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New User - Optimization Help Please!
#1
New User - Optimization Help Please!
Hi!

Thanks in advance, and please let me know if I am missing any information. 

I was diagnosed back in February, after an annoying 3 months back and forth with insurance and the sleep care clinic.

I am a mid-20s male, 5'7", 145 pounds.

I have had issues with my sleep for as long as I can remember, but in college I would fall asleep every day in lecture. I would be sitting in the front row and snoring 5 feet in front of the instructor.

I've finally gotten insurance to be able to get a sleep study, and have been using the Resmed Airsense 10 Auto CPAP for about 5 months now. Initially I used the N30 mask, but have recently switched to the F30i SW cushion. I also use a Releaf neck brace. I am also taking Modafinil/Armodafinil almost daily. 

Some issues I've had lately: 
My skin get's irritated...my scalp from the mask, my neck from the Releaf pillow. Perhaps I just have super sensitive skin? Any suggestions?
I have been using the F30i for about three weeks, and finally feel comfortable wearing it for most of the night! I know other people suffer much longer before they get comfortable with it, so I am very grateful! The only issue I have right now is feeling a bit bloated/gastrointestinal discomfort. I'm not quite sure if it's because my CPAP is on too high? Or maybe I will just have to get used to this?
I have just recently inserted an SD card into my machine and downloaded OSCAR. The screenshots should be attached. Could someone help me optimize the settings?             

Screenshot 4:     

More generalized data, before I realized I should insert an SD card:     
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#2
RE: New User - Optimization Help Please!
At 6.0 to 12.0 pressure with EPR 2, your events are predominately CA. I'll just cut to the chase and suggest that you first turn off Ramp, you don't need it, and your breathing is really ragged during that time. I suggest a minimum pressure of 6.0 and maximum pressure of 8.0 with EPR at 1. This will potentially reduce the CA events and should be pretty easy to tolerate. I don't know why a collar is neeed for your therapy, I just don't see positional obstruction except perhaps back about May10 and 20. Your biggest problem with fatigue comes down to short fragmented therapy and lack of sleep. You need to work on sleep hygiene and maintaining an objective of at least 7 hours of sleep.

If you want to zoom into some 2-3 minute segments of your flow rate during sleep, that may reveal additional issues that help us get to a root cause. We may want to look into some Enhanced Expiratory Rebreathing Space (EERS) to increase tidal volume and improve the CA results if the reduction in EPR does not reduce events.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: New User - Optimization Help Please!
Welcome to the forum.

I assume that you are being treated for daytime sleepiness, correct?

Settings.
Ramp off, at these pressures you don't need it
Set min pressure = 6,  It should rarely be set lower than this, and usually higher.  This is IMHO the min adult setting, mos have issues breathing at inhale (IPAP) pressures lower than this
Set EPR = 0 or off.  This is an attempt to reduce your Centrals.  Since you already have a few months on your machine this may not work, but we need to try.

Your history shows consistently "high" Central Apneas.  I would like to see a couple of zoomed 5-minute shots of your central apneas to see the character of them.  I would also like to see a redacted, we don't need your personal info, copy of your full sleep study, including the art tables and charts, not just the summary.

Your Aerophagia, let's see if this helps it before we make more changes.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: New User - Optimization Help Please!
Hi Sam R Squared,
Welcome to Apnea Board!

Remember that the SD card must be in your Cpap the entire time you are sleeping, otherwise you may only see summary data.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: New User - Optimization Help Please!
(07-13-2020, 10:10 AM)Sleeprider Wrote: At 6.0 to 12.0 pressure with EPR 2, your events are predominately CA.  I'll just cut to the chase and suggest that you first turn off Ramp, you don't need it, and your breathing is really ragged during that time.  I suggest a minimum pressure of 6.0 and maximum pressure of 8.0 with EPR at 1.  This will potentially reduce the CA events and should be pretty easy to tolerate.  I don't know why a collar is neeed for your therapy, I just don't see positional obstruction except perhaps back about May10 and 20.  Your biggest problem with fatigue comes down to short fragmented therapy and lack of sleep.  You need to work on sleep hygiene and maintaining an objective of at least 7 hours of sleep.

If you want to zoom into some 2-3 minute segments of your flow rate during sleep, that may reveal additional issues that help us get to a root cause.  We may want to look into some Enhanced Expiratory Rebreathing Space (EERS) to increase tidal volume and improve the CA results if the reduction in EPR does not reduce events.
Hi, thank you for your suggestions! Yes, I plan on getting more sleep starting tonight! 
Would a sleep collar be detrimental? I've been using it for the past 3 weeks ever since I switched from my N20 to the F30i mask. My doctor suggested it and I think other than some itchy skin, I haven't had any trouble with it. I tried using just the F30i without the Releaf collar and woke up the next morning with my mask off, so I just thought maybe it is just another layer preventing me from removing my mask subconsciously throughout the night. 

Attached are the zoom ins! 
           
(07-13-2020, 10:21 AM)bonjour Wrote: Welcome to the forum.

I assume that you are being treated for daytime sleepiness, correct?

