Brazen Therapy Thread

[Brazen]

Hi!
I'm new to this forum and very glad I found it. I have tried to read through many threads and I am amazed at all the great advice.

I think I am looking for some settings help? 
Or other suggestions?

I'm new to my OSA diagnosis and cpap. 76 nights in and really struggling.
My primary doctor sent me to a sleep specialist because I have been incredibly fatigued since Sept. 2020 and they find no other reason for it.
My at-home sleep study was negative for OSA, the specialist called it a "false negative" and scheduled an in-clinic sleep study.
In clinic determined an AHI of 7.7.  They did not put me on a cpap during the study so they didn't titrate pressures.
Can any of the OSCAR data confirm the OSA diagnosis?

My ResMed 11 was set at 5-15.
I have tried four different masks and the only one I can tolerate is the F20, small.

With the cpap my AHI is averaging 2.44.

I know it takes time to get used to the cpap. I know untreated OSA increases all sorts of health risks. I'm really trying to give it a fair chance.

I feel like I slept so well prior to the cpap. 
I would wake up 8-10hours later in the exact position I fell asleep. My partner reports very little snoring (only mild when I sleep on my back, which I rarely do) and no scary breathing patterns. Partner does report quick respirations and muscle twitches all night.
But, I was fatigued all the time. I have never woken up feeling refreshed.

Now...
It takes me longer to fall asleep.
In the morning I find I'm often taking the mask off in my sleep. (or my partner wakes me up mid-night and tells me to put it back on)
I'm waking up with terrible bloat/abdominal pain. That is the most uncomfortable part of the whole thing.
I'm just as tired, or more so.

I'm attaching some OSCAR data - an example of an average night and the overall stats since I started.
I did just add the SD card and download OSCAR last week so I don't have a ton of data yet.

If the suggestion is to change any settings, can I do that myself and is there a cheat sheet?
I see it's often recommended to turn off the ramp. I get the logic but it will make it harder to fall asleep. (I currently have that maxed at 45mins)

I really appreciate all the time and work effort you experts have put into this resource.

[Gideon]

First your numbers are great. No issues there but you have a touch of aerophagia, air in stomach which is causing you that bloating feeling.
Some minor changes.

Your exhale pressures are restricted to 4 until you pressure rises above 7. To take advantage of this set your min pressure to 7

For now I'd want to restrict your max pressure to 9 to minimize the aerophagia.

Your pressures are at the absolute minimum your machine can produce so you you really don't need the ramp. Besides while the ramp is active no events are logged. So please try this without the ramp for now. You will find that some of the "pros" around here do use the ramp. Then we like to see it as short as possible

You can get a manual via the CPAP manuals link at the top of this page. It is a manual process so not an instant process.

[Brazen]

Thank you Gideon!

I found the instructions to change the settings and will do that.
I'll try it without the ramp.

I see it's often recommended to set the EPR at 2 - mine is currently 3, should I change that?

[Gideon]

IMHO no. You want the max EPR to actually lower your average pressure to reduce or hopefully eliminate your aerophagia.

[Brazen]

Thanks Gideon!

In the machine settings there is "Mode" and lists the options as "CPAP" "AUTO SET" or "AUTO SET FOR HER".
It's currently set to "AUTO SET FOR HER".
Any recommendations on that?

I adjusted the pressure to min. 7, max 9.
Left the EPR at full-time 3
Turned off the ramp.

I'll give it a few nights and see how it goes.

[Gideon]

Don't use CPAP, instead use AutoSet with max=min= desired pressure. Because more parameters are logged.

I noted you were using the for her mode and it's working for you so no problem. If you were having larger issues I'd have suggested switching to AutoSet, at least until we worked out most of the issues.

[Brazen]

Thank you!
I'll report back in a few days.  Hopefully minus the bellyache.

[clownbell]

@OP - Gideon is the expert, not me. However I note that that some experts recommend using the lowest pressure that will do the job of controlling apneas -- because (1) lower pressures are easier to adjust to and (2) lower pressures tend to mitigate or eliminate the aerophagia. So that is consistent with the advice Gideon offered.

[ArcherNeedsSleep]

As someone who battles a bit of aerophagia, I found that the "for her" setting made it worse, and that changing to the normal APAP setting reduced the air I was swallowing.  So if you continue having issues with aerophagia, you might just try the normal APAP setting.

[Brazen]

I adjusted my settings last week, per Gideon's recommendations, and have significantly reduced the aerophagia issues. 
Pressure 7-9, EPR 3.  
My AHI is still consistently below 5. That's what I should aim for, right?
I have switched to the F30 mask. It's tolerable and most nights I can adjust it enough to almost eliminate leaks.

Is there anything else I should be looking at in the OSCAR data to potentially optimize my therapy or do I just leave it alone?

I've attached a couple OSCAR screenshots since the setting changes.