Need some help/advice - here's my symptoms and machine settings

[bbillingsley1985]

The EPR has been turned off because of previous recommendations earlier in my posts so that's why I currently have it off. I'm open to turning it back on if we think it'll help. I've tried it both on and off and really don't notice much difference while trying to sleep so it doesn't matter to me.

Yea what you said about masks is definitely true. I'm intrigued by the Activa but supposedly the vitera was supposed to also essentially float and maybe more user error than anything, but I was never able to get it to get a full seal and the mark on the nose is just a killer. That's why I think my best call is to give the p10 or p30i a try because of the fact that it sits under nose and nothing has to touch the top of my nose.  Advantage of getting p30i is I can buy a $15 N30i cushion later if I needed to and try that with the same setup.  But p10 looks like it's about as simple as they come which is probably what I need.... simplicity.

Is the only real difference between p10 and p30i the fact that p30i has hose on the top and slightly different headgear?  Or is there something else you've heard that may hinder the p30i

[SarcasticDave94]

Just note that a full face, unless it's the hybrid type with a nasal cradle like upper section, will have part of the cushion sitting across your nasal bridge.

So far it seems the suggestions I've given have not worked well. Then it's time to try suggestions of Gideon, Sleeprider, and others, and then see if it helps.

I've got the N/P30i in my arsenal of masks. They are fine for those that don't mouth breathe or can control this better. They will be pretty comfortable. Try this or the P10. I think the main difference is the top of head connection and the air tube frame on the x30i units.

[bbillingsley1985]

Dave I really appreciate the advice you and everyone here has provided. I know everyone is trying to help and I've gotten a lot better info here than from my own doctor.

I may just be a lost cause lol.  But yea only option I really see to do is give the nose /pillow ones a try because obviously 3 different kind of face masks haven't worked out for me.  I think nose will probably work out better for me and if I ever do notice mouth breathing I can get a jaw cover thing.  Also is nice to know I can keep the F30i as BackUp in case my nose is ever stopped up, etc.

I think what'll help me the most is hopefully finding a tolerable nose mask and then sticking with that exact same setup for a while and then maybe I'll start to see some changes. I'll quit posting as much unless I see something funky on the chart. I'll definitely update if for no other reason than to help others that's maybe going through similar issues.

Again I really appreciate everyone's help, it means a lot to me.

[SarcasticDave94]

BTW if it helps, make sure to get a mask starter kit. This gives you 3 or 4 cushions, 1 of each size with the headgear and elbow. This enables you can try the different cushion sizes.

[bbillingsley1985]

I'm going to attach my full sleep study here.  

So last night I turned EPR back on (to default of 3) per another suggestion and the CA's shot up way high again (22 events I believe).  As far as sleep quality, it doesn't feel any worse or better but it does show a lot more CA's on the chart for the night.  Because it doesn't seem to really affect me on quality of sleep (quality stinks either way) should I leave it on and try to get used to it if the plan is to eventually turn it on anyway..... or should I turn it off?

Also, after doing some research, could these be Central Apnea's.  I'm going to attach my full sleep study.  On page 1 I have just the summary but figured I'd give the in depth one here.  I know from reading other posts, the cpap won't work for Central Apnea's.  The study showed I had 14 total, or only 1.6 per hour which doesn't seem too bad and looking at their chart the bulk of them occured in the last bit of my sleep where I was probably up anyway tossing and turning.  I'm wondering if the EPR being turned on is tricking my brain into not breathing and maybe making that worse?  The times I wake up in the middle of the night don't really coincide with the CA's on the chart but again its usually 3 hours or so of solid sleep, then tossing and turning the rest of the night.

Mask wise, I used the Vitera last night and actually probably had about the best night leak wise from it (though still not great).  It's comfortable and all, just a big dark red mark on my nose.  I'll use it again tonight and then tomorrow I have an appointment to try out the pillow mask.  Have it narrowed down between the P10 and P30i.

Here's last night's chart, and 2 more pages from when my full study is done.

[SarcasticDave94]

The breakdown tells us you had 14 Central Apnea, 33 Obstructive Apnea, 1 Mixed, 43 Hypopnea. Overall, you had an event of some sort every 6 minutes or so. So I'd say there's something to treat.

Longest CA was 19.5 seconds, longest OA 30 seconds, longest mixed 17 seconds, longest Hypopnea 106.5.

I'd say your Hypopnea is the worst of your events, then Obstructive, and finally Central. Mixed was minimal.

There were some desats due to Apnea, so again IMO pointing to need for PAP therapy.

