Trying to find the right settings

[SarcasticDave94]

Yes clownbell is correct on my thoughts. Pillows and nasal type are covering less facial real estate and gives less places to leak and easier to seal. And I've had better seal and comfort results with my Fisher and Paykel.

[packfan23]

So update after another 4-5 months now.  I am still struggling.  I had a titration study done in January that showed I should be at 12 cm (study didnt use EPR) and my sleep doctor has been trying different sleep medications to help with my insomnia.  I tried Trazodone (50mg then 100mg), Doxepin (10mg, then 25mg, then 50mg), Dayvigo (5mg), and now Belsomra (Im at 10mg but she prescribed a 20mg trial).  None of it has really worked or helped.  The Dayvigo knocked me out but I had serious issues the following mornings feeling totally drugged and out of it for a few hours after awakening.  

After the titration she changed my settings to 14-16 cm.  Some nights are better and some are worse.  Im still using the Amara view FFM and I changed from the small cushion to the medium and had the best 2 nights.  I slept for 5-6 hours straight then had a bunch of issues after the initial awakening.  I havent been able to replicate it.  I changed my settings to 15-17cm and used 3 EPR to see if it would get any better.  The first night was pretty bad, the second and third nights got somewhat better (gave me hope), but the last 4 nights have gradually gotten worse.  Im waking up 10-12 times and tossing and turning.   

Ive noticed I have more success when i sleep on my right side, however its not consistent.  I usually sleep on my stomach because its the most comfortable and easiest to fall asleep, yet I have the worst nights.  Im at the point I dont know what to do.  My doctor is convinced the CPAP is completely doing its job and my sleep apnea is treated (she always says my numbers look so good), and its a matter of treating my insomnia.  I dont wake up feeling a rush sensation like I just had an apnea or get up to pee nearly as much as I used to.  At most I have 1 bathroom trip a night, and most nights I dont have any.  I dont have any reflux in the mornings or really at all, but some of that is due to changing my diet.  Ive managed to lose 30+ pounds dieting the past few months too.  But Im constantly waking up every few hours (some nights every hour) tossing and turning.  To be clear I dont have any trouble falling back asleep during these awakenings.

 However we are throwing darts at a board trying different meds every appointment, which is every 4 weeks.  Im attaching the last two nights.  Is there any advice or something Im missing.  Any settings I can tweak, or maybe I need a different machine besides the APAP?  I dont want to get into the habit of changing things all the time, but its basically up to me to figure this out.

Also forgot to mention my jaw drops and mouth opens when I sleep, and I wake up with insanely bad dry mouth. I have the humidifier cranked up but doesnt make a difference, I used Biotene to no avail. I started using the Xylimelts but they dont last the entire night.

[packfan23]

Does anyone see anything or have any comments?

[fishfinderG]

If you are waking up with your jaw dropped then you need a chinstrap or a soft cervical collar. Mouth leaks wake me up a lot so treating them has been super valuable. I use a nasal cushion and mouth tape and most nights I have 0.0 leak.

[frankwil]

I have been using CPAP for 17 years now, and have been through a lot of what you are facing. I eventually discovered that my jaw also drops and my mouth opens during sleep. My suggestion to you would be to purchase a good chin strap. In my experience - wide straps offer the most comfort and holding power. You may also want to try out a nasal mask if the pillows are not to your liking or don't work for you. It certainly seems that a lot of your issues stem from using the FF mask. I have only ever used nasal masks and have recently upgraded to the ResMed n20 from the original Miirage Activa, and I absolutely love it. My numbers in OSCAR have been stellar ever since I started wearing the chin strap - which is coming up on around 12 years now. I know that you have been dealing with this for a while, and I commend your diligence. You will come to realize after you finally nail this that it is so worth the trouble you went through to get there. Keep your eyes on the prize and hang in there.

Frank

[Greywolfe]

I currently have about a weeks' worth of OSCAR screenshots, I need to find the right settings for my machine.
Can I attach all in one posting, or do one at a time?
I just downloaded and started using OSCAR about a week ago?

[OpalRose]

I currently have about a weeks' worth of OSCAR screenshots, I need to find the right settings for my machine.
Can I attach all in one posting, or do one at a time?
I just downloaded and started using OSCAR about a week ago?

You have responses to this question here:

http://www.apneaboard.com/forums/Thread-...#pid446092

[packfan23]

So I tried the Brevida Nasal pillows last night with a chinstrap and attached are the results.  Overall, it was a horrible night with 10-15 awakenings.  Im curious why my Resp Rate would be almost double versus when I used a FFM?  I scaled the IPAP to 13 with EPR 1 as staying with the 15cm was a little much.  I did have some leaks and maybe some fine tuning with the chinstrap and velcro straps.  Is it worth continuing to use the pillows even after a horrible first night?  Also I switched to the M, L cushion which was better but at times I still couldnt feel the air in my nose.  Wasnt consistent anyway.  Im still not sure what else to try besides different masks.  Ill have to buy them outright as my insurance will not cover them while Im still paying for the machine............

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I have been using CPAP for 17 years now, and have been through a lot of what you are facing. I eventually discovered that my jaw also drops and my mouth opens during sleep. My suggestion to you would be to purchase a good chin strap. In my experience - wide straps offer the most comfort and holding power. You may also want to try out a nasal mask if the pillows are not to your liking or don't work for you. It certainly seems that a lot of your issues stem from using the FF mask. I have only ever used nasal masks and have recently upgraded to the ResMed n20 from the original Miirage Activa, and I absolutely love it. My numbers in OSCAR have been stellar ever since I started wearing the chin strap - which is coming up on around 12 years now. I know that you have been dealing with this for a while, and I commend your diligence. You will come to realize after you finally nail this that it is so worth the trouble you went through to get there. Keep your eyes on the prize and hang in there.

Frank

Thank you for the kind words and encouragement.  Im trying to push through even though its been almost 9 months.  I still havent slept a full night.  Some nights are better and others are like last night.  Im trying out the Brevida nasal pillows and didnt have a great first night.  But I wanted to try something different.  Im not sure what to do if it doesnt get any better.  Thanks again for the kind words.

[packfan23]

Hello everyone,

I was looking at my charts just trying to come up with something.....

I noticed in the attached pictures from before my inspiration time is higher than expiration.  Is that normal, or potentially an issue?  Maybe some restriction.  Or I can provide more screenshots or a more detailed view over a 2-3 minute window.  What is the normal discrepancy between inspiration and expiration times?  If its not normal and mine stats show some issue, what is the recourse?  I have an appointment tomorrow with my sleep doctor and want to provide more information for her cause I cant keep going like this.  

Thanks to everyone for any suggestions, comments, or remarks.

[packfan23]

Here are screenshots from the last few nights showing a 3-5 minute flow rate.  heavy flow limits

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another couple of captures.  idk if i should increase the IPAP further to 15-17 cm and go with 3 EPR or increase the IPAP even further at this point.