30 yr Male Just Diagnosed w/ Severe OSA

[Sleeprider]

Your idea is spot-on to increase pressure. You are already using EPR at 3-cm so you have that part right. You can stay in fixed pressure CPAP mode or let the machine do the titration work for you and change the mode to Autoset with a range of 7.0 minimum to 14.0 maximum, with EPR full-time at 3.

[ReturnofXile]

Thanks Sleeprider and Dormeo for your responses. I had actually tried letting the machine do the auto-titrating a couple of nights ago. Even the reducing the max pressure to 13 didn't help with reducing the fractured sleep (although to be honest, I don't think my pressure has ever been above a 13). I just seem to be quite sensitive to the higher pressures. One time, I tried a max pressure of 9 and it still resulted in several arousals once the pressure got up to a higher level. 

I'm just going to take the slow and steady approach and raise the pressure ever so gently and cross my fingers that eventually my body and mind will be able to adapt to a higher pressure. And I don't have to go that high either. A constant pressure of 9cm was enough to significantly reduce flow limitations and events were also almost non-existent. 

I will let you know how it turns out. I'm really hoping that I won't have to go a bi-level machine. So my end goal is to be able to sleep 7-8 hours uninterrupted with minimal flow restrictions and events.

[ajack]

I woke up every hour or two when I started. It may take a few months before you sleep right though. It is a shock to the system. MIN 9 looks to be what I would use and review.

[ReturnofXile]

I woke up every hour or two when I started. It may take a few months before you sleep right though. It is a shock to the system. MIN 9 looks to be what I would use and review.

Oh really? You'd think it be best to just take the plunge and set the pressure min pressure to 9? I was thinking about it today and realized that maybe sticking to a fixed pressure isn't such a good idea as I first thought. 

One of the main premises to my theory is that it would be the continued exposure to higher pressures that will get your body used to it (and eventually be able to sleep through it). So if I limit myself to a straight 7 and only increase by .2, then I'm effectively cutting off my exposure to higher pressures. Sure, the minimum pressure is slightly increasing, but I'm limiting my exposure to the higher pressures provided by the auto-titrating system.  With that said, I should just follow Sleeprider's advice and let the machine auto-titrate me. That way I can still work on raising the minimum pressure slowly, but also continue exposing my body to the higher pressures. Who knows, maybe I'll just learn to sleep through them with time.

[ReturnofXile]

Okay everyone, here's a bit of an update. I had a breakthrough with my treatment. Since I was still having problems with mask leaks, I decided to take the plunge and try the nasal pillows that came with the machine. Now I've always been a mouth breather at night because I always felt like I couldn't get enough air through my nose. However, during the day I have no problem breathing through my nose. Anyways to my surprise, I didn't have any problems keeping my mouth closed during the night. I inadvertently had discovered the tongue trick a few years ago (before CPAP) and so I guess I had the muscle memory down to prevent air getting into my cheeks and forcing my lips open. Lastly, I discovered lanolin on the forums and not only does it make my nares much more comfortable, but surprisingly, it cuts down on the leaks big time. I couldn't believe how well it worked! It creates such a good seal! 

Anyways now for the questions part. I have two of them. First off, I've noticed my flow charts still resembling flow limitation despite not having flow limitation on the flow limit chart. I've attached a screenshot. Could this indicate a possibly deviated septum? 

Secondly, I've noticed a pattern of breathing I often get as soon as I lay down and try to go to bed, I'm definitely still awake at this point, but it looks likes constant central events. Subjectively, my mind starts to wander and I notice that I've stopped breathing and then I take a breath. This really only happens at the onset of sleep. I've also attached a screenshot of that as well in addition to the last day. In regards to raising the pressure to deal with flow limitations, I'm at a 7.6 right now and it seems to be going well. Looking forward to hearing from you guys. 

Thank you and have a nice day. 

Btw, just wanted to let you guys know that you are awesome and it's nice having a supporting community to talk to this about. 

[Dormeo]

Wonderful to hear about your mask breakthrough!

About septum: probably best just to get in to see an ENT. Explain that you’re on APAP and are seeing some flow limitations. With luck, he or she will know what you’re talking about. Meanwhile, inching up the pressure remains a good strategy.

Our breathing while we’re awake is considerably less regular than while we’re asleep, so what you report isn’t surprising. Something similar probably goes on throughout the day, the difference being that while you’re falling asleep you are actually paying attention to your breathing.

[Sleeprider]

Your median results are 8/5 pressure, and everything looks great. There is no harm in trying higher pressures, and seeing if you feel better or not. Your flow limitations are minor, and slightly higher pressure might knock them out, but at this level, they are acceptable, and you seem to be comfortable. Glad to hear you got the nasal therapy to work. Many people assume they can't use it, but unless you try it, you never know. Let's not worry about any patterns from awake or disrupted sleep. I imagine if we tracked our daytime breathing pattern it would look pretty alarming.

