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New CPAP user with low PS..
#1
New CPAP user with low PS..
Hi there and thank you SO MUCH to everyone on this forum helping out.

I was diagnosed with OSA and prescribed CPAP after taking a home sleep study a few months back. My reported AHI was mild (5.2), but my doctor suggested that therapy was warranted given my presentation of symptoms. Never had a lab study for a more granular breakdown, but here's a redacted copy of the home study.
   

The last two weeks of getting acclimated to the machine (Resmed Autoset for Her) have been a bit of a roller coaster. After reading advice from this forum, I went ahead and bumped min pressure to 6 and EPR to 2 which vastly improved my feelings of comfort with the machine.

Finally, I was able to tolerate the mask for nearly 7 hours - I’ll attach that screenshot below. The problem here was that my partner observed me mouth-breathing (I’m using nasal pillows after a failed attempt with full-face), and I woke up with a dry mouth, sore throat, and fatigue. I also seemed to register a fair number of central apneas and leaks throughout the night.
   

The last two nights I tried to remedy my leak problem through mouth taping, but I have only been able to make it a couple of hours with this setup. Both nights I’ve woken up feeling suffocated and slightly dizzy and have removed the device. One night registered worse for central apneas and leaks, but here's last night where the graphs looked very clear.
   

I’m not sure where to go from here. I considered raising min pressure to 7 because that's the advice that I typically see, but noticed that my autoset pressure has not once hit 7. Conversely, because this worked outside of the mouth-taping scenario it seems possible that the pressure is too high. In scouring many other posts on this forum, I haven’t come across another profile where the pressure remains so low for the entire session, and I don’t really know what to make of that. My home sleep study only registered one obstructive apnea event, and I’m starting to question my diagnosis and treatment plan altogether. 

Any ideas on where to go next? Are there other things I should be considering given my home sleep study results? Doc basically just gave me my AHI # and some generic settings. I had to call the clinic just to get the detailed report.
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#2
RE: New CPAP user with low PS..
Take your min pressure to 7, if that doesn't work, to 8. Your numbers don't call for it but your comfort does.
Read the Mask Primer section on mouth breathing. Read the tongue technique. That is the long term goal.
Obviously your jaw is dropping. We want it to stay up. Try a soft cervical collar, and I hate adding additional stuff to wear, but in addition to it's therapeutic benefits it adds and you don't need it holds the jaw up as a side effect. I think it will help you.
The purpose of taping is not to seal air in, but to remind you to keep the chin up.keep that in mind.

Let us know how it goes.
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#3
RE: New CPAP user with low PS..
Thanks so much for the response, Gideon. Do you recommend bumping up the ESR to keep the EPAP the same, or leaving it at 2? 

I'll read the mask primer section as you suggest, I definitely had a misconception around the purpose of taping Smile
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#4
RE: New CPAP user with low PS..
Just a note: your sleep study showed quite a few hypopneas and movements. While your O2 levels were good, your study also showed a fair number of desats (drops of 3% or 4%, depending on the measure used). If you're fully or partially waking up on average 5 times an hour, that means you're not getting a good night's sleep.

I'm struck by how much better you did on your right side than on your left, where you spent almost half your time. Is that a pattern for you?

I don't have the expertise to size all this up, except to say your sleep on the night of the test was certainly disrupted. I think it is well worth your while to try solving problems with PAP, given your presenting symptoms. Do try taking Gideon's advice.

You might ask your bed partner whether he or she observes you frequently moving your legs about during the night. I'm curious whether restless leg syndrome or periodic limb movements might be a part of the picture. Maybe you just toss and turn a lot.

One final thought. Do try the collar to see how that works for you. It is a game-changer for a lot of people. But if it doesn't do the trick, you can try again with tape once you get more comfortable with treatment.
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#5
RE: New CPAP user with low PS..
Here as evidenced by your chart EPAP is not an issue so don't worry about it. If it becomes an issue, and that is possible, we will simply adjust at that time.

In General, I favor higher EPR (3) as that manages a number of things. BUT I am not in favor of altering something that seems to be working well without due cause. I am not against a trial of EPR=3 to see if it feels better.
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#6
RE: New CPAP user with low PS..
Thank you so much for that observations. Yes, I do tend to toss around in bed quite a lot. I was sort of surprised to see that I'd spent 16% of my time during the sleep study on my right side. It was my understanding that I sleep exclusively on my left side and back, although sometimes I switch to my right side to get comfortable before switching back. Maybe I am sleeping on my right side though... I was restless on the night of the sleep study, but I don't imagine that explains all of the time.

The criteria for RLS never really resonated with me, but perhaps there's something there that I should consider again. I do have bouts of insomnia during the night, and I know that I switch positions when I have anxiety about being unable to sleep. I also have an autoimmune condition that causes pain and inflammation in my spine (especially the upper spine region), so that may be a contributing factor in my tossing & turning as well, although that's been more effectively managed over the years. 

I will definitely look into the cervical collar. Thanks again for your advice.

I'll stick with the ESR settings for now, and circle back if it presents a problem for me tonight. Thanks!
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#7
RE: New CPAP user with low PS..
I'm just a plain user, not an expert. Given that, I second Gideon's advice regarding the tongue trick. It took a long time (and I mean a looong time) for me to learn it but it was definitely worthwhile. It does a great job on curing mouth breathing. Give it a try and don't expect overnight success -- but keep at it.
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