Because there were Central Apnea, I'd believe some Hypopnea were Central based, but the breakdown doesn't label Central vs Obstructive Hypopnea. Even so, your Central based events were likely not equal to Obstructive, maybe a 60/40 split Obstructive to Central, something like that. Note that you do have Central events, so you do have a tendency to have them.

You may find you can do well with the CPAP based therapy if you can balance it to treat Obstructive and Obstructive Hypopnea events and avoid as many Central based events as possible. Failing to accomplish that balance, ASV would be your best bet.

[bbillingsley1985]

Just an update that I did get the P30i mask and tried it for the first time last night.  I'll kind of list down what happened last night and I also have 2 questions.

She gave me P30i cushions and also a medium N30i cushion just so I could try out both.  I adjusted my machine from "Full Face" to "Pillow" and didn't alter anything else with the machine.  Immediately when I put the P30i on, it felt like I had a ton of air going through me compared to the full face masks.  It was weird getting used to because even while trying to sleep I couldn't breathe through my mouth even if I wanted to with the way the air flow was going through my nose.  A really weird feeling when you open your mouth as the air is going through your nose.  I'd be confident that there would be no way I could breathe through my mouth with that thing on.

Sleep wise, it was a huge adjustment compared to full face.  I thought it would feel more comfortable than full face but it didn't initially.  She gave me a medium cushion and small cushion and suggested I start with the small so I did last night.  I would say it took me approximately 30-60 minutes to fall asleep after putting it on.  When I first put it on it felt like too much air and sort of felt like my heart was racing so I tried to settle down and take shorter breaths and calm down a little.  After falling asleep somewhere around 12:15-12:30 the next ~3 hours went like a blur.  I jolted up around 3:15-3:30 and honestly wasn't even sure if I had fallen asleep yet until I checked the clock.  I don't know if that's necessarily a good thing or a bad thing but it was different because prior to cpap and with the full face I was always pretty aware of how much I'm sleeping at a time.  When I woke up at 3:15-3:30ish my nose was hurting a little on the inside of the nostrils but mainly on the outside of the nostrils where it was pushing up against them.  I think small is probably too small for my nose and probably I had it a little too tight.  I'll try a medium cushion tonight and loosen it a bit.  It felt like I had absolutey zero leaks.....I couldn't see how I could of had a leak with how much air was flowing through me, but the chart shows I did indeed have leaks past 1 am.

After 3:30 I couldn't fall back asleep so I turned off the machine for a bit and since my nose was sore I through the N30i cushion on and turned the machine back on.  I knew I pretty much wasn't going to sleep the rest of the night (when I jolt up after 3 hours I'm usually done) so figured I'd give it a quick trial run.  The N30i cushion was super comfortable and I loosened the straps because my nose was a bit sore.  The chart showed leaks during that time so if I go with that cushion I'll need to tweak it but impressions were it was very comfortable but the way I was laying (side sleeper) I felt like at times it was cutting off pressure from either my left or right nostril depending on how I was laying.  I never fell back asleep the rest of the night, so everything in that 1h26min stretch on the chart I was awake just laying there adjusting.  The leak rate was pretty high in that stretch.

Here are my questions.  On the 1st pic, it looks like my leaks were great until about 1 am where it shot up.  With the medium cushion and a few more tweaks I can get that under control I believe.  Where my question is, you see at 3:20 I had 2 CA's back to back.  I'm pretty sure that coincides with the moment that I jolted up.  Now I have never woken up during cpap or prior with shortness of breath or any of that stuff, I was feeling fine when I woke up (other than the nose pain) but the fact that back to back CA's occurred right around the time I woke up made me think that maybe that jolted me up.  I don't know the exact moment it occured so its also possible that I alreayd had jolted up and was just holding my breath for a bit during that time.  On the 2nd and 3rd pics, I zoom in to show the flow rate and all right as those happened.  Is there anything you can tell from that in regards to was it a Central or was I just holding my breath?   Anything I can do about that?

Second question.  I feel like with the pillow mask I should probably lower the minimum pressure.  I'm honestly thinking maybe lower it to 5.  I have the EPR on so that will by default make it like a 1 I guess.  Is this a bad idea?  Any suggestions on if I should or shouldn't lower the pressure.  I just know it felt like I had a air compressor blowing through my nose all night.  6/7 was needed for full face, but feel like I can get by with less pressure using the pillow.  I did confirm that I also had the machine set to pillow as resmed says to do for both P30i and also the N30i.

