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New to treatment, need help with settings
#1
New to treatment, need help with settings
I'm a former smoker who smoked for 33 years and averaged between 2-3 packs a day. I quit 15 years ago. I've also beend diagnosed with COPD and adult ADHD benign hyperactivity disorder. I have been recently diagnosed with severe sleep apena as a result of a sleep study done earleir in the year. In the sleep study results it said I stopped breathing 30 times in an hour and that I responded well at a pressure of 11 cmH20.  

I just picked up my iBreeze 20A last month. It was configured to run in CPAP mode with a pressure of 6 cmH20. I saw the prescribing physician last week for my one month review. They weren't able to download my settings/uage logs so we talked about what the settings on the machine were and what my initial experiences have been. When I told him what my settings were and what i was experiencing he said my settings on my machine were all wrong. He told me switch the machine to run in APAP mode but didn't give me any values for Pmin and Pmax. When I switched the machine over to APAP mode the machine was set with a Pmin of 4 cmH20 and a Pmax of 12 cm H20. 

What I am currently experiencing
I've gotten up at 4AM every day for last 35+ years. I normally got between 4-5 hours of sleep a night. I usually fall asleep fiarly quickly, within 20-25 minutes of going to bed and I am usually wide awake when I get up at 4AM. Since starting CPAP treatment I am finding that I am feeling more tired/sleepy during the first part of the day than when I went to sleep the night before. By this I mean I am constantly yawning and I feel like I could go back to bed from 4AM until about 8AM. I am yawning until about 10AM. I am noticing focus issues, like my ADHD meds aren't effective but I am attributing this to the decreased quality of sleep. So I am not really seeing any improvement in the quality of my sleep.

I don't know if it matters, but I am not able to leave my machine plugged in during the day while I am at work as our dog likes to chew on platic things and since she is a super chewer, I don't want to risk her chewing on the machine itself, much less the tube or cord.

What my current Settings are 
Machine: Resvent iBreeze 20A
IPR: Off 
Ramp Time: 0
Pmin: 8 cmH20
Pmax: 15cmH20
Humidifier: 6 (8 is max, water runs down my face when set to 7 & 8. I get the occasional nosebleed at 4-5) 
Auto On: On
Auto Off: Not Set
Preheat: Not set
Mask Type: Nasal Pillow
Tube: 15cm

Reviewing my results for the last week 
AHI: between 8-15 (average is 8.6)
4.6 hours of sleep.

What my questions are:
  1. Is it common for for someone with adult ADHD to experience focus issues after first starting CPAP treatment?
  2. Should IPR be turned on? If so, should I set it to 1,2, or 3?
  3. Since my sleep study results say I responded well at 11 cmH20 what should my Pmin and Pmax be set to?
  4. Are these settings more or less "set it and forget it" or will they need to be changed over time or with the seasons (slight pollen allergy)?
  5. The results I see on screen really don't tell me a lot, and I can't seem to download/use the Resmed app from Google play for my android phone. Is there something else I can use to see what kind of results my machine is sending via wifi?
  6. What kinds of things should I be looking for in the results to tell me if what the machine is doing is working?
Any help / guidance is greatly appreciated.
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#2
RE: New to treatment, need help with settings
You need a bit of differential pressure, Turn IPR on to a mid value (2?) and try that.
do you feel starved for air or have ANY difficulty breathing with your CPAP? Be detailed and specific! Saying I feel fine means you are not in need of any adjustments.
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#3
RE: New to treatment, need help with settings
I think so. At least once durig the night I do find myself waking up to take a large deep breath or two through my mouth and the I am able to go back to sleep. I also noticed that I almost always take a couple of really deep breaths first thing in the morning after taking the nasal pillow head band off. The machine isn't making any kind of noise or anything overnight to indicate mask leakage so I don't know if that is the problem or if the machine I have can alert me to it if it is the problem. 

Mask Fit
Since switching to APAP mode the details I see in the morning when I stop my machine shows my mask fit switching between 1-2 stars out of three. I run the mask fit function every nght when putting the nasal pillow head band on to make sure I have it on correctly before starting the machine for the night. I am also noticing that the inside of my nose is sore on the left side near where the cartiledge inside the nostril meets the face, and my nose is running a lot for like the first 30 minutes after taking the nasal pillow head band off in the morning. 

Nosebleeds
I am not usually prone to nosebleeds, and rarely if ever get one, but I had another nosebleed this morning about 20 minutes after taking the nasal pillow mask off. That makes three nosebleeds in the six weeks I have been using the machine. All on the left side of my nose. I had one the first week on the machine when I wasn't using the humidifier. One the second week I was using the humidifier but prior to turning the humidity up to it's current settig of 6. This is the first one since turning the humidity up to 6 out of 8. Each one lasted about 5 minutes, but stopped with pressure applied keeping my head tilted back.
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#4
RE: New to treatment, need help with settings
I haven't had any luck getting my SD card for my iBreeze to load into OSCAR Sad . I did find the iMatrix software though and have managed to make a few screen shots of the details but I am not sure what they are telling me yet. I still have a lot of catch up reading to do.

The machine says my AHI is low,1.7 last night, but I am always waking up tired and feeling kind of tight in the chest like I had to work to exhale against the pressure. I did turn IPR on last night and set that 3 initially.

I generally tend to initially sleep on my side, but throughout the night I tend to alternate between that and sleeping on my back. Not sure how much that affects anything you see in the graphs. What should I pay the most attention to right now, starting out?

           
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#5
RE: New to treatment, need help with settings
OSCAR does not currently support the iBreeze machines.
Useful links
Download OSCAR (current version is 1.4.0)
Best way to organize charts
How to attach charts to your post

Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#6
RE: New to treatment, need help with settings
Can you zoom in on those charts also post events chart
Remember: when you change your setting it takes time for your body to adjust
Also you have mask leak or mouth leak as your using nasal mask
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#7
RE: New to treatment, need help with settings
I don't see where iMatrix software lets me export zoomed charts. It does let me export a report, but that only has summary data on it and not detail data.
This chart and event graph are from last night.
       
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#8
RE: New to treatment, need help with settings
(07-14-2022, 08:50 AM)jallen Wrote: I don't see where iMatrix software lets me export zoomed charts. It does let me export a report, but that only has summary data on it and not detail data.
This chart and event graph are from last night.

there is a view tab in upper left corner of graph/daily draw down the menu select 5-15 min rather than 5hrs it will zoom in
your leak are all over the charts even reaching 100-120 l/min try to control the leakage
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