New Cpap User Looking For better settings Oscar

[focker58]

34 y/o Male 190 lbs
Sleep Study: 7.8 Ahi at home test slept great that night too.
Symptoms: extreme daytime fatigue, brain fog, derealization, waking up short of breath, etc.
Doctor was between low testosterone(260 total t) or sleep apnea. I decided I'm going to try the CPAP for 90 days before injecting testosterone.

Its been three weeks with it. Started with 4-20 on the AS11 with the f30i mask. First 4 days was awesome then started having issues with mask sealing only sleeping 2 hours and waking. Switched to the F20 mask no more leaks sleeping longer too. But the pressure was so high I would wake up with my cheeks inflating and belching air. Called the doctors office they turned it down to 4-15. Now I have been sleeping around 4 to 7 hours a night on this thing. I don't have much data as I recently bought the sd card. Looking for advice on settings my AHI is still close to my sleep study. Thank you.

[jdougc]

Welcome to the forum,

Are you on any medications that affect your breathing or sleep?
Do you have any health issues that  affect your breathing or sleep?
Can you post a copy of your sleep report with your personal info redacted.

We need to see the device settings.
Your minimum pressure is too low for an adult, set it to at least 8 cm. Set ramp to 7 cm for 5-10 minutes, if needed.
Your Flow Limitations are too high and causing your pressure to increase throughout the night. Are you using EPR? Set EPR to 2 or 3, you might see an increase of CAs though, keep an eye on that.

You are having positional apnea.  You can see positional apnea where either Hypopnea or OA events are clustered together. Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…
You may need a soft cervical collar.

[focker58]

Thanks for the reply. Ill bump up my minimum to 8.  Haven't changed pillows in about 2 years. I have memory foam pillows. Only use 1 when sleeping. As far as positions go, I sleep pretty wild. I prefer to start on my side or back. I normally end up on my stomach which I dislike, as it kills my lower back.  I attached my settings and sleep study. 

Are you on any medications that affect your breathing or sleep? No. Melatonin 2mg every once in a while if I have an earlier shift at work.
Do you have any health issues that  affect your breathing or sleep? No.
Can you post a copy of your sleep report with your personal info redacted. This is all I got from the DR. See new attachment.

[jdougc]

You may need a soft cervical collar. You have positional apnea.
Try to stay off of your back, unless you get an inclined pillow, but this makes it difficult to side sleep, which is the best possible position for apnea.

 Set EPR to 3

[focker58]

Got my pressure set at 8 to 15. EPR up to 3. I will see how that works tonight. Then get the collar next time I make it to town and see how much of a difference it makes.

[jdougc]

Try holding a pillow under your chin, until you got a soft cervical collar, some people have had a little success keeping their chin from tucking to their chest.

[Deborah K.]

You are too often bumping against your high pressure setting, and your median low pressure setting is over 12.  You need to raise your pressure settings to at least 9 to 20.  Your machine will only go as high as you need, so it shouldn't be a problem.  

To avoid aerophagia, try the settings Doug suggested tonight and see how you feel.  You need to eventually work up to the settings I suggest, but do it slowly if you show signs of aerophagia.  Aerophagia is more than puffed cheeks, but your puffed cheeks may be a precursor to aerophagia, so take it slowly.

[jdougc]

From 9:00 until around 9:45 he was at the maximum pressure because of the flow limitations. ResMed aggressively raises the pressure to ward off worse events.
Later in the night it was positional apneas causing most of the highest pressures, increasing the pressure probably wouldn't help.
A collar might help or if sleeping on your back and inclined pillow might help.

[focker58]

Slept good last night 5.2 ahi 7 hrs again. Woke up naturally at 5am which was nice. I was on my back when I awoke with 2 pillows for some reason. Bought a cervical collar will give it a shot tonight. Lol my wife is making fun of me saying I've got too many gadgets, I told her anything to get more energy for her and the kiddo.

[jdougc]

I am glad you slept well and your attitude to do what it takes!