Need some help after mask change

[tomkatt]

Hey, long time lurker here and I'm running into trouble. Not sure how much info is needed, but to start I was diagnosed with obstructive apnea back in mid-2017 with the following stats:

• RDI (AHI): 116.92
  
• RDI (AHI:REI) 25.2
  
• Hypopneas: 85
  
• Obs: 63
  
• Centrals: 11
  

I didn't have decent insurance at the time and the DME was unhelpful, I ended up with a 5-20 range prescription which was... less than helpful. I researched a ton and I've managed my own care (and CPAP machine config) all these years and until recently was on 8-13 min/max, and using a Philips Dreamwear nasal cushion mask. I have a Resmed Airsense 10 machine

I've been frustrated with Philips in recent years with all the recalls for CPAP and ventilators, and in the last year or two, mask quality/QC has been terrible, I've had to basically discard one out of every three pieces of kit (particularly nasal cushions) I've bought of theirs due to various defects (not enough air, poor CO2 exhaust and whistling, bad connection leak on the connector, etc.).

I recently switched to the Resmed N30i and it it's much more comfortable, but I'm boggled by the number of clear airway events I'm seeing, and not really sure how to address it. Was hoping someone here might be able to help. Normally my numbers are below 5 AHI (often much lower, usually between 1-3) but lately with this mask and the large number of clear airway / central events, it's been as high as the mid-40s.

Also, I've noticed the N30i reports a much higher leak rate. However, I'm not experiencing said leaks, it's making a good seal as far as I can tell. By contrast the Dreamwear would report no leaks but regularly be blowing air in my eyes at night.


I'm just stumped, and don't have a sleep doctor near me these days, as I've moved to a rural area. Haven't actually been able to work with a specialist since my diagnosis, but haven't really needed much help until now. 


Please let me know if any additional pics are needed. Also, in the images depicted, only the right side stuff I've selected. My time of day is screwed up on my machine and it's sometimes splitting part of the previous day. I've focused the pics on most of last night's details.

Thanks in advance.



   

   

   

[tomkatt]

I forgot to add in the original post, if it matters, I have been known to mouth leak, and I use a soft cervical collar to prevent this and keep my jaw up. I change the collar regularly (about every 2 months or whenever it stops being firm).

[super7pilot]

I didn't have central's on my sleep lab. But it is my understanding that they need some sort of more specialized bi-level machine like the Resmed aircurve as opposed to CPAP/APAP.

The folks with knowledge of that will likely chime in at some point. The high altitude of Colorado doesn't help either.

[tomkatt]

I didn't have central's on my sleep lab. But it is my understanding that they need some sort of more specialized bi-level machine like the Resmed aircurve as opposed to CPAP/APAP.  

The folks with knowledge of that will likely chime in at some point. The high altitude of Colorado doesn't help either.

I hear you. I'm also in Colorado, over 5800 ft elevation. My centrals were minimal on my lab, and they didn't consider it worth noting given the large number of obstructives and hypopneas. I was diagnosed with obstructive apnea.

I've only ever had a large number of centrals when undergoing CPAP therapy, and I've had to adjust my settings for every mask I've used until I got it sorted. I had it worked out with the Dreamwear for years, but their QA seems to have taken a nosedive in the past year or two, and I'm sick of their crap. I just don't trust Philips as a brand anymore given how badly they've botched literally everything the last several years.

[super7pilot]

Then you might try going up on your minimum to your median. So set minimum to 9 or even a tick higher.

On Resmed machines the nasal pillow setting has a reduced pressure because of the small mask volume. The F30i has more volume and needs more pressure. But I also have ZERO knowledge about resperonics machines and their mask settings. so I might be horribly incorrect.

[tomkatt]

Then you might try going up on your minimum to your median. So set minimum to 9 or even a tick higher.  

On Resmed machines the nasal pillow setting has a reduced pressure because of the small mask volume. The F30i has more volume and needs more pressure. But I also have ZERO knowledge about resperonics machines and their mask settings. so I might be horribly incorrect.

My bad for the confusion, I'm on a Resmed machine (Airsense 10). Used to use a Dreamstation before the debacle, and until recently was using the Dreamwear mask. So increasing the minimum airflow might help with the clear airway/central events? Alternately, would using the "nasal" mode on the N30i cushion cause any issues (resmed says to use "pillows" as the mode).

[SarcasticDave94]

Show us a new, no zoom OSCAR chart to get a bit better overall view.

You had 11 CA on the test result you made mention of. This itself may not be enough for the doctor to say CA are an issue. On the test, CA is Central Apnea, in the machine CA will be clear airway due to the CPAP doing its checks when there's a breath airflow restriction.

If CA are an issue now and you're at higher elevation, CO sounds like it, you may want a Titration with ASV mode included. Make certain the test is done nearly the same elevation as your home.

And edit your left panel use info to reflect the ResMed.

[tomkatt]

Show us a new, no zoom OSCAR chart to get a bit better overall view.

You had 11 CA on the test result you made mention of. This itself may not be enough for the doctor to say CA are an issue. On the test, CA is Central Apnea, in the machine CA will be clear airway due to the CPAP doing its checks when there's a breath airflow restriction.

If CA are an issue now and you're at higher elevation, CO sounds like it, you may want a Titration with ASV mode included. Make certain the test is done nearly the same elevation as your home.

And edit your left panel use info to reflect the ResMed.

I'm not sure that CAs are an issue now, I wasn't having them with my other mask. These literally started with me changing to the the mask. Prior to this, a normal night for me still had a few centrals, but nowhere close  to what I'm seeing. It was more like the attached image here (this was with the Dreamwear mask):

   

The above is from earlier in March before I changed headgear.

Here's a few from the last week (I've been messing with the settings trying to sort out the problem, so settings vary).

March 24th:
   

March 26th:
   




Also thanks for the heads up about the profile, I thought I fixed that. I'll get it sorted, and I'll upload a new chart from OSCAR after I sleep again tonight, but

[tomkatt]

Quick edit - my original test in 2017 was at altitude, I've been in Colorado for nearly 15 years, and have lived at my current altitude for over 3 years (previously I was near Denver, slightly lower but still at or over 5200 feet). I don't know the details of the test, but they gave me an at home test with titration and a pulse oximeter attached to a machine that recorded the readings and audio for snoring. As far as I know it was a full apnea test, since prior to the test they didn't know if it was central or obstructive apnea, but after I was diagnosed with obstructive apnea. If you like I can post a screenshot of the original papers (minus identifying info), as I still have it.


Also, gonna take super7pilot's advice and move my min closer to my median pressure. I already tried lowering it from 8 to 6.8 and 7.4 that didn't help at all, but I didn't realize the airflow was lower on the pillow setting, so I'll try bumping the minimum to 9 tonight and see how it goes. 

I was previously on a range from 8-14 with my old mask, but generally the pressure hovered between 9 and 10 most of the night, and rarely went above 11.

[SarcasticDave94]

Lots of events at the beginning of a session might be sleep wake junk (SWJ). CA in any form will be consistently inconsistent, here then not randomly without changes.

Titration is always a lab test to check pressures and modes needed.

I would try standard response.