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New to CPAP (~2 months), still struggling
#1
New to CPAP (~2 months), still struggling
       
Hi All -

I first want to thank all those that spend their time in trying to make a positive difference in other peoples lives!

I found out about this forum through Reddit, and figured I'd give it a shot.

Background:
I'm a 29 year old male living in New York. Early last year, I started having problems with my sleep where I would wake up from it gasping for air. Almost like I haven't taken a breath for a long time, and at times I would wake up with headaches. After a few episodes of this, I took myself to an ENT in March 2019, he thought that he saw signs of silent acid reflux causing acid to push up and clog by tubes at night. He asked me to follow a diet and take some omeprazole for about a month. I followed that and started having amazing sleep, although I can't attribute it all to that. I was also taking probiotics, sleeping with a humidifier on, raised the side my bed where my head lays by 6" during that time... Anyway, I hadn't had an episode for a long time until it came up again later around November, and again in January. I thought maybe it had to do with drinking, because I picked up a pattern that I seem to run in to these episodes the night or the night after drinking. We get into quarantine with covid19, I didn't have a drink for a while, and I started getting these episodes more and more through April and May. So i scheduled an appointment with a sleep doctor, he order a at-home sleep study test. And it was perfect because I had an episode of not falling asleep the night of the test. Turns out that I have mild to moderate sleep obstructive apnea. Some details below:



Code:
pAHI(4%): 3 per hour
REM pAHI(4%): 0.8 per hour
pAHIc(4%): 1.6 per hour
%CSR: 0%
pRDI: 17.6 per hour
Lowest O2 saturation: 92%
Supine pRDI: 16.3 per hour
Non0supine pRDI: 19.8 per hour


CPAP Therapy:
As mentioned in the title, I've been on ACPAP for almost 2 months now (with some gaps inbetween).
My doctor order me the Philips Respironics DreamStation Auto CPAP Machine, along with Philips Respironics DreamWear FullFace mask. I had use that for 21 days straights, but I was having too many issues with it. Felt like I couldn't get a good breath with it, wasn't able to line up the nose opening slit with my nostril. It felt off. Then my doc suggested I try the ResMed AitFit N20 that I'm currently using. Initially I was using it in a size medium, and I immediately felt a difference in terns of air flow through my nose. However when sleeping with it for a few days, I felt that I was really only breathing out of 1 nostril. The size felt too small, and it seemed to pinch in the left of my nostril. I then order a size Large online a few days later, and that appears to be working out better. Fits more comfortably, receiving good air flow through bots nostrils (i think). I still seem to be having some issues with sleep, which is why I'm here. I feel like I wake up a decent amount of night, whether it's adjusting my mask, or to get a good few breaths in without it. Last night, I woke up and my nose felt completely shut. I was not getting any air in through my nose, and realized I had trouble inhaling through my nose. My nose wasn't stuffy, but it just felt extremely dry and closed up. Also please note that I sleep with a humidifier and heating tube (heating tube at highest setting 5, moisture setting at highest setting 5 also) .So I woke up for a bit, and then went back to sleep there after. I'm not sure what caused this, but perhaps my data might paint you guys a better picture.

So my questions:
1. Why did my nose close up last night?
2. Are there any supplements I can take to help with moisture since the humidifier doesn't seem to help, or maybe I'm not using it right?
3. Should I try a new mask?
4. Do I need a chinstrap?

Please let me know if any more information is needed, thanks for the help in advance!

Adding a couple more screenshots I took of my 'Overview'


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#2
RE: New to CPAP (~2 months), still struggling
Welcome to the AB forum Goose.

You have 2 basic problems, the solutions which are diametrically opposed.  we need to find a balance between the two.
 
1. Central Apnea. 3.68 CAI.  The solutions are 
    a. reduce pressure
    b. reduce/eliminate flex
    c. reduce pressure fluctuations
    d. Reduce PS (doesn't apply to PR CPAPs)
2. Flow Limitations/RERAs. RERAs are a series of flow limitations ending in Arousal. The solutions are
    a. increase pressure
    b. increase PS  (doesn't apply to PR CPAPs)


So.
Set min press=8 (4 is just too low, especially with a PR machine.) Improve comfort and apply increased pressure to treat OA, H, Flow Limits, and RERAs
Turn Flex Off to reduce your CAI.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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 to CPAP (~2 months), still struggling
(08-15-2020, 08:10 PM)bonjour Wrote: Welcome to the AB forum Goose.

You have 2 basic problems, the solutions which are diametrically opposed.  we need to find a balance between the two.
 
