn't sealing very well for you. It could be cushion size isn't correct, or strap adjustment. You have constant leaks all night. I've not tried the F30i, but the F20. I struggled for over a year with it and decided it was a failure. I moved on to a Fisher and Paykel Vitera full face and I've got much better comfort and leak control. I'm not saying you must try this Vitera but something needs changed. I do know that a lot of PAP users mistakenly think tighten with leaks, but in a lot of cases this makes it worse. Over tightening crushes the cushion and opens up more areas to leak.

Second, CA, clear airway, is referring to Central Apnea. Basically you are not breathing, but the airway isn't restricted. Your CA are likely treatment emergent Centrals, caused by increased breath efficiency, and specifically removing of CO2. Your breath efficiency is much better than before PAP, and it takes time for your body to reprogram for the PAP enhanced breathing. I suggest trying this edit just to see if CA drop. Reduce EPR to off.
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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#3
RE: Need some help/advice - here's my symptoms and machine settings
Thanks so much for the tips. Yea the masks is a struggle.  I guess one perk of using an actual health place and probably overpaying for the masks is they are great to swap the masks out for me so I can pretty much try everything. When/if I ever find a mask I like I'm sure replacements are much cheaper online.  I also don't love that the F30i replacement cushions are $90 through the company or $50 something is cheapest online. Others have much much cheaper cushions online so I probably should try something else anyway.  I'll look into the mask you suggested.

On your second point, to make sure I understand, you recommend trying to turn the EPR feature off on the Resmed machine?  I'll have to Google to know what EPR even does but the thought is that may reduce the CA's?  I'll give that a try.

I know many have asked this but is it normal to basically still see no improvement after about a week. Does it take weeks/months for body to fully adjust?  Do you think I'm on the right track and will ever actually sleep?  Just hate wasting what's amounting to over $1000 of it isn't going to help.

Thanks a lot or the tips.
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#4
RE: Need some help/advice - here's my symptoms and machine settings
ResMed's EPR stands for Exhale Pressure Relief. It's advertised as a comfort item, but there's therapy as well due to an actual setting value of 1-3 cmH2O, and due to the pressure support factor. EPR 1 drops pressure by 1 cmH2O, as does 2 and 3 respective. If on a BPAP, this is the same as pressure support, except PS adds pressure on inhale while EPR subtracts on exhale.

The reason I suggested turning it off temporarily was to reduce the higher breath efficiency you're getting to reduce CA.

This treatment emergent CA issue is for up to 3 months for most users. A select few, the time could be longer or it might just remain. This is a very few PAP users though.

Second time issue, some feel good results immediately with PAP treatment. Others, feeling better is delayed weeks, months. It's variable because of the individuality of Apnea, how long one suffered before treating, and so on.
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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#5
RE: Need some help/advice - here's my symptoms and machine settings
Gotcha. I'll temporarily turn it off and see if that makes any difference.

Last question. Is my setting of 6-20 pressure reasonable?  Should I tweak it any in your opinion.

Thanks again for all the advice.
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#6
RE: Need some help/advice - here's my symptoms and machine settings
It's reasonable for now. Let's try the EPR edit first. One or two nights at most will tell us how the CA will respond. You can post a chart tomorrow if you want. Make sure you tell us how you feel, noting differences before and after editing EPR.

Your Min pressure of 6 may need to increase at some point, but let's hold off for now to keep any result or feel variance solely a result of editing EPR.
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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#7
RE: Need some help/advice - here's my symptoms and machine settings
Here is my chart this morning. Definitely looks better compared to last night.