[bbillingsley1985]

Quick update on night 2 with the P30i.  I fell asleep quickly and looks like I got really close to 4 and a half hours of straight sleep.  I then jolted up right around 3:30.  There were 2 CA's right around the time I woke up just like last night.  I really wish I knew if those 2 CA's occurred before or after I woke up.  If it occurred before I woke up then I'm thinking those 2 CA's caused me to wake up.  If I was already up then I obviously did those myself adjusting.  Anything you can tell from Pic2 that would indicate if I had woken up or not?  Anything I can do to fix that if so?  

When I woke up my nose was hurting pretty bad both inside and out (I'm so high maintenance with these masks lol).  My throat was also dry.  Would that indicate my mouth had opened up or just the pressure from the air flow?  There was absolutely no leaks that I could tell at any point from the nose area with these pillows but looking at the chart you can see that shortly after I fell asleep the leaks started to rise?  Could this mean my mouth might have been opened?  If so that's obviously a problem.

As far as my rest, I slept solid from 11:15 to 3:30 am.  Woke up at 3:30 am with nose pain, and back of throat was dry.  At that point I threw the mask off and actually slept without waking up once with no mask from 3:30 until I woke up around 6:30.  All in all it was amazing to only wake up once during the night but the negative was I did the last half with no mask at all.  Can you tell from the charts if my mouth was likely open while sleeping (leak rate was near 18 for the last 2.5 hours or so).  Also I did lower the minimum pressure to 5 and set the EPR to 1 and that really seemed to work well for me.  The lower air flow helped me relax better right off the bat (maximum is still default at 20).  Looks like the pressure never rose past 7 or so most of the night. Afraid the minimum setting of 7 may have been too high for me....but again who really knows.  Just trialing and erroring trying to figure out what works best.

[SarcasticDave94]

Just what I see, leak rate was up to 18ish before and during these 2 CA, and your flow rate turned into an "off" pattern just after. Maybe that's you moving about, but it's a guess only. And if that's from movement, that appears to me to be after the CA.

[bbillingsley1985]

Just to update what's happened over the past few days.  The tldr version is, I have 3 questions.  What should my pressures be set to, what should I do about epr, and what is a reasonable leak rate for the F30i mask.  Here's some details below of my progress over the past 4-5 days.

I tried the P30i another night and after waking up again with bad nose pain I had to abandon it.  Switched to the N30i the next night.  It was super comfortable just like the F30i, no pain or issues but I noticed the same pattern of leaks as I had with the P30i which was significant.  I know the P30i didn't come out of my nose at all so the only conclusion I can draw is that I had my mouth open.  So the options become:

1. Stick with N30i and tape my mouth shut/use a jaw sleeve/etc.  Don't love the idea of taping my mouth shut for safety reasons and I feel like anything that would allow my mouth to slightly open I'll probably still open it and/or breathe through it anyway.

2. Go back to the only full face mask that worked for me which was the F30i.  Most comfortable mask I have by far and looking back into page 1 of my posts, my chart showed the best success with that F30i.

I've now ruled out that the standard full face masks (Vitera and F20) do not work (red marks on nose) and pillows/nasal doesn't work (leaks through mouth).  So I decided to revert back to the F30i and stick with it a few weeks straight and really see if I can get used to it.  I've worn it for 2 straight nights and like the peace of mind that yes I'm trying to only breathe through my nose but if I breathe through my mouth while sleeping I'm covered.

I attached my chart from Sunday night.  I unfortunately forgot to put the SD Card in the PC before I left this morning so I don't have last night's data but the AHI was virtually the same as Sunday night.  I have 3 questions.

1.  I had forgotten to change my min/max pressure from the pillow settings I was tweaking with.  I needed less pressure with the pillow/nasal compared to the full face.  I also had EPR on and at 1.  Looking at the chart, it looks like my median pressure was 7.54.  What is your recommendation on what my min pressure should be set to.

2.  As for EPR, it's proven from past chart data that my CA's rise when EPR is on.  Should I leave it off forever or should I throw it on at 3 and just try to get used to it?  It's sounding like eventually I am going to want to have that on for better therapy anyway?  Sleep wise, I always sleep like crap so I haven't noticed it affecting my sleep quality at all rather its on or off and I've tried it pretty much all ways.  On the attached chart, notice I had about 7 CA's in the last 30-45 minutes.  I was pretty much up tossing and turning during that time so that gives me hope that most of those CA's is me just tossing/moving/etc.

2.  Quite simply, what is a reasonable leak rate I should expect.  You see that night it was always below 13 with a median of 2.4 until around 5:50 am....I'm pretty sure I was awake and tossing and turning starting at that time and pulling mask down readjusting so I'm not too concerned about the leaks on the last part.  Is a leak rate like that OK, or do I need to try to adjust the mask more?