NEWBIE : Newly Diagnosed 39YO Male with an AHI of 74.1

[ajack]

You ignore anything while you are awake. Thanks for mentioning that, it explains the cluster at the end of the night.
I'd try min 12 tonight and see. As you know, there are leaks that still need fixing. The machine has a mask fit function under options, that blows high pressure to help fit it.
I'd ignore the CA for now, till the OA/H are resolved, then review. They are probably new user pressure induced and for most people resolve over 12 weeks.

[lemonbomb]

You ignore anything while you are awake. Thanks for mentioning that, it explains the cluster at the end of the night.
I'd try min 12 tonight and see. As you know, there are leaks that still need fixing. The machine has a mask fit function under options, that blows high pressure to help fit it.
I'd ignore the CA for now, till the OA/H are resolved, then review. They are probably new user pressure induced and for most people resolve over 12 weeks.

Thanks man, what about my leak rate? I'm surprised that it says that there is a leak because I checked for leaks and I dont think i found a single leak in the system.

[Sleeprider]

I'm going to suggest an alternative to ajack, and you're welcome to consider either approach. I think Ramp is wasted on you, and suggest you turn it OFF. I think a minimum pressure of 9.0 is a more conservative start, and just below your median pressure. The increase in pressure around 03:00 looks like a cluster of positional obstructive apnea. We often recommend a soft cervical collar or other means to avoid chin-tucking, but be aware that it is likely that this cluster relates to you tucking your chin towards your chest, and higher pressure will often not help with positional problems. Read the Positional Apnea Wiki here: http://www.apneaboard.com/wiki/index.php...onal_Apnea

My preference is to make the minimum pressure 9.0 rather than jump all the way to 12.0. The Resmed Autoset is fast enough to respond to a need for higher pressure when it arises, and it appears you do pretty good in the range of 9.0 to 14.0. For now the maximum pressure of 20 is mainly in play if you have a positional issue, and I suspect this will eventually settle at a lower pressure. This looks like a good start to therapy, and the only things needed is to drop ramp and use a somewhat higher minimum pressure.

[lemonbomb]

Today wasn't a good day. Woke up tired.

You see I usually wake up at around 6am with my phone alarm. My first two days I've been waking up by myself without my alarm at around 5am with the CPAP machine. Last night (my 3rd night) I woke up at 4am, thought it was 5am and took off my mask. I realized it was 4am and went back to sleep without my mask. Then woke up at 5am and placed my mask back on. I'll share the OSCAR once I get into my office

[lemonbomb]

These were my settings last night;

Standard Settings

Ramp Time : 10mins
Climate Ctrl : Manual
Temperature : 27C
Humidity : 8
Tube Temp : Auto
Pressure Relief : On
Smart Start : Off
Mask : Fullface

Clinical Settings

Therapy
Mode : AutoSet
Max Pressure : 20
Min Pressure : 12
Mask : Full Face

Comfort
Response : Standard
Ramp Time : 10 mins
Start Pressure : 4 mins
EPR Type : Full Time
EPR Level : 3


The items in blue were the one i modified last night. And my OSCAR charts are below. I seem to have taken my mask off at 3:30am and placed it back at 4:30am. MY AHI was basically almost the same as yesterday.

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I'm going to suggest an alternative to ajack, and you're welcome to consider either approach.  I think Ramp is wasted on you, and suggest you turn it OFF.  I think a minimum pressure of 9.0 is a more conservative start, and just below your median pressure.  The increase in pressure around 03:00 looks like a cluster of positional obstructive apnea.  We often recommend a soft cervical collar or other means to avoid chin-tucking, but be aware that it is likely that this cluster relates to you tucking your chin towards your chest, and higher pressure will often not help with positional problems.  Read the Positional Apnea Wiki here: http://www.apneaboard.com/wiki/index.php...onal_Apnea

My preference is to make the minimum pressure 9.0 rather than jump all the way to 12.0.  The Resmed Autoset is fast enough to respond to a need for higher pressure when it arises, and it appears you do pretty good in the range of 9.0 to 14.0.  For now the maximum pressure of 20 is mainly in play if you have a positional issue, and I suspect this will eventually settle at a lower pressure.  This looks like a good start to therapy, and the only things needed is to drop ramp and use a somewhat higher minimum pressure.

I'll try lowering my min pressure, maybe i woke up because the min pressure was too high and I unconsciously wasn't too comfortable with it.

By the way what do you suggest for EPR.

Also my mouth was still dry even though I made the Humidity Max (8).

[lemonbomb]

I'm going to suggest an alternative to ajack, and you're welcome to consider either approach.  I think Ramp is wasted on you, and suggest you turn it OFF.

