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New user, helped needed
#1
New user, helped needed
Hi there,


I am a new user, but I have been reading the forum for awhile and I have been using CPAP therapy for almost 2 years.

During the past few months I have been struggling to keep my nightly usage above 4 hours. Ideally I would like to be able to wear my CPAP mask for the whole night (7.5 hours), or at least 6 hours. I am the kind of sleeper that isn't able to sleep throughout the night, usually I wake up to go to the bathroom or I am experiencing discomfort with my mask, or dry mouth because of the CPAP.



I was diagnosed with mild sleep apnea with a AHI of 8. I am currently using a Resmed Airsense 10 with a minimum pressure of 13 and a max of 20. The mask is a Resmed F20 with climateline tubing.

I appreciate if anyone has any suggestions to help me improve my therapy.

Thanks!


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#2
RE: New user, helped needed
With minimum pressure 13 and maximum pressure 20, EPR 2 and Ramp at 20 minutes from 6.0, your event rate is very good, but comfort is not there. There are many possibilities to improve that. For someone with a mild diagnostic AHI of 8, your pressures are very high. I'd like to help you get more comfortable, and I think a lot of that is going to involve lowering your pressure and considering alternative mask interfaces. Let's start with the mask. A full face mask (FFM) is a lot of hardware. Are you certain you need that? A nasal pillows mask is so light and minimal it would certainly be more comfortable. Read our mask primer wiki and consider if a nasal pillows mask might be worth considering. http://www.apneaboard.com/wiki/index.php/Mask_Primer

Your pressure is very high, and the only events we really saw in your charts was a cluster of OA on 128 at 1:20. That may be positional. I'd like to see you decrease the minimum pressure to 8.0 and maximum pressure to 14, and change the ramp time from 25 minutes to Auto. Let's increase EPR to a setting of 3. My hope is to stabilize pressures and make you more comfortable without giving up efficacy. Your results are fine, but if you don't sleep comfortably, it doesn't matter. Let's reduce some of the higher pressures and see where it takes us.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#3
RE: New user, helped needed
Thank you for the suggestions! I will talk to my provider about switching masks and I will try the nasal pillows and nasal masks to see if those provide me more comfort. 

I changed the settings on my device last night and they helped me sleep through the night without waking. However, I did see more event flags on my Oscar chart. Is this to be expected when changing the settings? Also, it looks like my flow limits were more prominent. Could this also be attributed to lowering the pressure?

I appreciate any other feedback you have for me.


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#4
RE: New user, helped needed
The difference in event rate is insignificant from 0.83 to 0.86. In return, both your median and 95% pressure are 2-cm lower inhale and nearly 3 cm lower on exhale. You FEEL better, and part of that may be a significant improvement in tidal volume from 380 to 440 mL and minute vent from 4.88 to 5.83 L/min and a significantly longer therapy time. We call that a win. There were several OA events, but the RERA (respiratory effort related arousals) are significantly lower. Flow limits should have been lower with the increase in EPR, and based on the respiratory flow increases, I think the graph and statistics may be misleading. Flow limitation reported by the Resmed machine is not a hard calculation, but is a relative index based on your baseline flow. I think if we did a deep dive, we would actually see an improvement.

I think you should try keeping these settings and working to get longer therapy times. We can then review where it should go after a few days. We may slowly increase the pressure settings, but we don't want to surrender the gains in comfort. Certainly an AHI of 0.86 does not call for making changes.
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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#5
RE: New user, helped needed
2nd night of using your recommended changes to my settings. I am feeling better again today and I think that is due to the longer usage time, a little over 6 hours last night. I remember waking up during the night 2 times and both times it felt like i wasn't getting enough air.


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#6
RE: New user, helped needed
Sometimes, the lowest AHI does not yield the best quality of sleep, and your slightly higher AHI but better sleep with these lower pressure are showing that is the case for you. Your pressure still moves withing a 2.5 cm window, which is very good to avoid sleep disruption. You've finally moved over 6-hours to therapy time. Your tidal volume and minute vent moved back on this night, but RERA has backed off even further. Your breathing looks more even and free of arousal spikes through the night. Still looking good, and I like the way this 8-14 pressure with EPR 3 is unfolding for you.
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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#7
Gross 
RE: New user, helped needed
Wow I am kind of embarrassed but I started my machine last night and realized that I wasn't tired, so I stopped the machine and took my mask off and then ended up falling asleep without it for a couple hours Oh-jeez.

I was able to wake up and put my mask on in the middle of the night. The good news is that besides waking up a couple times after that, I was able to sleep with my mask on until the moment I woke up to start the day. Usually that doesn't happen and I usually take my  mask off 1.5 to 2 hours before I actually wake up because of discomfort or dry mouth or because I wake up and can't fall back asleep with my mask on. These settings have definitely improved my comfort.


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#8
RE: New user, helped needed
You could be waking for thr bathroom because of the apnea itself.. also, do you have a full face mask? Your dry mouth may be because of mouth breathing from a nasal mask.
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#9
RE: New user, helped needed
(02-01-2021, 05:01 PM)CentralApneaUser909 Wrote: You could be waking for thr bathroom because of the apnea itself.. also, do you have a full face mask? Your dry mouth may be because of mouth breathing from a nasal mask.

Yes I am using a full face mask, the Resmed Airfit F20. I am going to talk to my provider and try one of the nasal pillows and see how that works for me.
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