New user (Chitlom) looking for advice

[Chitlom]

Hi and Thank you for all I have learned from this community as I start my CPAP adventure.

I have been on CPAP for 3 weeks. 

My Sleep Study Results were as follows:

Obstructive Apnea Index was 47
Central Apnea Index was 2.5 
Apnea/Hypopnea Index was 79
Desaturation Index was 56
The lowest associated O2 value was 78%
Relative Snoring 58,6%

The first week I used a loaner mask. I am not sure what it was but it was large and leaked. My AHI numbers the first week were between 8-12, but I had not yet discovered ApneaBoard and was just using the machine the way the DME presented it to me.

The second week I used the F30 Mask which started leaking every night around 2am. The leaking was waking me up.[attachment=12352]

In the past 7 days I have tested 2 masks, first the P10 and then the N30i. The N30i is more comfortable but my AHI numbers looked better with the P10 (the P30i is not available where I live). My AHI numbers over the past week were:

May 23 . 40    P10
May 24  .95    P10
May 25  .43    P10
May 26 1.37   P10
May 27  1.36  N30i
May 28  2.83  N30i
May 29  1.98  N30i

I would like some advice on how to move forward regarding my settings and which mask to continue with.

I should mention that since starting CPAP therapy I don't feel that much different, now that I am on the CPAP, as I did before starting. I am not feeling bad, just not feeling the remarkable change that some people report after starting CPAP.

Thank you in advance for your help.

I have attached 5 days of screen shots:

[DeepBreathing]

G'day Chitlom. Welcome to Apnea Board.

Your numbers look very good, and even the worst of the plots you posted is well within the "treated" category. It's really now a matter of maximising your comfort and ensuring you get consistently good numbers. Not everybody gets that instant remarkable change - for most of us it's a gradual process with some setbacks along the way. Some of the first indicators that things are improving will include:

• Fewer toilet breaks during the night
  
• Less inclination to doze off after lunch
  
• Fewer morning headaches.
  

The hardest part will be finding a mask which suits. It must be comfortable, fit properly and not leak. The small difference in AHI between the P10 and the N30 is really negligible, so go for the one which is most comfortable. In either case there is likely to be some leakage through your mouth, though it looks like you've got that under control.

You might want to raise the minimum pressure just a bit, which will help reduce the small number of events you're having. I did notice you've got a few central apneas one night but that seems to be an isolated cluster which you can probably ignore.

[Melman]

I agree with DeepBreathing. Since your median pressure is between 8 and 9 I suggest a min of 8. You may find increasing EPR to 2 will also help reduce the small number of events and improve your comfort.

[sheepless]

did you remember to change your mask type in the machine settings? nasal vs pillows. it might have something to do with the ahi difference.

[Chitlom]

Thank you. It is great having your input. I otherwise feel a bit alone on this journey.

I will increase my Min pressure to 8 and see how it goes.

[Chitlom]

Thank you for your advice. The DME gave me the machine at with an EPR of 3. I was getting double digit AHI's so I tried changing it to 2 which improved my AHI. The next night I changed it to 1 and my AHI was much better. So the next night I changed it to 0 which caused my AHI to go back up and I woke up bloated like a balloon. 

So ever since I have kept it at 1. I will try changing the Minimum pressure to 8 and after seeing how that change goes can try changing my EPR to 2 again.

I will then let you know how it is going.

[Chitlom]

Thank you for the tip. It is my understanding that both the N30i and the P10 are considered "pillows" on the Resmed Machines. Before learning this I tried the N30i  in "Cushion Mode " for a couple of hours but the machine blew too much air (interestingly Oscar shows the "Cushion Mode" for the whole night.