What is the logic in removing the Ramp, currently I like it as I am still getting used to the CPAP. But of course ill try it later tonight 

[lemonbomb]

The increase in pressure around 03:00 looks like a cluster of positional obstructive apnea.  We often recommend a soft cervical collar or other means to avoid chin-tucking, but be aware that it is likely that this cluster relates to you tucking your chin towards your chest, and higher pressure will often not help with positional problems.  Read the Positional Apnea Wiki here: http://www.apneaboard.com/wiki/index.php...onal_Apnea

This is amazing! I did this test;

Two ways to check for this Positional Apnea

• Sit relaxed in a chair and as you fully relax let your chin drop to your chest and note the increased airway resistance that may range from an increased effort to a snore or full blockage.
  
  
• Another test is to gently push upward on the soft part of your jaw or neck right in front of the throat.
  

And yes when i tuck in my chin I lose like 80% of my airway. And i actually sleep with two pillows stacked under my head. I'll try a different pillow and if not ill get a cervical collar.

This is great advice!  

[lemonbomb]

Would this help with the Positional Sleep Apnea?

[commercial link removed, instead, search for "Soft Firm Foam Cervical Collar Neck Brace Neck Brace"]

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Moderator Action: Link Removed

To maintain our status as an educational organization, the only commercial links allowed in this forum are to CPAP-related manufacturer websites. This is stated in the Apnea Board Rules with details given in the Commercial Links Policy section.

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[Sleeprider]

That collar looks fine. Go for a fairly loose fit. Keep in mind commercial links are not allowed on the forum. I think one of the moderators has already spotted this one. Your most recent charts show clusters of OA which suggests positional apnea. Using two pillows causes your head to tilt up resulting in the chin-tuck I was talking about. This position must be avoided, and the relatively high pressure you experience will go away once you avoid the chin tuck by eliminating a pillow or using a collar.

You are welcome to keep ramp if you find that to be a comfortable transition to sleep. My suggestion for lower minimum pressure should help you to adapt and make that transition, and as you saw, the step up to 12 cm was too much too fast for comfort. Based on the presence of more CA than OA, my recommendation for EPR is to use a setting of 2 for now. Also on comfort settings, consider reducing the humidity from 8 to 4 or 5. You don't live in an ari climate, and excess humidity may increase nasal congestion.

[lemonbomb]

That collar looks fine. Go for a fairly loose fit.  Keep in mind commercial links are not allowed on the forum.  I think one of the moderators has already spotted this one.  Your most recent charts show clusters of OA which suggests positional apnea.  Using two pillows causes your head to tilt up resulting in the chin-tuck I was talking about.  This position must be avoided, and the relatively high pressure you experience will go away once you avoid the chin tuck by eliminating a pillow or using a collar.

You are welcome to keep ramp if you find that to be a comfortable transition to sleep.  My suggestion for lower minimum pressure should help you to adapt and make that transition, and as you saw, the step up to 12 cm was too much too fast for comfort.  Based on the presence of more CA than OA, my recommendation for EPR is to use a setting of 2 for now.  Also on comfort settings, consider reducing the humidity from 8 to 4 or 5.  You don't live in an dry climate, and excess  humidity may increase nasal congestion.

Hi SR,

Yup got my warning from the mods, wasn't aware about the commercial links. But thanks I'll go ahead and buy the collar its just $5! So I did all but the humidity. And switched from the F30 to a DW Nasal Pillow.

Standard Settings

Ramp Time : 10mins
Climate Ctrl : Manual
Temperature : 27C
Humidity : 8
Tube Temp : Auto
Pressure Relief : On
Smart Start : Off
Mask : Fullface
Clinical Settings
Therapy
Mode : AutoSet
Max Pressure : 20
Min Pressure : 9
Mask : Full Face

Comfort
Response : Standard
Ramp Time : 10 mins
Start Pressure : 4 mins
EPR Type : Full Time
EPR Level : 2

* Switched to DW Nasal Pillows

And my night went well! I used a single pillow and as much as possible would try to tilt my head back (which I could immediately feel the air flow better). I also rarely felt the pressure now. In fact I would raise my mask as some times I thought the machine was off.

I also as previously said changed my masks from the F30 to a DW Nasal Pillow (I bought 3 masks). I was initially worried as I thought the vents would register as high leaks but my leak rate was even lower than my previous F30 Usage! Amazing! I am loving the small form factor and was more comfortable. I how ever felt a bit of uncomfortable in the middle of the night as my inner nose would feel raw. Probably due to the pressure of the pillows pushing up into my nostrils. I would have to adjust them every now and then.

I'll try the DW nasal cushion tonight!

Once again, thank you everyone! This community is amazeballs! I was very hesitant with the start of my journey. But with a community like this it feels nice to have your pro advice! I wish it was night time again as I am excited to sleep tonight!

NOTE: The spikes in the end was me just rustling in bed as I was already awake. I seem to be involuntarily waking up earlier now.
Also on a side note I ended up buying multiple masks as the masks are being sold here in the Philippines for almost thrice the price. For example the DW masks are roughly about $300 (Php 13,000.00) vs in the US which are roughly ~$120. And for the DW i just bought a DW nasal cushion full set and just the nasal pillow. So with the free bundled F30 that came with my machine plus the DW it was a no brainer.