Only change I made was turning off EPR as you suggested and I spent some time readjusting the strap to try to help with leaks. It seemed better this time. Looks like between 2-3 am I had a stretch with maybe significant leaks just looking at the chart. What happens is when I sleep on my left side there are no leaks, but when I readjust and sleep on my right side, it will somehow leak a little bit. Maybe need to tighten that side more or just get a new mask as you suggested. I did look up your mask and the only killer is since I am 100% a side sleeper I really think I need a mask where the hose attachment is on my head instead of at the front of my face. With that type of face mask, I'm also worried about red marks on my nose. When I toss and turn all night, the few nights I tried the F20 my arm was getting tangled and a week later from using that F20 the red mark on my nose is finally almost entirely gone away. Are there any head attachments one that you've seen good success with?

As far as how I slept, I still woke up several times but until the end it was pretty decent. I'd say I slept from about midnight until 3ish am before I woke up once and then the last bit of it from maybe 5 am to 7 am I mostly toss and turned waking up and falling back asleep several times. That's usually the pattern, I can sleep 2-3 hours solid but then from there on out It's usually tossing and turning.

I feel decent so far honestly, I usually wake up feeling kind of a sick/groggy/hungover type way for the first 20 minutes every day of my life the past 5+ years. It was maybe a little better this morning.

What do you think about this chart? Any other suggestions on tweaks to try?


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#8
RE: Need some help/advice - here's my symptoms and machine settings
Very nice to see this improvement. Dave gave you good advice! I'd recommend sticking with these settings for a while longer. As Dave suggested, you may want to raise your minimum a little down the road. You may also want to re-introduce EPR gradually -- but not now. Feel free to post more charts to this thread.

You might take a look at hose stands, aka hose lifts. They will get your hose out of your way even if it originates near your mouth. The Hose Buddy is very sturdy; the Houdini swivels especially well but is prone to breaking. There are others out there. (I'm using a Houdini modified by my husband. If you ever try one and it breaks, let me know and I'll show you the fix.)

As Dave said, people feel improvement differently. A lucky few will spring out of bed after their first night feeling great. But for most of us, improvement comes gradually, in fits and starts, over a period of time that may be measured in weeks rather than days. Patience is the key, along with a willingness to experiment and problem-solve.

Do you mostly breathe through your nose during the day? If so, a nasal pillow mask might be an option. Something to tuck away in the back of your mind.
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#9
RE: Need some help/advice - here's my symptoms and machine settings
I do mostly breathe through my nose and as far as I know I mostly breathe through my nose while I sleep. There are a few times I breathe through the mouth at night which is why I thought I originally should try that but maybe I should of tried nose first. The Dr was not helpful in helping me decide and just said do whatever.  My friend has a Dreamwisp which is just a nose mask but the tube is at the top.  I considered trying that but wasn't sure if it would still be helpful if I did breathe through my mouth at times at night.  I know on my right nostril I do have enlarged turbonites so the pathway on my right nostril isn't 100% full but it's close / can still breathe fine.  I usually don't ever get sick / have allergies so they are usually fine.

Based on the chart today, did the leak it showed seem like a problem?  I'm not really sure on what normal is supposed to be.

At least for a while I'll plan to leave the EPR off.  The decision will be all about the mask.  I do have 30 days to swap it out for something else so my option is either stick with this mask, find another full face mask or try the nose only mask or pillow mask as you suggested.  Any advice on what you would do mask wise knowing my info?

I really appreciate all the advice you guys provide and for free.
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#10
RE: Need some help/advice - here's my symptoms and machine settings
You wouldn't do very well with a nasal mask if you breathed through your mouth for part of the night. And on this more recent chart, your leaks, while substantial, are not so large as to interfere with your treatment. If the leaks aren't waking you up, and if they stay at this level or better, then you can put the issue on your back burner.

All that said, if you think of a way to try a nasal mask, do go ahead and see how it works. Would your insurance allow you to try a nasal mask and, if it doesn't work, trade it back in for a FFM? Or, if your budget allowed and you had a copy of your prescription, you could try an online supplier who offers free mask trials. You pay for the mask; if it doesn't work for you, you pay the shipping to send it back to them but then they'll provide you with a different mask, if it's not more expensive the first one.
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