Settings.
Ramp off, at these pressures you don't need it
Set min pressure = 6,  It should rarely be set lower than this, and usually higher.  This is IMHO the min adult setting, mos have issues breathing at inhale (IPAP) pressures lower than this
Set EPR = 0 or off.  This is an attempt to reduce your Centrals.  Since you already have a few months on your machine this may not work, but we need to try.

Your history shows consistently "high" Central Apneas.  I would like to see a couple of zoomed 5-minute shots of your central apneas to see the character of them.  I would also like to see a redacted, we don't need your personal info, copy of your full sleep study, including the art tables and charts, not just the summary.

Your Aerophagia, let's see if this helps it before we make more changes.
Hi, thank you Smile Yes, I am being treated for daytime sleepiness. 
The sleep clinic I had my study at is very incompetent...so I have not received my full sleep study...I will contact them again to try to receive it.
I took an in-clinic sleep study and the results did not have any suggestions of sleep apnea or narcolepsy...and honestly I felt really good sleeping there that night. However, I thought it was a fluke so I had an at-home sleep study done a month later and was diagnosed with sleep apnea through this test. Would an at-home sleep study report be helpful still?

Here are some 5 minute snap shots of CAs.

           

(07-13-2020, 10:24 AM)OpalRose Wrote: Hi Sam R Squared,
Welcome to Apnea Board!

Remember that the SD card must be in your Cpap the entire time you are sleeping, otherwise you may only see summary data.
Hi! Thanks for the welcome Smile

Yeah, I wish I had put an SD card in from the beginning, but my DME company did not send me one Sad
Just grabbed an old SD card though and put it in last night. Thanks for the reminder!

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#6
RE: New User - Optimization Help Please!
In case you're wondering about sleep hygiene, you'll find the guidelines below. At first, I thought they were mickey mouse and didn't really apply to me; when I got desperate enough, I started using them and found out they actually helped.

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.
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#7
RE: New User - Optimization Help Please!
(07-13-2020, 10:48 AM)Dormeo Wrote: In case you're wondering about sleep hygiene, you'll find the guidelines below.  At first, I thought they were mickey mouse and didn't really apply to me; when I got desperate enough, I started using them and found out they actually helped.

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.
  • Thanks for these guidelines!
    I have blackout sheets on my windows, and lately I have been to lazy to put them up during the day. Would sunlight be an important upstream factor for sleep hygiene? Otherwise, I just keep my lamp on as I am working from home.
Also, I forgot to mention in my OP, but even with modafinil I will feel afternoon sleepiness around 12-2pm after I eat. 
I assume it's due to my lack of sleep, even with using the CPAP and Modafinil...so I hope that this gets better once I improve my sleep hygiene? 
I welcome any other thoughts on this matter!
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#8
RE: New User - Optimization Help Please!
Sunlight is quite important! Here's some good information:

https://www.sleepfoundation.org/bedroom-...-and-sleep

The links toward the bottom will give you more.

So yes, it'd be great if you could get some sunlight soon after you get up, and throughout the day. Probably the best thing you could do for that postprandial sleepiness is go outside and take a walk.
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#9
RE: New User - Optimization Help Please!
(07-13-2020, 10:10 AM)Sleeprider Wrote: At 6.0 to 12.0 pressure with EPR 2, your events are predominately CA.  I'll just cut to the chase and suggest that you first turn off Ramp, you don't need it, and your breathing is really ragged during that time.  I suggest a minimum pressure of 6.0 and maximum pressure of 8.0 with EPR at 1.  This will potentially reduce the CA events and should be pretty easy to tolerate.  I don't know why a collar is neeed for your therapy, I just don't see positional obstruction except perhaps back about May10 and 20.  Your biggest problem with fatigue comes down to short fragmented therapy and lack of sleep.  You need to work on sleep hygiene and maintaining an objective of at least 7 hours of sleep.

If you want to zoom into some 2-3 minute segments of your flow rate during sleep, that may reveal additional issues that help us get to a root cause.  We may want to look into some Enhanced Expiratory Rebreathing Space (EERS) to increase tidal volume and improve the CA results if the reduction in EPR does not reduce events.

Hi!

I removed my collar and adjusted my sleep settings as you have suggested. I mistakenly loosened my mask a bit too much (I had read on one of the wikis that the mask should not be tight on one's face, so I wanted to ensure that I wasn't doing it wrong...however, I think I could have made it tighter).

Attached are some of the screenshots of the events.            

Around ~8:35, I woke up and tightened my mask. I did not experience any leaks for the last hour of sleep that I got. 
However, I had a handful of Clear Airway events still.

           

Tonight I will make sure my mask is on well. However, should I change any of the settings? Or perhaps my body just has to get used to these newer settings?
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#10
RE: New User - Optimization Help Please!
The first 3-hours looks really clean and good, and fair after that. I think just continue with this and see how things go. There is nothing to suggest you need higher pressure unless you feel air-starved. There are no OA events and it looks like things went south after you tightened the mask. Maybe we can do without the mask pressure graph and show the leak graph. Also, on the leak graph, right-click the Y-axis and select the Y-Axis option and override the auto scale and set it to 0 to 80.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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