New CPAP User ready to quit - Central Apnea, ASV

[tntfrahm]

[attachment=16498][attachment=16498]Good morning.  I am new here and have been using CPAP for the past two weeks.  Using the Resmed Airsense 10. They have changed my mask three times.  I have used the Mirage FX, the F20 and am now using the F30.  I am getting the worst sleep of my life.  I am keeping the mask on for 5-6 hours a night but (despite the smiley face) I am getting large leaks at the mask (25-31L) and my AHI has not come down.  Any ideas would be appreciated.  I have attached a screenshot from last night.  Hoping this is the right location for this post. Thanks!

[Lhart]

I would suggest trying a size smaller on the mask if you have tightened the straps as far as possible. It will take awhile to get used to, don't give up. It has changed my life for the better. I went through 4 masks before finding the right one that worked for me.

[Sleeprider]

tnt, you are experiencing mostly central apnea events. This may be treatment emergent central apnea or you may have had some centrals during your diagnostic sleep test. This is a pretty difficult problem because it will take some time to work out whether this problem can be resolved through adjustments on your current Resmed Airsense 10 autoset, or if you might require an advanced positive pressure machine like ASV (adaptive servo ventilation).

If you're open to trying some new strategies, I'd like to take you back to a fixed pressure of 6.0 with EPR set to OFF. The objective of this is to eliminate the central apnea as much as possible and possibly help with leaks, then see if there is a residual obstructive apnea component we need to work on. We can help you to get to the therapy you need, but with this much central apnea, it won't be the usual easy solution of just increasing pressure, and will take some patience on your part.

[DeepBreathing]

Hi tntfrahm. Welcome to Apnea Board.

Following on from SleepRider it's important to know if those central apneas were occurring before you started APAP therapy. Did they show up in your diagnostic sleep study? Could you post a copy of the study report, please - make sure to include the charts and tables, not just the summary. Also, make sure to erase your full name, date of birth and other identifying information.

[tntfrahm]

Thank you!  Between the lack of input from my doctor and the equipment provider, it feels like no one is “driving the ship.”

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Thank you!  Between the lack of input from my doctor and the equipment provider, it feels like no one is “driving the ship.”

[tntfrahm]

When I “run mask fit” it shows the frowning face.  When I wake up in the morning it’s smiley faces all around despite these numbers. So frustrating!

[Sleeprider]

You are apparently using a full face mask. Have you ever tried nasal pillows or a nasal only mask. I ask because the fit is so much easier, as long as you don't breathe through your mouth. The central events may be real or not. We have seen similar charts clear up when leaks are resolved, so we want to pay equal attention to both issues.

[SarcasticDave94]

Welcome to the Apnea Board tntfrahm. My take is that the leak smiley and frowny faces are there to taunt us and not help. I've only found that machine leak test to be vaguely helpful, as in it can tell that I've gotten to the ballpark but it didn't know where in that park I'm located. That's where OSCAR data comes to help. It presents leaks as a graph over your sleep session.

Try what Sleeprider and DeepBreathing suggest and include setting up OSCAR with data from an SD card. If you don't have one for your APAP get a standard SD card between 2-32 GB, any brand will do. Shop for that size with least expensive in mind. Alternately your DME might provide you with one, your choice on if you want to go that direction. OSCAR is free and located in the top banner for download.

Also keep working on mask fit and adjustments. You may need to change cushion sizes or mask type and model. Keep in mind going extremely tight isn't the right answer. Also note that changing sleep positions can move a mask while sleeping. Keep at it and work on the data and we'll help get it going in the right direction.

[Melman]

unfortunately, most of us need to "drive are own ship". We're here to help you. Mask leaks can be frustrating to deal with. You may find some helpful information in the mask primer (see link below). In the meantime, it is important that you follow Sleeprider's and DB's suggestions.

[tntfrahm]

This is the sleep study.  I don't see central sleep apneas on it.