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New to this - Need help
#1
New to this - Need help
I had an in-home sleep study and the result showed an AHI of 12.4.
About 2 weeks ago, I got a ResMed Airsense 10 for Her (I am male, but it was cheaper and they said they set it up as the regular ResMed), with the climate tube and Dreamwear mask with nasal cushion.
They gave me two sizes of cushions, a M and a MW. The APAP was set with pressure 4 to 20, with ramp starting at 4 and time auto. EPR was off.
In the first few days I felt more comfortable with the wide cushion, but was getting lots of leaks and then the machine would increase the pressure and become very uncomfortable. I was waking up several times during the night and in the morning I would feel more tired than before using the machine, even though my AHI had dropped to less than 2.0.
Reading comments here, I started experimenting and tweaking it. I turned EPR to 2, what made a huge difference. I also changed the machine response to soft. I tried to turn off ramp, but it felt more uncomfortable, so I put it back. Based on my reading on OSCAR, I conservatively increased the starting pressure to 5. 
However, I was still experiencing several leaks. I then decided to give the M cushion another try and adjusted the mask so that it would not be too tight. That apparently did the trick, as my last 3 nights have been much better.
However, in spite of having an excellent AHI now (see the charts), it seems that there still leaks happening and I am not sure how to determine if it is through the mask or through the mouth.
I am posting here the charts of my last 3 nights, hoping that someone could make sense of what is happening and could provide me with some suggestions.
Please note that on the second night (Sat Feb 6), we had a huge thunderstorm here, what disrupted my sleep.
Thank you!

           
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#2
RE: New to this - Need help
You have been doing your research and there is not much that will improve on those results. The minimum pressure the machine can produce is 4.0, so when you have EPR on a setting of 2, the logical minimum pressure is 6.0. With EPR at 3, you need a minimum pressure of 7.0. That will produce a minimum pressure of 7.0/4.0 (inhale/exhale). If you are sensitive to pressure, an EPR setting of 2 with minimum pressure at 6.0 is probably good enough from what I see here. On most of your charts, your minimum exhale pressure never gets above 4 and you only get part of the EPR you have set, so I think a minimum pressure of 6 with EPR 2 will be the most responsive and comfortable settings.
Sleeprider
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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 to this - Need help
You have min of 5 and EPR at 3 (exhale pressure relief). What EPR does is lower the min by 1 to 3 depending on your settings. The problem with the way you have this set is 4 is as lowly as it can go. So your EPR of 3 can’t happen. Raise your min to at least 7 then with your EPR at 3 your min exhale would be 4.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: New to this - Need help
Thank you both for the suggestions. I will give it a shot.
Regarding the leaks, based on the charts, is there any way to tell if they are mask leaks or mouth leaks?
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#5
RE: New to this - Need help
Your leaks appear to be mainly momentary seal leaks as indicated by the spikes that come and go quickly. A mouth leak tends to be a leak that rises to a moderate level, at or below the large leak line and stays flat until you arouse and correct the leak. An example below at 04:15. Your leak rate is quite acceptable.

[Image: attachment.php?aid=29760]
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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#6
RE: New to this - Need help
As sleeprider says your leaks are low and nothing to worry about unless they disturb your sleep well done
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#7
RE: New to this - Need help
Thanks again to all who responded. I changed the minimum pressure to 6 with EPR 2. Seems to be working really well - the AHI dropped even more. However, I am facing a very odd issue and I cannot figure out why. Please refer to the charts of the last two nights. As you can see, on Feb 10 around 5:15am I woke up feeling a lot of pressure on the mask. Either the pressure woke me up, or because I woke up the pressure increased. No matter what, I cannot understand why the sudden increase of pressure. I checked the mask for leaks and there wasn't any (what the chart confirms) and continued trying to get back to sleep until 5:30am, when I gave up, turned the CPAP off and on to force the pressure to go down again. Then, later on it surged again but went down by itself. I don't remember if I was awaken at that time.
On Feb 11, the same happened around 4:40am. I kept trying to deal with it until 4:52am, when I gave up and turned the CPAP off and on.
Of course I could limit the maximum pressure, but before I made any changes, I would like to understand what is happening. Any ideas?

       
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#8
RE: New to this - Need help
In both cases, the increase in pressure is due to flow limitation increasing. I don't think the arousal is pressure but a RERA (respiratory effort related arousal). I'd like to increase minimum pressure to 7.0, EPR to 3 and maximum pressure to 11.0. Are you game?
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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#9
RE: New to this - Need help
(02-12-2021, 11:22 AM)Sleeprider Wrote: In both cases, the increase in pressure is due to flow limitation increasing. I don't think the arousal is pressure but a RERA (respiratory effort related arousal).  I'd like to increase minimum pressure to 7.0, EPR to 3 and maximum pressure to 11.0. Are you game?

Sure. I will try for a couple of nights and post here the results. Thanks!
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#10
RE: New to this - Need help
(02-12-2021, 11:22 AM)Sleeprider Wrote: In both cases, the increase in pressure is due to flow limitation increasing. I don't think the arousal is pressure but a RERA (respiratory effort related arousal).  I'd like to increase minimum pressure to 7.0, EPR to 3 and maximum pressure to 11.0. Are you game?

I don't think this helped: I am still waking up several times during the night and still see some increase in pressure that I cannot explain (see Feb 13 zoomed chart). Also, getting more leaks (may not be related).
I am also adding last night's (Feb 14) chart, just in case.

       
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