Please help adjust my setting

[1978]

Hi, there.  Just started CPAP treatment 2/28 and have been struggling to get a good nights rest.  Hoping I can get some help adjusting my settings to maximize it's benefits. 

male/45 
airsense 11 with n30i mask
auto, 5.0 - 20.0, ramp off, EPR on but ramp only (essentially off)
humidity 5
tape mouth

First week I received a mask I wasn't fitted for (p10) and was miserable as I wasn't able to fall asleep with the mask on. Would lay in bed all night with mask on and finally fell asleep in the morning after taking the mask off.  I received the correct mask (n30i) on second week and it was much more comfortable and i've been able to fall asleep with it easier, although some nights it still take a few hours.  Around this time I also turned ramp off which I feel helped as I felt I wasn't getting enough air at times.  Issue I'm having is I'm waking up frequently throughout the night and don't feel rested when I wake up.  Prior to CPAP, I did wake up couple times a night to pee but definitely not as frequently as I do now.  

I attached my sleep study and 3 nights OSCAR data with the settings above. 

Last night I changed the setting to 6.0 - 20.0 with EPR 1 but didn't fall asleep until around 5:30am so not sure if this data will be helpful.  This is the Mar 21 report attached   

             

---

oscar screenshots

           

---

Oscar screenshot of 3/21

   

[1978]

oscar screenshot from last night at 6 - 20 pressure and EPR at 2

   

[OpalRose]

Looking over your most recent chart, it looks like you are waking due to the leaks.  
The leaks look like mostly mouth breathing.  So that is something you need to work on.
Are you still using mouth tape?

In the meantime, try to practice the Tongue Suck Technique.  Sometimes this takes a few months to master, but is well worth it.

Tongue Suck Technique:
Place your tongue to the roof of your mouth with tip of tongue behind front teeth.  (NOT PUSHING ON TEETH).
Gently suck upwards and back.
This places the tongue in a natural position, with the back of tongue sealing the back of the throat so that if your mouth/jaw drops open while sleeping, no air will escape.

If you're willing, raise your minimum pressure to 7cm, keep EPR @ 2.  (We'll keep watch on the CA's *)

* I can't tell from your sleep report if you experienced any clear airway events.  So I'm not sure if what we see on your charts are treatment emergent.  Post another chart in a day or two.

[1978]

Yes, still using mouth tape but I remove and reapply when I wake to sip some water so it loses it's adhesiveness throughout the night.  I'll try the tongue suck technique, thanks for the tip!  I also have a chin strap that i don't use bc it's uncomfortable but I'll start and try to get used to it.  

Will raise min to 7 and keep EPR at 2 and record the next few nights and re-post.

Should I leave humidity level at 5?  I started at 4 but raised it 1 early on as I kept waking with extreme dry mouth but may be from mouth breathing and why I started the tape.  I still wake with dry mouth but not sure if it's from leaks in the tape or humidity setting.  

I appreciate the help!  Really need CPAP treatment to work as I was diagnosed with CHF with 10% EF last year due to persistent afib weakening my heart muscles.  I'm currently in sinus rhythm after an ablation and cardioversion but not breathing throughout the night isn't helping.

[OpalRose]

Sorry to hear about the CHF.

One thing, be careful with chin straps. Most of them tend to pull your jaw back, which you don't want. A chin strap should pull your jaw up, not back.

Keep the humidity where it's comfortable for you. Everyone's needs are different.

[1978]

My last 3 nights 

March 23: tried the chin strap but wasn't comfortable and removed after laying in bed awake most of the night until 5:15a.  Went to bed around 9a and fell asleep, no chin strap just tape. 
March 24: went to bed just around 2:15a, took me a couple hours to fall sleep, then woke up in the morning with my mask off next to me.  Put back on and slept around 8:30a
March 25: fell asleep around 4:15 - 4:30a.  woke up several times with dry mouth.  all 3 nights I used tape.  

I have to call the cpap supplier soon to resupply.  Would the f30i help contain the leaks from mouth breathing?  am i able to breath through mouth with the f30i or will i still need to tape my mouth?  the nasal pillows are comfortable and i'd like to make the n30i work if possible but willing to do what i need to get better sleep. 

would pressure setting adjustments help? 

Thanks! 

             

[OpalRose]

Not too concerned about the CA's on the 23rd chart as you said you were awake. But we'll need to keep watch on that.

If you want to keep using the nasal pillow mask, you may have to continue using tape, but even that doesn't appear to be working that well for you.

If you switch to the full face mask, then mouth breathing won't affect your therapy, but you'll still have a dry mouth to deal with.

Your pressure never goes much beyond 10cm. If you want to narrow the pressure range, set it to 7min - 12max. You can also try the soft setting instead of standard.

You can also try reducing EPR to 1.

These aren't major adjustments.

[1978]

i don't mind continuing the tape.  The tongue suck technique works great when my mouth opens while i'm awake but my tongue moves when swallowing post nasal drip and have to reposition tongue after.  i have congestion and my ENT doc gave me Ipratropium sprays which helps alot but doesn't eliminate it entirely.  Will continue to try and get better at it.  

If the full face mask won't help with my dry mouth, I'll continue with the n30i and try the setting adjustments you suggested and report back after a few nights.  

Just to clarify, is the soft setting "autoset response: soft" or "mode: autoset for her"

[OpalRose]

I know the AirSense 10 has a soft mode. Check on your A11 by going to Auto mode, click on Response, then see if there is an option of standard or soft. If so, use soft.

I'm not sure the For Her mode would help in any way.

You will probably be more comfortable using the nasal pillow mask so keep trying.

[1978]

Ok, changed the autoset response setting under comfort to soft. it has standard and soft as options so i'm pretty sure this is the setting you're referring to. Thanks again!