Newbee - Suggestions on Proper Approach?

[Snoring Bear]

I'm new to this board and new to cpap treatment.   I'm using a one-week loaner Resmed Airsense 10 Autoset (without humidifier being used since it's a loaner).  I was given a F&P Eson2 nasal mask to start with. 

I've read a lot of info from this forum...especially on tailoring the SleepyHead Charts with what's needed.  I still don't understand the interplay of each of the charts which is why I am posting two recent nights of activity.   I'd appreciate any insights on interpreting the info.

Initially, the sleep therapist had me at a 7-20 setting;    a day later he changed it to 10-20. I'm in APAP mode & using a 15 minute ramp time; EPR full-time at 3cmh2o. - Last night I had a pretty good leakage (around 6:10 a.m.)  that lasted about 15 minutes or so of me fiddling around with the mask.  I eventually got it under control.

I'll be getting my own new Resmed 10 Autoset with humidifier on Tuesday and an Airfit P-10 mask;  I sure hope the P-10 is easier to keep sealed!  I assume the humidifier is good to use; I'm in an area where there isn't a lot of humidity (CA).  

I'm hoping to get a good handle on this process.  If anyone could provide any insights/recommendations based on the 2 charts I uploaded and the above information, I would really appreciate it!

[CB91710]

The humidifier will make a big difference. Without it, I am blowing clots out of my nose in the morning. Nothing serious, no active nosebleeds, but "evidence".
I'm in the western IE, this time of year I tend to run my humidifier at 4.

I'm a little concerned about your centrals on the 2nd chart, and would be concerned that you may have complex apnea that needs an ASV for treatment, however, on just two nights, and one not being bad, it's premature to be overly concerned about that.
Particularly with the min pressure being at 10, you may want to reduce the EPAP from 3 to 2. I tried mine at 1 but it was not comfortable when trying to go to sleep.

I think you'll like the P10, I did not care for the Eson (nosE :facepalm: )

[Sleeprider]

There are a couple things here. Obstructive events are somewhat clustered together and events are higher during periods of higher leaks. I think your pressure settings are fine, and things will settle down as you adapt to using this machine, however you may have a positional apnea situation where your chin tucks and obstructs your airway, and disrupts the mask seal. We describe this in the Optimizing Therapy wiki (link in my signature), in the Positional Apnea section. Read there and see if that matches your experience. As a general note, your respiratory statistics are very good (tidal volume, minute vent, resp rate etc) and other than the high leak rate, your therapy looks pretty good. It will get better.

[cate1898]

Hey Snoring Bear, welcome to the forum! Glad you found us. I predominantly use the P10's and find them the most comfortable and lightest footprint of a mask that there is. Hope it works for you!

[Snoring Bear]

There are a couple things here.  Obstructive events are somewhat clustered together and events are higher during periods of higher leaks.  I think your pressure settings are fine, and things will settle down as you adapt to using this machine, however you may have a positional apnea situation where your chin tucks and obstructs your airway, and disrupts the mask seal. We describe this in the Optimizing Therapy wiki (link in my signature), in the Positional Apnea section. Read there and see if that matches your experience.  As a general note, your respiratory statistics are very good (tidal volume, minute vent, resp rate etc) and other than the high leak rate, your therapy looks pretty good.  It will get better.

CB, Cate & SR-

Thanks very much for your input/advice! -  I've added another night's activity (last night).  Seems I'm often disturbed by cold air blowing out of mask... not normally a lot, but bothersome anyway. - I'm hoping the humidifier and P-10 will correct that.

I read about "positional apnea"... I don't know if that's my issue, but will keep following up on that as a possibility.  -   Btw, how do I tell where the CV's are?   I can't really tell.   I've seen some other peoples' charts that have CV actually on the chart which would make it easy...I'm not sure if I'm missing something...?

I return my loaner machine tomorrow and get my new one with the humidifier & P-10.  I know this is the right treatment for me and with help from you experienced members, I'm sure I'll have good results.   Thanks again!

