[Treatment] TECSA for 4 months

[alpir]

Hi!

I've been using an AutoSet 10 for 4 months, and I'm already used to the machine. 
I got a sleep study done last year, the results were: AHI: 18, Arousal index: 36. Some mixed apneas without CPAP, none during the titration.

I've been having issues with TECSA, and nothing I tried seemed to help. I think it's getting better with time, but slower than I expected. Here is a small list of some stuff I did to try to fix it:

• Set the machine to CPAP (9mmH2O) mode without EPR. Later I was able to set EPR to 1, and sleep as well as I was sleeping without it. I'm now seeing the statistics, and the RDI went up with the EPR change though.
  
• I built a simple EERS by taping the mouthpiece vents of an aftermarket N30i cushion and putting a ResMed leak valve in the tubing. It didn't work, mainly because it's noisy and the noise woke me up frequently. I then put some cloth around the vents of the valve to reduce the noise, but it still didn't work.
  
•  I noticed central apneas happen along with leaks, so I've been taping my mouth, and I'm waking less up. Before the taping I was waking up once or twice with dry mouth.
  

I'm definitely sleeping better than before, but I'm still tired.
Is there anything else I could do to improve my sleep? My AHI varies bewteen 1.5 and 10, generally around 4.5. I attached two recent nights.

There is one last thing that might be related. For some days I'm with a cold and have not been able to sleep with the CPAP, the attachment with the worst score is from 2 nights ago. I switched to a F30i mask with a knightsbridge chin strap, because of the mouth leaking that was waking me up (even with tape). For some reason the central apneas have increased. Event with the F30i I have not been able to use the CPAP all night long, so I have been more tired than usual. 

[Deborah K.]

Did your sleep study show a lot of CAs?  If you're not sure, post a redacted copy of your sleep study.  If you don't have a copy, ask your doctor's office or sleep lab for a copy.  If they were not high, then your CAs are treatment-emergent and will diminish as time passes.  

If the CAs were high or very high, you may need a bilevel machine or an ASV machine, different types of machines from the AutoSet you have.  You may need a ResMed AirCurve 10 Vauto, or possibly a ResMed AirCurve 10 ASV, depending on the percentage of CAs your sleep study shows.

In the meantime, it would be good to set your machine to Apap mode and set a pressure range of 8 to 13.  That could help us see how much pressure you really need.  Most people need a range of pressure, as they don't breathe the same all night, same as they do when awake.  

Again, welcome, and best wishes for achieving great therapy and comfort!

[alpir]

I attached some nights where the settings were 6-11cmH20 with EPR on 3, along with a summary of the sleep test (it's in spanish though). I'll set the pressure to 8-13 tonight.

[SarcasticDave94]

No Central Apnea on the test.

I would try EPR 2. I would consider a min pressure 7 as well. Watch for changes to Flow Limits, but the goal is trying to diminish pressure changes to help lower CA.

[LaurenceShaw]

I switched to a F30i mask with a knightsbridge chin strap, because of the mouth leaking that was waking me up (even with tape).

Folks, please use the link of Supplier #37 if you are interested in the Knightsbridge Dual Band chin strap.  A keyword search will likely lead you to counterfeits.

(The Knightsbridge has straps which pass under the jaw and lift vertically to work with the natural rotation of the jaw.  In contrast, traditional neoprene chin straps wrap around the tip of the chin and force the jaw backwards and almost directly into the jaw joint, which is uncomfortable, ineffective, and can cause jaw joint damage and narrowing of the air passageway.  The More Info page of the above link has a drawing illustrating this.)

[alpir]

Here is my last night's charts. So, should I raise the minimum pressure to 9 and set EPR to 2 in order to have min EPAP at 7? Or just 7-11 with ERP 2?

Thanks for the help!

[SarcasticDave94]

You can try both settings if you want.

[alpir]

Here are the charts for the night of the 23rd. Centrals went up.   
I didn't sleep last night with the machine because of my cold.  

I'll keep the settings for some days because I don't remember feeling more tired than with the previous settings.
For how long should I keep waiting?

(Thanks for the help!!)