New to CPAP need help

[tootired4this]

Hi I'm new to using CPAP, I had a sleep study performed over a year ago and had to wait 16 months for the diagnosis and to receive my cpap machine. I was diagnosed with severe obstructive sleep apnea. More than 30 events an hour.


I've been using my machine for about a week now, I've managed to get mask leak down to a relatively low number but I'm still getting 7+ AHI on a daily basis alongside a large number of RERA events, looking through the graphing it seems there are a number of oddities in the breathing flow rate which look like RERA events and aren't getting flagged so I suspect it's higher than being shown. I've made some changes to try and make things better including turning EPR to 3 which seems to have reduced flow limitation down but I'm still feeling terrible I wake up exhausted and it takes hours until I feel like I have any level of energy.


I've attached last nights oscar report.

[SarcasticDave94]

Your Max pressure 15 isn't high enough. The pressure red trace is skimming along the top most of the night, indicates more Max pressure needed.

Your flow limits are high, too much of them for EPR 3 to help. Last resort is more than 9 Min pressure.

This precludes the other items though. You game some Positional Apnea patterns, especially at the beginning. See the cluster of events? That's what I mean. You're sleeping in a way that your chin tucks towards your chest, kinking off the airway. Read my signature link.

[Deborah K.]

I suggest you change your pressure range.  You are starting too low, and as Dave said, you need a higher pressure limit.  Your median pressure is over 14, so for now, raise your 9 to at least 11, and your high pressure setting to 20.  The machine will only go as high as you need.  

So, set pressure at 11 to 20.

With your extremely high flow limits and high pressure needs, you may well need a bilevel machine.  The ResMed AirCurve 10 would be great. I had to make that switch, and it was so worth it!  I sleep much better now.  If it interests you, read my long thread below my signature, where Sleeprider and some others helped me get my doctor to prescribe the machine I needed.

Best wishes for achieving great therapy and comfort!  

[SarcasticDave94]

Good interpretation. I meant more min than 9 not the typed 5 I had to correct.

[tootired4this]

Thank you both, I've changed the device settings this morning to 11-20 for pressure, I ordered a soft collar yesterday and i'm hoping it arrives today.

Oscar report for today/last night is worse, I tried jury rigging a soft collar using some fabric and rigid material I had which doesn't seem to have helped and I slept without using a pillow. The early part of the report can probably be ignored as I was awake for the first 30 minutes it was on before falling asleep I also tried napping with the machine earlier in the day. Would elevating my torso during sleep help? Sleeping in the following sort of shape,

__/

to help with Positional apnea whilst I wait for the collar to arrive?

[CPAPfriend]

Pressures are too low. Start increasing both min and max and continue so long as things don't get worse. Not medical advice, etc. You're one of the clearest cases for insufficient pressure, for what it's worth.

[tootired4this]

Wore the collar last night/this morning. woke up at 2am not wanting to try and get back to sleep but eventually did. Collar was suffocating and hot, both to big and to small for me. I have a wide short neck.

Oscar shows lots of CA events which I understand to mean clear airway, so that means I wasn't trying to breath inspite of having a clear airway?

[SarcasticDave94]

Yes CA indicate as you say. Unless there's sleep study indication of CA issues, these will be treatment emergent CA. This is caused by extra flushing of CO2 from the CPAP machine slight pressures over natural.

This does not mean lower any pressures though. Your nervous system breathing is expected to be in a certain value and adding CPAP changes the balance the brain expects. It'll take a bit of time to relearn this.

If CA are a real hindrance, you can lower EPR to 2 and see if it helps. Turn off the Ramp as well.

The first big cluster around 01:15 also has some high leaks, possibly from the max pressures the CPAP used attempting to clear your airway. Since it couldn't do anything, this is another indicator these are Positional Apnea. If the first collar isn't working, you'll have to try another. It's very clear your Positional Apnea will hinder your therapy a lot. Get this resolved, and likely your therapy pressures can be reduced.

[tootired4this]

Had my first night of sleep where I woke up not feeling like a zombie so huge win!

I wasn't able to find a cervical collar that fit so I bought a large wedge pillow to raise my back with the hopes of reducing positional apnea as I'm a back sleeper and it seems to have helped a lot. I did wake up with really bad dry eyes which I think is because the mask is leaking air out the sides of my nose towards my eyes.

Here's my latest oscar report. Whilst there are a number of events that the resmed didn't flag I still feel much better than I did yesterday here's hoping today wasn't a one off.

[tootired4this]

Last few nights have been pretty bleh, waking up early in the morning and feeling tired but not zombie like at least.

I haven't been able to find a cervical collar that fits, but the elevated wedge pillow I've been using seems to be helping, considering the help that just using the wedge pillow has been I'm planning to buy an adjustable bed and mattress as at the moment I find myself sometimes sliding down the wedge pillow at night.


Not sure what to make of the oscar readouts, I think I should probably raise pressure min to 15 but it honestly feels like there isn't much room left for the machine I can see it's bouncing off 20 max most nights.