Second attemp at therapy

[Jonkier]

Hi all

First post from me but have read a few threads, and am very thankful and appreciative to all the people that offer their time and expertise to help people here.

I'll try to summarise my journey thus far, without too much waffle. 

Went for a sleep study back in May of 2023 (results in attached docs) and came back with AHI of 22/h. Symptoms were persistent fatigue, lethargy, low vigor/motivation for exercise, trouble focusing etc etc add to that my wife observing me waking from sleep and gasping for air. I would be aware of this frequently, also. 

Here in Australia I paid the $400 or so to do a 4 week trial with a machine which included weekly sessions with a therapist. To cut to the chase on what happened with this trial, I was so stubborn and against the idea of CPAP that I put the mask on for about 5 minutes, then decided it wasn't going to work. The poor therapist had no data at all to work with. Handed the machine back early. 

Fast forward 6 months and my sleep and symptoms were so bad, I decided I would try again. I purchased a BMC Luna 2 machine, with a Resmed Airfit 20 full face mask, and tried again, this time without any guidance from a specialist. I watched various Youtube videos regarding settings etc etc and for the first night I believe I had the machine set to Apap mode at 4-14 pressure. First night got about 6 hours of sleep with the mask on, over 2 stints. Felt okay in the morning, slightly bloated and a bit of a headache, but was happy that I had kept the mask on. Things went downhill from here. Couldn't keep the mask on as was experiencing bad aerophagia. Probably went about month trying and messing around with fixed pressures of 5, 6, 7cmH20. Eventually gave up and put the machine under the bed. 

That brings us to now. I happened to see a Youtube video mentioning that EPR can assist with aerophagia, which made me think ah, maybe I'll give it another shot. Sleep and symptoms still present, and bad enough that I would wake in the night, sit on the edge of the bed and think to myself 'this is killing me', meaning it quite literally. 

So, after believing that CPAP (not apap) is the way to go an EPR is bad because central apneas etc etc, I set the machine to auto again at 4-14cmh20, with an EPR at max of 3. Got a few hours of sleep the first night, but the pressure stayed on 4 all night (is this enough pressure to keep the airway open?). Last night I set the pressure to 6-14 with EPR 3 again. Got a 5 hours stint of sleep with the mask on, without waking, at least I believe I didn't wake. This would be the longest stretch of sleep for myself probably in years. Comfort breathing was fine. Felt okay this morning, not like a new man, but not bad at all. Data says I experienced 1 hypopnea, so AHI 0.2.

I am a bit of a data junkie and would absolutely love some assistance in reading what's going on. As you all know OSCAR does not support Luna 2, but I managed to download the Resmart package that shows what I believe is the flow rate. Have attached some images of areas of time in the chart where it seems to look semi-normal and some areas where it's different. Any information would be so appreciated. 

That's my story in a nutshell. Feeling happy that this could work for me and have a signicantly positive impact on my life. 

Best regards to all,

Jon

[Jonkier]

More images...

[Jonkier]

Sorry to bombard you guys with images, but went back and found that very first night of 6 hours sleep where more events were recorded. Sharing some images of those...

First image is a central apnea at 00:13.
Second image hypopnea at 02:15.
Third image two central apneas at 03:18.

Hope that's enough to work from

Thanks again,

Jon

[Jonkier]

Okay so from a little digging around and checking other flow rate shapes, I think maybe I am mouth breathing.

Even though I tolerated a pressure of 6cmH20 and EPR 3, I tried increasing the pressure to 6.5cmH20. My BMC Luna 2 is actually set to auto mode at 6.5-14cmH20, but never goes above the lowest setting. 

So anyway, an hour on 6.5 and I woke with bad aerophagia, which is what stopped me in my tracks with the cpap therapy 6 months back. I'm thinking maybe I am mouth breathing and swallowing air???

I have a friend with severe OSA (70+ AHI) who mouth breathes, on a much higher pressure, and has never experienced any aerophagia. Stumped at how I seem to have such a low threshold for aerophagia, where 6cmH20 is fine, but 6.5 and above is bad news. 

One final question, when I first turn on my machine the exhale pressure seems v high, to the point where I sometimes have to remove the mask so I can breath properly. Most times, after a few minutes the machine starts to lessen the pressure on exhalation and I can egt comfortable. I have ramp turned off. Is this normal for machine when using EPR, or is my machine just not that good?

Thanks all

Jon

[Deborah K.]

You would get a better response if you downloaded and posted charts from Oscar, a free service that clearly charts your night's sleep.  Most of us cannot read your charts well enough to help you.

[Jonkier]

Thanks for replying Deborah. I wish I could use OSCAR, gutted that I can't. 

I have a BMC Luna 2 machine that is not compatible with OSCAR. All I am able to get is the Resmart charts. I thought perhaps the flow rate graph might be enough.

Thanks,

Jon

[Jay51]

From some research that I have done, damage can occur to the esophageal sphincters from acid reflux.  Recommendations were raising the head of the bed (as tolerated) to help compensate if acid reflux diagnosis is confirmed.  The other possible cause was neurological and physiological.  Neurological diseases and neurological malfunctions could possibly affect the strength and closure of the sphincters also.  Anatomical abnormalities (rare) could also affect aerophagia.

[HalfAsleep]

Can you sell the Luna and get a Resmed? They don't cost so much these days (e.g. card to cloud, no modem). Then you'll have Oscar. This is especially important if you're a data geek!

But get full advice here about any kind of equipment or settings first. Sometimes, little by little is the most effective way to reach goals. IMO CPAP therapy is a great example of this truism, since there are so many variables, and not just the pressure. These include mask fit, body position, humidifier settings, hose management.... Several of these can be addressed via Oscar.

Good on you for keeping at it to implement a therapy for your breathing.

[Jonkier]

Jay51 thank you for the response. I've never really experienced any acid reflux so perhaps it's not that. Not sure of any other neuro/physiological issues, nothing I am aware of. 

Thanks Halfasleep. I definitely would be keen to get a Resmed. I would be more than happy to spend the money on a new one if I can actually see a positive result from cpap therapy. The Luna 2 machine seems like a good machine, very quiet too. I was hoping it would be life-changing, then changed my hopes to just seeing a positive change in sleep and subjective feeling throughout the day. At this point the best I have done is 5 hours and felt about the same as I normally do. 

Although I don't have anything to compare the BMC Luna 2 to, and am of course not clued up on the algorithms across different machine ie how they control and change pressure etc. Could it be a case that one could use exactly the same settings and mask/hose combo across 2 different machine and see different results?

Thanks again,

Jon

[Jonkier]

GUYS!!!!

Found a place that rents out machines, got an Airsense 10 Autoset for 4 weeks. 

Settings shown on the images. Managed to fall asleep for about an hour when first went to bed but woke up and felt claustrophobic and took mask off. Then put it back on around 130am-sih for a couple of hours. Lots of awake time and plenty of burping, which I now see is probably from the machine ramping up the pressure,

Lots of leaks, which is due to the f30i nose cusions being pushed aside when lying on side. Not too impressed with this mask and might try f20 full mask tonight. 

Any help with data and settings would be massively appreciated. Please let me know if theres anything other images you'd like to see.

Best,

Jon

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