[Snoring Bear]

The humidifier will make a big difference.  Without it, I am blowing clots out of my nose in the morning.  Nothing serious, no active nosebleeds, but "evidence".
I'm in the western IE, this time of year I tend to run my humidifier at 4.

I'm a little concerned about your centrals on the 2nd chart, and would be concerned that you may have complex apnea that needs an ASV for treatment, however, on just two nights, and one not being bad, it's premature to be overly concerned about that.
Particularly with the min pressure being at 10, you may want to reduce the EPAP from 3 to 2.  I tried mine at 1 but it was not comfortable when trying to go to sleep.

I think you'll like the P10, I did not care for the Eson (nosE :facepalm: )

CB-

I read a thread just a while ago about someone who was going to need ASV treatment.   Although you said it's premature to be overly concerned about having Complex Apnea at this stage, I have some questions:

1.  Can the Resmed Airsense 10 Autoset do ASV treatments?


2.  If #1 is no, will I have a problem getting a new Resmed 10 Autoset machine and then later needing to replace it with an ASV machine if I'm deemed to have Complex Apnea?



3.  Would it be advisable for me to try to keep the "loaner Resmed 10 Autoset", if possible?  


4.  How long would it take to reliably determine if I have Complex Apnea?



Thanks very much for any help with these questions!

[CB91710]

ASV machines are different (and far more expensive) than the standard APAP machines.
Generally, unless it is obvious that Complex Apnea is the problem during the sleep study and titration, the sleep doc will prescribe a conventional APAP machine. They will normally monitor for the first 90 days or so, primarily for compliance, but if AHI remains high and they see a lot of centrals, they may pull you back and prescribe an ASV.

Keep in mind that the information you get on this forum is far more advanced than most patients have, and ASV machines are prescribed all the time. The fact that you are aware of it and know to inquire will help you get the proper therapy.

Just monitor your charts through Sleepyhead and compare your total AHI to your CA vs OA/H. If you maintain 5+ AHI and continue to see a lot of both CA and OA, it may be time to ask. On the other hand, sometimes a small adjustment in EPR or pressure can result in a big reduction in CA.
Keep in mind that SWJ... "Sleep/Wake/Junk" will also record false events, so if you are still sleeping very lightly, that could be the source.

Sleeprider is one of your best resources for adjustment recommendations.

[Sleeprider]

Your sleep apnea remains predominately obstructive, with your last chart showing 4.35 OA and 1.39 CA. This wiki describes the qualification process for ASV, and you are far from needing ASV http://www.apneaboard.com/wiki/index.php...ackup_Info

The cluster of OA suggests you might benefit from the use of a soft cervical collar. Read this wiki to see how much more severe problems than your own have been resolved using this approach http://www.apneaboard.com/wiki/index.php...onal_Apnea

[Snoring Bear]

Your sleep apnea remains predominately obstructive, with your last chart showing 4.35 OA and 1.39 CA.  This wiki describes the qualification process for ASV, and you are far from needing ASV http://www.apneaboard.com/wiki/index.php...ackup_Info

The cluster of OA suggests you might benefit from the use of a soft cervical collar.  Read this wiki to see how much more severe problems than your own have been resolved using this approach http://www.apneaboard.com/wiki/index.php...onal_Apnea


Rich & SR-

Thanks for the additional information. I went to the group sleep meeting today. Because I had some significant leaks during the past week, they sent me home with the loaner machine. 

As soon as I get a night with below 5 API's, I can go back and get the new Resmed 10 and the Airfit P10.  They showed me how the mask I've currently been using needs to be a bit loose to get a proper fit and seal.   I believe my numbers should change quite a bit with the better fit mask... at least the leaks should improve!

They also suggested I do a sinus rinse 3 hours before going to sleep. I'm not really looking forward to that...I hope that works okay.  - Thanks again for all your help!

[Sleeprider]

I have never intentionally inhaled water to my sinuses, but have experienced the sensation while water skiing. Sounds like some kind of medieval torture to me.