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New machine and I feel like crap
#1
Hi all! I've been reading this forum for a few months but this is my first post. 

I'm not new to apnea (first diagnosed Feb 2013 with an "at home" sleep study of AHI = 36) and have been using a ResMed S9 Auto CPAP since. When I first started using the cpap I found that I felt way more rested than I had in years and pretty much settled in to using it every night (even when camping.) My AHI's averaged around 4-6 but I often had warnings of high leak rates. 

Fast forward 5 or so years and I talked my Dr into writing a prescription for an upgraded machine. After the wranglings with the insurance company I ended up with the ResMed AirSense 10 Auto and the ResMed Airtouch F20 mask. My visit with the DME revealed that I had been experiencing leak rates with the old system of 40-80 l/min nearly all the time, but "not bad" for AHI. She sent a recommendation to my Dr that I get another sleep study to review the possibility of being treated with a Bi level system...This hasn't happened yet. In the mean time, I've started using the new machine.

My first night had a huge leak rate (79 liters/min) but after that I settled in with the F20 and have been getting great numbers with regards to mask fit. My problem has been with the increase in AHI's and the fact that I wake up feeling like I'd been run over by a bus and frankly not truly waking up until after lunch.

Both systems were set at APAP, Min: 5 Max 20. The difference is that the S9 had EPR turned off. The AirSense 10 has EPR On with a setting of 3.

Comparing my old numbers in SleepyHead with my new system numbers I see that with the old one I was in apnea events much longer through the night but not as often. The new machine has nearly 75% more events but I'm in them for a much shorter time.

I'm not an expert and that's why I'm asking here, but my guess is that when the EPR cycles to exhalation I'm dropping down below the point where the pressure can keep my airway open.

Here are some of my screen shots. Thanks in advance for any advise 

   

   
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#2
I agree your end-point may be bilevel, but your immediate need is a soft cervical collar to keep your head and neck aligned. This is going to help with leaks, but more to the point, prevent the chin-tucking that is blocking your airway, even at the maximum pressure of 20. Lots of members use it, and you might be next. You're looking for a comfortable in a soft collar that is 2-1/2 inches tall under the chin to 3-inches and prevents the positional apnea problem.
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#3
Welcome to the forum.
As you know, your treatment is very bad. Now that you are using EPR=3, your EPAP is lower. Since you are used to having it off, turn it off as the higher EPAP will help you.
You also need to set your minimum pressure higher. Keep the floor close to where the need is. I would start with 12. The key to effective PAP is to prevent events, instead of chasing after them.
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#4
Thanks for the replies! I have a soft collar on order from Amazon and hope to see it in the next few days. I bumped up my min pressure last night to 8 but woke up this morning with a report from MyAir saying leak rate of 14 liters/min (good) but an AHI of 16.7....and yes, I feel like something straight out of Walking Dead.

Tedvpap, I think you're right. I've used an APAP for over 5 years without EPR with no issues, no reason I have to have it now. I have found that breathing is way more comfortable with EPR, but with this systems maxed at 20 most of the night I just can't afford to have it drop down to 17 for exhalation. 

Since I'm still in a stupid "compliance period" I'm going to call my DME and let her know I'm turning off EPR. That totally blew me away...I have CPAP data showing 100% compliance for over 5 years but the insurance company still want's it for 12 months with the new machine.

On another note: My last mask was a Quatro FX and I used it for over 5 years without many issues...other than some leak issues. The new ResMed SoftTouch F20....wow, that thing is so comfortable and I'm able to keep leaks at a bare minimum without latching it down super tight. I just hope that foam holds up...time will tell.
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#5
I am the type who would make a reasoned and formal objection to the requirement for compliance with your history.  I would put it in writing and send it registered.  Your problem isn't compliance but adjustment to a new device...unless they are prepared to require you to continue with the same dated machine and can find a new one for you in defiance of a prescription by a qualified medical professional.  If they tell you to blow it out your ring piece, you initiate a class action because you'd not be the only person 'served' that way by the company.

Perhaps, though, it's just easier to actually comply while making the necessary transition to the new device?  Sleep-well
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#6
While I was home for lunch I pulled the data from last night's sleep into SleepyHead. 16.7 AHI. Large Leak was 1.06%.....All of the events occurred in 3 clusters the worst being 4 min after waking at 3:40 this morning for a BR trip.


I have a soft collar on order, but I'm going to go buy one from Walgreens right after work. I'm betting that's much of my problem.
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#7
Once you get started with the collar, I think EPR should not be important. If it is comfortable, then use it. If your obstructive apnea cannot be controlled at 20 cm with EPR at 3, then a bilevel machine is really necessary since they can achieve higher therapy pressures. A general guideline is that if a person titrated over 15 cm, insurance will usually reimburse for bilevel as medically necessary.
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#8
Sleeprider Wrote:Once you get started with the collar, I think EPR should not be important. If it is comfortable, then use it.  If your obstructive apnea cannot be controlled at 20 cm with EPR at 3, then a bilevel machine is really necessary since they can achieve higher therapy pressures.  A general guideline is that if a person titrated over 15 cm, insurance will usually reimburse for bilevel as medically necessary.

Thanks Sleeprider...and thanks for the advise on the collar!

I bought one yesterday from Walgreens and wore it last night. From the point of putting it and my mask on and laying down I could tell that I was in a drastically different position than I'm normally in. While the collar felt a little too big (in height) I wore it all night. Woke up this morning feeling pretty good. The AirSense data shows AHI = 3.2 and leak rate = 0 (ZERO)!!! That is the first night in over 5 years of cpap that I've not had a pretty high leak rate.

When I go home for lunch I'll pull the data into SleepyHead and get some more details on what type of events I had
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#9
(05-25-2018, 09:23 AM)Snore of Thunder Wrote: <snip>
I bought one yesterday ... felt a little too big (in height) I wore it all night. Woke up this morning feeling pretty good. The AirSense data shows AHI = 3.2 and leak rate = 0 (ZERO)!!! That is the first night in over 5 years of cpap that I've not had a pretty high leak rate.
...

Wow!  Congrats, and thanks for the inspiration (I was toying with the idea); I'm not going to wait for delivery, I'm going to try the local chain pharmacies and try to sleep with it on tonight.
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#10
(05-25-2018, 09:23 AM)Snore of Thunder Wrote: Woke up this morning feeling pretty good. The AirSense data shows AHI = 3.2 and leak rate = 0 (ZERO)!!! That is the first night in over 5 years of cpap that I've not had a pretty high leak rate.

That's good progress! Pretty soon you'll be able to say "New machine and I feel like CPAP", which is how it should be.
"I wanted to be a Boy Scout, but I had all the wrong qualities.  They were looking for kids who were trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent.  Whereas I tended to be devious, fickle, obstructive, hostile, rude, mean, defiant, glum, extravagant, cowardly, dirty, and sacrilegious."  (George Carlin)
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