1. Central Apnea. 3.68 CAI.  The solutions are 
    a. reduce pressure
    b. reduce/eliminate flex
    c. reduce pressure fluctuations
    d. Reduce PS (doesn't apply to PR CPAPs)
2. Flow Limitations/RERAs. RERAs are a series of flow limitations ending in Arousal. The solutions are
    a. increase pressure
    b. increase PS  (doesn't apply to PR CPAPs)


So.
Set min press=8 (4 is just too low, especially with a PR machine.) Improve comfort and apply increased pressure to treat OA, H, Flow Limits, and RERAs
Turn Flex Off to reduce your CAI.

Thank you, sir. Adjustments are made.
I'll post more OSCAR screenshots tomorrow!
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#4
RE: New to CPAP (~2 months), still struggling
I woke up a few times last night, although I don't remember why.
Screenshots from last night's sleep, ignore the events prior 1:30AM.

Edit - Can't attach 3rd screenshot due to reaching attachment quota.


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#5
RE: New to CPAP (~2 months), still struggling
Goose, all we need is the first page, if we need more we will ask. If you are asking about an issue you see on another chart go ahead.
Your pressure is too low.
Set min Pressure =8 Then let's see where you are at.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#6
RE: New to CPAP (~2 months), still struggling
(08-16-2020, 10:06 AM)bonjour Wrote: Goose, all we need is the first page, if we need more we will ask.  If you are asking about an issue you see on another chart go ahead.
Your pressure is too low.
Set min Pressure =8  Then let's see where you are at.

Got it.
I did set the min pressure to 8 last night, and I just confirmed that it is still 8.
Not sure why it still says 4 on OSCAR.
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#7
RE: New to CPAP (~2 months), still struggling
Likely it was the brief session on the left.

Set min = 9 to night.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#8
RE: New to CPAP (~2 months), still struggling
Lousy sleep last night. I was constantly woken up to air leaks from the mask,. I've never had the pressure go this high before (in the 15-17 range). So I kept tightening frame, which helped. But after a while I started to get headache (I guess from tightening?), so I would loosen the frame up for some relief. I would also just stop and start it again so that the pressure goes back down to 9. Rinse and repeat. Then I eventually took the mask off at 4AM and put it back on around 5:20AM.

I was also waking up because I would feel my open up a bit, causing the air flow rushing out of my mouth while making noise.

What do you suggest? Cap the max pressure at maybe 14,15? Buy a chinstrap so that my mouth doesn't open up at night?

Edit - Also I did change the min pressure to 9 despite screenshot showing 8.


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#9
RE: New to CPAP (~2 months), still struggling
here is what we've got Goose.  
Centrals reduced with the flex, not as much as I hoped but they dropped
Obstructives are up, mostly due to a chin tuck that wasn't there before. This drove your pressure up.
Since you haven't had this before I don't want to just have you jump in and add something else to your night. If you have a collar feel free to wear it, otherwise let's just watch for it.

Set your Max pressure to 14.  At this point I see no reason to go higher than that.

Every PR APAP/CPAP will be a problem for you.  Your only tool for OA, H, FL, RERA, and even UARS, with these PR machines, can ONLY be treated with pressure increases and you are running into mask issues with the pressures, not a surprise.  Be sure to fit your mask at pressure and lying down, relaxed.  Review the manufactures mask fitting video.

My choice would have been to start you on a ResMed AutoSet, it gives us more options.  Make sure your next machine is a ResMed!

You are currently failing CPAP, have you talked to your doc about this?  If not do so and frequently.  This is to establish the fact that your DS is not working for you.  When he agrees, the fix is a BiLevel, and your opportunity to get a ResMed VAuto.  A BiLevel has Pressure Sup[port the ability to offer a different Exhale and inhale pressure, EPAP and IPAP.  This difference, which your DS is not capable of, is the best method of treating hypopnea, Flow Limits, and RERAs that you have.

The other option is ASV. The ROT with ASV is to beat obstructive events and demonstrate that you still have a Central issue.  You are 2+ months in and you still have an issue with central apneas.  I tried to defeat them but could not, but 2-3 months is the time it takes for some treatment-Emergent Central Apnease to resolve and go away. Well, it's not happening.  ASV is the only machine that is actually designed to treat Central Apneas.  It is a definite possibility that you will eventually end up there.

I would like to see a couple of 2-minute views of your central apnea, but not last night, too much stuff happening around them.  I want to see what that waveform looks like.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#10
RE: New to CPAP (~2 months), still struggling
Thanks, bonjour.

I've just set up an appointment with my sleep doctor for this Thursday. I've had a couple of appointments with his assistant, but the conversation was geared more towards mask fits/sizing. I was not diagnosed with central sleep apnea, only obstructive. I'll see what I can do with getting a new machine since my apnea appears to be more central than obstructive, or both.

Attached a couple of 2-min screenshots of CAs from Saturday night.


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