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dryeyesandsleepapnea therapy thread: data geek loves OSCAR
#1
dryeyesandsleepapnea therapy thread: data geek loves OSCAR
Hello everyone! I'm two months into my CPAP treatment and tolerate it well but am having trouble finding good settings.

I'm a mid 30's male, ~25 BMI, diagnosed at 5.5 AHI with a pressure of 11.0. I use an AirSense 11 with humidifier. Initially I started on the F30 full face but it leaked (too big), now my primary mask is the AirTouch F20 full face, and I recently picked up a P10 nasal pillow as my therapist wanted me to test it.

I started using OSCAR the day after getting my machine. Here are the major days and screenshots where I noticed issues.

1. Full night with F20. 4.3 looks decent on paper but there's many events. No leaks. I've read some older posts and learned that a high flow limitation means an obstruction. The therapist couldn't figure out why my two large event groups are camel humped like that (the two weeks or so before this were similar) so she recommended I turn ramp on to see if that helps. Ramp has been on since 18 March and starts at 4.0.

2. Full night with P10. Here the AHI is much better but there's many leaks. Are these mask leaks or mouth leaks? I mouth tape when I use the P10 and notice a few minor mouth leaks but can't remember any huge ones.

3. I napped with the F20 and went through the night with the P10, changing machine settings each time. I wanted to confirm that AHI seems to go up (and leaks go down) with the F20 and vice versa with the P10. I used the masks in opposite order on another day and the results are the same. 

I've used the P10 about eight nights. Each of the following days, I've woken up tired and have had to nap in the afternoon. With the F20, I wake up neither tired nor refreshed and still nap. The only time I've felt refreshed with a good amount of energy was day three or four back when I used the F30, and never again since then.

Do you see any issues in the screenshots? Any thoughts on what I can tweak or try?


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#2
RE: dryeyesandsleepapnea therapy thread: data geek loves OSCAR
Most of your problems can be resolved by adding exhale pressure relief (EPR) to cut the flow limitations and make therapy more comfortable. It may also be worth moving to Autoset mode to allow the machine to respond to obstructive events with higher pressure. This may or may not help with leaks in nasal therapy. It appears you leak from the mouth, so that may take more time to resolve. Your are currently using fixed pressure at 11 cm and events are mostly RERA and hypopnea with some OA thrown in.

Set machine to Autoset mode with minimum pressure 11.0 and maximum pressure 14.0 with EPR full-time at 3. This maintains the pressure set by your care providers, but offers the comfort and therapy benefits of bilevel pressure giving you a 3-cm reduction on exhale, or more precisely a 3-cm increase during inhale (pressure support). Read the wiki on Flow limitation to better understand why EPR helps improve your sleep by reducing respiratory effort related arousals (RERA) here http://www.apneaboard.com/wiki/index.php...limitation
Sleeprider
Apnea Board Moderator
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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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#3
RE: dryeyesandsleepapnea therapy thread: data geek loves OSCAR
When you post your next chart, it would be helpful if you included these six graphs (and no other graphs):

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.
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#4
RE: dryeyesandsleepapnea therapy thread: data geek loves OSCAR
Here are the graphs Dormeo requested. Apologies, just saw the wiki for chart organization. I did some reading after my post last night and turned on EPR 3. This is with the F20 as that seems to be the better option with no mouth leaks. I selected only the nighttime data to ignore yesterday afternoon's nap. 

Sleeprider, should I still try Autoset with the F20?


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#5
RE: dryeyesandsleepapnea therapy thread: data geek loves OSCAR
Yes try autoset. Based on the limited examples shared your obstructive apnea got worse when increasing EPR to 3, you can confirm by looking at more of your data to see if that was the case. This does make sense when you understand the basics of PAP treatment.

PAP treatment with EPR consists of 3 variables. EPAP, IPAP and EPR. EPAP is the lower pressure used during exhalation. IPAP is the higher pressure used during inhalation. EPR is the difference between EPAP and IPAP. On this machine set pressure is your IPAP and EPAP = IPAP - EPR.

EPAP is the continuous pressure that holds your airway open. EPR is the amount the pressure changes during inhale/exhale and this change in pressure helps increase flow (which is why it was recommended to treat the flow limitations).

Now that you understand the basics you can probably see that turning EPR on and to 3 dropped your EPAP 3 cm making it more likely for obstructive apnea to occur. This is why Sleeprider originally recommended switching to autoset mode and setting max pressure to 14 cm because it would allow the machine to increase back to 11 cm EPAP if it felt it needed to.

Your findings with nasal mask vs full face mask are fairly common with many people requiring higher pressure with a full face mask (and them not working for the odd person).

For now the recommended 11-14 range would be a good start and then more recommendations may be made depending on the results.
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#6
RE: dryeyesandsleepapnea therapy thread: data geek loves OSCAR
The settings I suggested, I meant to be used with whatever mask you settle on. You're really going to be amazed at how much better it feels. Your last chart on the 25th shows several clusters of OA that suggest positional apnea. We will keep an eye on that. http://www.apneaboard.com/wiki/index.php...onal_Apnea
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
RE: dryeyesandsleepapnea therapy thread: data geek loves OSCAR
Thanks everyone for the help! It's incredible to be doing such a deep dive on PAP therapy here.

I did a short trial this afternoon during a nap. Please let me know if the settings look ok. The first half of the nap felt ok; I don't remember falling asleep. The second half was marred by mask leaks. I will have to check the straps again now that we're going up to 14.

Edit: My therapist mentioned positional apnea at the start, thanks Sleeprider for the reminder. I'm sleeping supine with the F20 for now as even with a CPAP pillow, I can't find a good side position where it doesn't leak. I can feel myself chin tucking slightly. Tonight I'll try removing a layer of foam in the pillow and next week I'll look into SCC. Side sleeping is much easier with the F30. Let's see how the new settings get on with the F20 and I'll keep doing my tongue training.


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#8
RE: dryeyesandsleepapnea therapy thread: data geek loves OSCAR
I hit the attachment space limit. Here's an empty fourth post so I can post links.
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#9
RE: dryeyesandsleepapnea therapy thread: data geek loves OSCAR
Here are my graphs from the full night with 11 to 14 autoset and EPR 3 full time. I hope Dropbox links are ok as I've hit the attachment space limit. Please remove the space between the www. and dropbox in the URL.

[Image: Screen%20Shot%202022-03-27%20at%2012.25.03.png?raw=1]
[Image: Screen%20Shot%202022-03-27%20at%2012.25.16.png?raw=1]
I switched back to my cervical neck pillow to try to help with chin tucking.

I'm going to reduce or even eliminate my naps to get back to a decent bedtime.
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#10
RE: dryeyesandsleepapnea therapy thread: data geek loves OSCAR
I have edited your links above to display your screenshots.  To help, here are the steps required. Change the dl=0 at the link's end to raw=1 and embed this link in an image ("img") block.

Example:
Your original link:
Code:
https://www.dropbox.com/s/2e9ut0603abrgo4/Screen%20Shot%202022-03-27%20at%2012.25.03.png?dl=0

The same link modified to display the image:
Code:
[img]https://www.dropbox.com/s/2e9ut0603abrgo4/Screen%20Shot%202022-03-27%20at%2012.25.03.png?raw=1[/img]

I hope this will help.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
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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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