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Newbie feeling worse overall with CPAP
Newbie feeling worse overall with CPAP
Hey guys, 
I'm a 30YO male who started CPAP a couple of months ago after being diagnosed with sleep apnea with an AHI of 25/hour. Prior to being diagnosed I didn't really feel bad at all, and only had a sleep study done due to my extremely loud snoring and choking in my sleep as reported by my wife. I've been using CPAP almost 8 weeks now. 
After a trial I ended up purchasing a Resmed Airsense 10 autoset and P30i mask. I used other masks during the trial but couldn't stand them. I sleep on my side or stomach and a full face mask just ended up in leaks or unable to get to sleep. After countless days with a red nose I've now got the strap tension correct and comfortable, and go almost every night with 0% leak rate. I would probably have trouble getting to sleep without it now that I'm used to it. The mask is no longer an issue for me at all. 
During the trial I felt like I was getting too much air and breathing too deeply and heavily, so they turned the ramp function right up which helped. Then after a while I found I felt suffocated when putting my mask on and couldn't get to sleep, so after a good bit of reading online I turned the ramp function off and bumped the minimum pressure up slightly and that made a huge difference. I now fall asleep easily within minutes of putting the mask on. 
So far I've had plenty of good and bad nights, but cant really say any of the good nights have been significantly better than any nights I would of had prior to CPAP. I don't notice myself feeling any different during the day either, except on the bad nights when I obviously feel worse off. On average I feel like I'm worse off now, as I didn't really have any trouble sleeping at all prior to CPAP (even if I was having apneas and snoring like a freight train). I'm sticking with it though and hoping it pays off in the end. Also hope I can get help to dial my settings in properly. I've got a couple of questions:

1. Last night was a bad night. I woke up this morning with a sore chest. I've got a deep raspy cough. I don't think I'm sick as the back of my throat looks fine. I'm pretty sure the humidifier ran out of water (there was virtually none left in it this morning), which I guess could explain it? Is it possible too much humidity is a bad thing and could also cause irritation? Mine is set at max (5) and I've noticed now that I'm getting 8 or 9 hours sleep most nights, that it is using a LOT of water (probably 2/3rds or more of the chamber). Previously I could go 2 nights before having to refill it.

2. I'm using the SMALL P30i pillow. I'm used to it now and it seems to be fine. But is it possible that its too small and was causing the feeling of suffocation when putting it on, and I probably didn't need to turn ramp off completely? I've been meaning to try the medium but haven't got around to it yet. 

3. I've noticed in OSCAR that my "clear airway" apnea seem to make up a majority of the events. Obstructive apneas never get above 1 but clear airway get close to 3 some nights. What does that mean? 

4. My max pressure is set at 20, but it has never once gone above 12.5 on any night I've used it. I guess being APAP it doesn't matter so should it just stay at 20? 

5. How do I know what the min pressure should be?

6. Is there anything else anyone notices from my OSCAR data:

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RE: Newbie feeling worse overall with CPAP
Will try to answer some of your questions.

1.  Sometimes, too high of a humidity setting can cause you to feel congested in the morning.  Turn it down a notch and see how you feel with it.

2.  Many here have found that using a larger size mask pillow helps with the air flow.
Try one size up.  

3.  Did you have CA's on your sleep study?  Sometimes, they show up when just starting out and settle down after a bit.  You could try EPR set at 2 instead of 3.

4.  The max setting doesn't matter too much, unless we saw Flow limitation and/or snores on your graphs.  These tend to cause the pressure to raise and in turn can cause sleep disturbance.  For now, I see no reason to change it.

5.  I believe your minimum pressure setting is too low.  It can cause you to feel "air starved."   It should be more aligned with your Median pressure.  See left sidebar stats.

I would set the Minimum pressure to 7cm with an EPR set at 2. (7 - 2 EPR = 5 Epap) The lower EPR may help with CA's and also bring your Epap up a bit, which may help with Obstructives.
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RE: Newbie feeling worse overall with CPAP
Thanks for your help!

I've changed the minimum pressure and EPR and will see how I go for a few nights. 

Then I will try reducing the humidity and upping the mask size. I don't want to change too much at once.

Attached is my sleep study. The only reference I can see to central apneas is in the comments saying they were occasional? 

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