[ajack]

I woke up every hour or two when I started. It may take a few months before you sleep right though. It is a shock to the system. MIN 9 looks to be what I would use and review.

Oh really? You'd think it be best to just take the plunge and set the pressure min pressure to 9? I was thinking about it today and realized that maybe sticking to a fixed pressure isn't such a good idea as I first thought. 

One of the main premises to my theory is that it would be the continued exposure to higher pressures that will get your body used to it (and eventually be able to sleep through it). So if I limit myself to a straight 7 and only increase by .2, then I'm effectively cutting off my exposure to higher pressures. Sure, the minimum pressure is slightly increasing, but I'm limiting my exposure to the higher pressures provided by the auto-titrating system.  With that said, I should just follow Sleeprider's advice and let the machine auto-titrate me. That way I can still work on raising the minimum pressure slowly, but also continue exposing my body to the higher pressures. Who knows, maybe I'll just learn to sleep through them with time.

Your median was 8 and your 95% was 10.3, so 9 sat in the middle and happened to be 1 under your 95% and will resolve any events that would happen under 9cm, without having to respond to them afterwards. These numbers aren't set in stone. You will see over time what your average 95% will be. I would continue to auto.

[ReturnofXile]

Okay everyone, it looks like I've run into a new problem. I've been using the nasal pillows with Lanolin and it's been good. However, a couple of nights ago, I noticed moisture in my nose. It's not in the tube, but I can feel the ripples as I'm breathing. It's very uncomfortable and it causes me to blow my nose constantly. 

I'm not sick and my allergies are under control, and I clean my equipment every day. So what about humidity levels? My bedroom the past few nights has been 72 (F) with an ambient humidity of 80%. I cranked up my heated tube to 86 degrees and turned the humidity setting off on my Resmed 10 autoset machine and still had moisture in my nose. 

Could the ambient humidity levels be responsible for my problem? Can the Resmed machines handle situations where the ambient humidity is extremely high? I would think that it would actually require a dehumidifier, unless the machine can simultaneously act as both a humidifier and a dehumidifier. I'm tempted to pull out my old dehumidifier to see if it makes a difference. 

Also, while I do have a basic understanding of relative humidity vs absolute humidity, it appears that I need someone with a more nuanced understanding of the topic to help me. Would it be correct to postulate that when the cool humid air (72 F) flows through the CPAP machine  and enters the tube and gets heated to 86 (F), that it would actually allow even more humidity from the ambient air to rush into the heated tube, thereby raising the absolute humidity (kind of like an osmotic effect with water vapor)? 

So summing up, what happens when you have a extremely humid room and that air gets compressed though a CPAP machine and delivered to a heated tube? Does the humidity of the room and the humidity of the tube act as closed systems, independent from each other, or do they interact with each other? 

Definitely looking forward to a solution to this problem. 

Thank you and have a happy 4th of July!

[ReturnofXile]

Alright, here's an update for you guys. I did solve the humidity problem and sinuses by using a neti pot. Anyways, I've run into a new possible problem. When I awoke today, I noticed my mouth was slightly pursed open. I've been trying to get the nasal pillows to work, but the past couple of days, I have felt tired even after getting 9+ hours of sleep with an AHI below 1. Now I'm wondering if it's possible that my mouth is opening up hundreds of times per night and causing mini arousals without me remembering it. I felt amazing the first couple of nights on CPAP treatment, but I was using a full face mask then. What happened these past two days reminds me of how it was before I started CPAP treatment. 

I've always assumed that my mouth was staying closed, but maybe it isn't. I tried to do a test today where I would purposefully open my mouth, but my god it was extremely uncomfortable. I would think I would remember waking up to that feeling, but who knows.  I really like the idea of trying to breathe through my nose as there's numerous health benefits from doing so. I have a chin strap and tape on hand to possibly try tonight. 

So my two questions are:

1. If the chin strap and tape doesn't work, would it be possible to wear a full face mask and breathe through your nose? My initial thought would be that it would work because it's all pressurized. 

2. Everyone keeps saying that the resmed machine can adjust for leaks. But say you have a fixed pressure. Can the machine still increase the pressure to offset the leaks?


I've uploaded today and yesterday's charts for you guys to look at, as well as one where the leak rate seems normal. The leak rates seemed to be significantly higher than usual. I'm just trying to figure out if this is a real problem or just a one time occurrence with the mouth falling open. Do you think these charts indicate a problem with mouth breathing? Will appreciate any feedback. Thank you.