Need help optimising treatment

[trenton78]

Hi, I've just started with CPAP and I'd very grateful for any advice/help with my treatment. I was diagnosed two years ago with OSA (AHI approx. 21, sleep study attached). I'm currently using a test-device (Resmed Airsense 10). I'll only get my own machine and mask next week. Currently I'm trying out the N30i mask. 

I have no idea how to read the Oscar data. Subjectively the first two nights were quite good, last night was bad (I had trouble with leaks and comfort). 

Thanks for taking a look!

Trenton

   

[attachment=30761]    

[staceyburke]

There are 2 things I would change. First your low pressure is 5 and that is quite low. Most adults need more air than that. All of us are different but I need at least 9 or I’m tearing my mask off and gasping for air. So I would move the min pressure to 8. 

Second you are using ramp. Most of us turn the ramp off. During ramp you are getting NO therapy.   It there for people to fall asleep before you get to therapy pressure. So I would just turn it off. 

Then don’t change this tonight BUT watch your centrals. If they get worse turn the EPR off. What the EPR does is lower the exhale pressure to make easier to exhale. The problem with this for some people, is the larger the spread between the exhale and inhale pressure brings on centrals. After you get A custom to Pap therapy they many times go away and you can start using EPR again.

[trenton78]

Thanks for the tips, that's very helpful! I'll try with a higher minimum pressure tonight.

[Melman]

Welcome to the forum. You've got the best machine. Be sure your permanent machine is an airsense 10 autoset. Your AHI looks good but the pressure variations are probably disrupting your sleep. I suggest you increase your minimum pressure to 7 or 8 and increase EPR to 3. Those changes should reduce the flow limitations and and pressure swings. Do away with ramp unless you absolutely need it. A starting pressure of 7 or 8 is fairly low. Leaks don't look too bad but they effect your comfort is subjective. See the link to the mask primer below. It may provide some help. The initial comfort challenge varies from person to person. It may help to wear the mask with pressure while awake reading or watching TV to get accustomed.

[trenton78]

Thanks to both of you for your tips. I tried a higher minimum pressure (8) and it felt fine.

Then don’t change this tonight BUT watch your centrals. If they get worse turn the EPR off. 

But I do seem to have more CA events. So do I try turning EPR off or do I wait a few days?

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[staceyburke]

It is up to you, if you want to try a little less EPR.  It won't be a problem to go down if you don't mind the added pressure on exhale.  I would try it at one and if you feel you need to raise it do.  The good thing I see is these are when you are waking up.  That happens a lot - but if the centrals are waking you up then of course it would be better to lower the EPR.  So it is more how do you feel these are effecting you.  Are they waking you up?  Do you wake up short of breath?  If so lower the EPR if they are coming on after you wake up leave it alone.

The other thing is that central vary on the night - one night you will have some the next night not as many at the same pressures, really for no reason.  OAs and Hs are pressure driven and stay pretty constant at the same pressure..

[Sleeprider]

The use of EPR stabilized pressure, decreased flow limitations, hypopnea and RERA, but increased CA events. This is pretty common, and it is the result of increased ventilation that washes out CO2. The centrals will diminish as you adapt and become accustomed to CPAP with the higher EPR. I'd recommend keeping these settings a while longer and see how things settle out after a week. On your other charts you used a recording oximeter. It might be interesting to see how the increased EPR compared for pulse and oxygen events.

[trenton78]

On your other charts you used a recording oximeter. It might be interesting to see how the increased EPR compared for pulse and oxygen events.

Thanks for the advice on the EPR. I'm keeping the setting on 3 for now. I had to give the oximeter back. Here's the last recording with it. Not sure what can be read from the data.

[attachment=30849]

I'm trying out a new mask now (P10 instead of N30i) and the first night wasn't great (see screenshot below). I seem to have considerably more events and subjectively it feels like I'm not breathing as well with new mask. I do like that it's so lightweight. 

The N30i wasn't that comfortable for side-sleeping although it produced better results. I'm not sure if there's anything I can tweak with the P10 or if I should ditch it all together. 

[attachment=30850]

[dapal]

I started with N30i, then F20, then F30 but now feeling good with P10. I push my mask away let some air out then put it back in place I could feel little air going to my nose. I like P10 because it stay in place and air won't be leaked out. You need to practice breath out by nose or use soft collar or chin strap if you breath out by mouth like me.

[Sleeprider]

Give the P10 some time for the kinks to shake out before making a decision. I have used one for many years. Both charts suggest a minimum pressure of 9.0 to help stabilize pressure.