alotofrice - Therapy Thread

[alotofrice]

Hello,

I'm new to CPAP and have a Airsense 11 with a full face mask (Airfit F20). Even though I've been religiously following the instructions, I don't feel better and constantly have issues around waking up etc... I'm hoping to get expert help on this.

Since I'm so new to this, I'm struggling with interpreting the OSCAR output and need some help to figure out what to tweak. Would someone mind taking a look at the data for me?

Thank you so much for your help in advance! 

[staceyburke]

I see 2 changes I would make.

1. If you look at your pressure chart it is like a mountain, with high peaks.  That is caused by your flow limits.  Compare the pressures to  your flow limits and you can see your pressure goes up when you have flow limits.  That is how resmed tries to stop larger events.  Flow limits are apnea just like the O and H events and the pressure goes up to stop flow limits from becoming A H or O event.

We use EPR to help with FL.  You have the machine set for the max of 3 BUT you have it set to ramp only.  Set it to FULL TIME.

2. You have some positional apnea.  Positional apnea is when you sleep in a position where you cut off your own airway and you can not get enough air.  it is also called chin tucking - where your chin drops down to your sternum.  Many people do this - sometimes it happens when you sleep on your back or with to high of pillows - both force your chin down.  If you cannot change of sleep position you should try a collar.  I have links to collars that show a person with a collar and the same person without and you can see a huge difference. Please take a minute to look at it.

[alotofrice]

Hello everyone, 

I've been using my new APAP machine for a month and with mixed results. My device / high level data is: 
- AirSense 11
- Full face mask Airfit F20
- Diagnosed with AHI of 54 / hour 
- The prescribed pressure is 5-15 but then after some initial feedback from this forum, I changed the setting to 9-15. 
- In terms of consistency, I've been using it every night, the inconsistent number of hours usage is usually due to me inadvertently taking it off in my sleep (not sure how that happens). 

Frankly, even though I was super excited to get my APAP machine (I literally drove across the city to find it given the shortage), I still feel like crap and it is super demoralizing. I'm hoping to get the experts across this forum to help and suggest tweaks to my settings given how much I'm struggling. I've attached both my 1 month log and my last night data. 

Thank you so much in advance  

   

   

[Gideon]

A few things

Your Flow limits are still driving your pressure.
In your first post you were advised to set EPR=3, Full Time, to help manage them you turned it off. It was likely originally set to Ramp only because any EPR may, not will, increase central apneas. We do not know if this includes you, but we can't know without trying it. If you react significantly we will correct for it.

In the meantime you have a positional apnea, also pointed out in your first post, while somewhat diminished it is a significant problem as most of your obstructive events are involved in this including your flow limitations. I'm assuming pillow modifications discussed have been tried but failed so please get a soft cervical collar and see if we can fix this.

Turning EPR on, Fulltime will help by eliminating your RERAs and better managing your flow limits. Any value will help. should this significantly increase your flow limits we will react approptiately.

[alotofrice]

Thank you for your advice. I've set the EPR to 3 and full-time just now, I'll test and report back on results. 

With respect to the sleep angle, I'm still toying around with it (different angles / different pillows etc.). I'm normally a side sleeper but with the tubes etc, I find it hard to side sleep so I sleep on my back. Do you have any suggestions on full masks that are decent for side sleeping and doesn't cause leaks? 

I'll also look at chin straps but the problem is I'm already quite uncomfortable so I'm not sure if I can fall asleep if I have more things on my face... 

Thank you again and I'll report back after I try these new settings.

[Gideon]

I've used the Amara View quite successfully. It should help with the claustrophobia as well.

I do not lightly suggest a collar as I do not like to recommend adding more stuff to use at night.

You will likely find the collar better than a chin strap since it goes on below the head. That and most chin straps pull back, not up, and back can cause more apnea.

[alotofrice]

Good morning!

I changed EPR to 3 last night but unfortunately my AHI actually went up to 8.53. I also deliberately piled pillows in various ways so I think that I was sleeping on my side. The data is below, would you mind taking a look and letting me know your thoughts? Thank you for your help and sorry to be a bother! 

   

[Gideon]

Many clusters of obstructive events, indicating a very strong positional element.

You said pile pillows. You want 1 fairly flat pillow under your head, you need more height for side sleeping but I'd guess your side sleeping is resulting in a strong fetal position with your chin tucked into your chest. Get a collar and try that.

[alotofrice]

Thank you for your quick response.

Pardon the beginner question, I read somewhere that EPR is more of a comfort setting (not sure that is true) and if I can 'tolerate' EPR being off and if it gives me better results, I should keep it off to optimize my sleep. Is there any truth to this? Thanks!

[Crimson Nape]

While Resmed states the EPR option is for comfort, its pressure difference concept is the premise of a bi-level CPAP. Its range is more limited than a bi-level, and the pressure setting difference in only in whole steps. For some users, getting creative with the use of the EPR option can provide the benefits of bi-level therapy at a low cost.

- Red