[Pressure] First Night on APAP - leak advice

[Ron AKA]

I'm advising the that ramp isn't needed for only 1cm of pressure relief. I'll leave it at that.

It is 1 cm now, but what will it be when the minimum pressure is optimized? You don't know that, do you? I guess what I don't understand about your comments is that you seem to assume you know more about these CPAP machines than the engineers that designed them. Consider the user of a machine that has paid to get the state of the art treatment with all the bells and whistles, and the first thing you tell them is to turn them off. The Auto Ramp feature is one of the very few improvements that ResMed made over the older S9 machines. Doesn't it seem reasonable to try the new features first and then decide if you like them or not?

[Zedoary]

 Would coughing spells influence the leak percentage?  I have some chest congestion due to allergies and had several coughing episodes during the night, also frightening with the cpap.  It's hard enough to get your breath without the pressure.  Someone mentioned a potential cause of mouth breathing, which if I do it awakens me immediately, but the coughing is oral.

I read before sleep so the ramp allows me to breath without feeling like I'm fighting or forced into an abnormal breathing pattern, as my breath is no where near that regular when I'm awake.  

I'll post tomorrow's stats with screen shots. When I tried loading screen shots this afternoon, I had a pop up that said I didn't meet the posting requirements for attachments so I deleted them and put text instead.  I'm also having trouble getting the machine to use the wifi...it isn't happy with the reception in the house.  So no data on the phone app yet.  Thanks for all the input.

[Sleeprider]

Zedoary, the method for attaching images on the forum is at this link and no minimum number of posts is required using this method http://www.apneaboard.com/wiki/index.php...pnea_Board  It appears you may be trying to post an image hosted off-site.

1. Click on the NEW ATTACHMENT "Choose File" or "Browse" Button. This will open a dialog box with a list of folders on your computer.
   
   
2. In the Dialog box from Step 1, Navigate to the Folder where the attachment is located.
   
   
   1. Highlight the Attachment file or image.
      
   2. Click "Open", or double-click on the file to be attached.
      
3. Finally Click on Add Attachment.
   

[Ron AKA]

Nasal pillow masks are sometimes supplied as a "fit pack" which means they include different size mask inserts. The idea is that you try the available sizes and see which work best for you. I have used the ResMed P10 mask fit pack and tried both the large and medium inserts. What I found is that the medium inserts go further into my nose and leaks are reduced. The large insert has the pillows sit more outside the nose. So from a leakage point of view, the medium work best for me. BUT, and it is a big BUT, the medium ones irritate my nose a lot. So, I have gone back to the large size insert and put up with the leaks. My suggestion is to try the different inserts if you have them, and decide which work best for you.

[Zedoary]

I took some of the advice and we really looked at leaks, reseating the pivot joint and hose at the machine, which seemed to have a significant leak. We can add a strip of teflon tape as well today to help seal, but even without it   leaks were significantly reduced.  Success! Ron, I'm using the small insert based on the guide, but I can try going up and see what happens. I do have the full set. 

I've uploaded screen shots of last night's data.  I'm open to any advice in these early days to maximize the settings, etc.  I'm not seeing anything near what they expressed my ~190min/415 min overnight sleep study showed.

I'm really celebrating making it through 2 nights over 4 hours of use relatively incidence free. This entire experience with a new  concomitant diagnosis along with the second dx of OA requiring a CPAP, coupled with a REALLY bad sleep study experience with burned out sleep lab staff, caused this decidedly non type A person, to be diagnosed with medical anxiety. At least my Sleep MD was excellent. Many people fear fire, I fear respirators or being dependent upon one. The CPAP was just too close for me. The literature has a horrid published success rate, and clinical trials are very controlled situations. Real life data is always worse than trial data in my experience.

This group gave me ways to gain some control of the situation, by not settling for the machine the DME wanted to provide (calls to 42 DME's to tell me that they would not do my rx machine on rental with my insurance or even self pay rental. Insisting they would "look at my study and provide an appropriate machine that would be fine for me" but it would NOT be the Resmed Airsense 10 AutoSet, regardless of Rx). The general attitude is that as a new user I would never know the difference. I used the forum and purchased online out of pocket. It's helpful to  feel I can control the rate and flow until I get used to the device and that I can monitor how well it is working myself.  Thanks everyone.

[Ron AKA]

First off, I think you are doing fine. That is a pretty good result for the first night use. Those leaks don't look that bad to me. I certainly do much worse with my AirFit P10 pillow mask.

My suggestion would be to increase the minimum pressure to 8 cm and try that for several days to see what you can achieve. After that you could try turning the EPR to Ramp Only and over several days to see what that achieves for results. At that point you could choose which option is working better for you and then fine tune it to your needs. I suspect you will be able to achieve average AHI at or under 1.0 once you have the settings well adjusted.

[Sleeprider]

I don't agree about turning EPR to ramp only. Why would you not use it through the night when there is absolutely no suggestion that it is a problem, and likely contributes to comfort. In your case Ron, you have central apneas that are made worse by using EPR during therapy, but most people don't. This therapy looks perfect, and I would leave it exactly as it is for several more nights, then look at possibly increasing minimum pressure closer to the therapy requirement. I agree that will likely end up at or near 8.0. EPR should be unchanged unless Zedoary has some reason for changing it.

[Ron AKA]

I don't agree about turning EPR to ramp only. Why would you not use it through the night when there is absolutely no suggestion that it is a problem, and likely contributes to comfort.  In your case Ron, you have central apneas that are made worse by using EPR during therapy, but most people don't. This therapy looks perfect, and I would leave it exactly as it is for several more nights, then look at possibly increasing minimum pressure closer to the therapy requirement.  I agree that will likely end up at or near 8.0.   EPR should be unchanged unless Zedoary has some reason for changing it.

I have two reasons for suggesting to try no EPR during the therapy hours. First it reduces maximum mask pressure almost one for one by the amount your reduce EPR. Some people are bothered by a higher mask pressure, and the pressure fluctuating with every breath, can make it hard to maintain a mask seal.

The second reason is that it can result in a better OA incidence. That is what I have found. I ignore the CA events. 

And if you don't try it, how do you know if you will like it or not?

[Sleeprider]

So by turning off the feature that reduces exhale pressure, you reduce maximum mask pressure? Interesting, first time I've ever heard that contention.

[JesseLee]

Zedoary,

I think your results look good and congratulations for getting treatment and making a positive impact in your sleep, you will not regret it! After just a couple of nights of therapy I wouldn't draw any conclusions about making changes just yet. It appears that the settings you have are working well.
With the EPR at 3, I don't see any significant CA to recommend change. Are you comfortable with the pressure changing when you go from inhale to exhale?
For ramp, when I first started I enjoyed the ramp feature, but I started to get used to therapy and was falling asleep faster so, ramp is now off for me. It's a comfort feature so you get to pick.
I encourage you to try the settings you like for at least 3 or four days. If you chase and play with settings nightly, it may make it harder to get used to therapy.
With leaks under control, I think you are doing great!
How do you like your mask pillows? If they are comfortable, keep on keeping on.
And lastly, keep a positive attitude, it will do wonders I promise.

Happy sleeping! And that's a good looking dog, always been a fan of the German Sheppard