3 weeks in and would appreciate some advice. (Clear Airway events)

[JRBall]

Hi everyone! 

This is my 3rd week using my APAP and I have the Airsense 11 Autoset. I have a diagnosis of severe SA in REM sleep at 35.5 AHI. These past few weeks I have been using various masks as I am doing a mask trial with the supplier I bought my machine from. Last night I used the ResMed AirFit P30i, with a chin strap, as I have a deviated septum and breath through my mouth at night. I was using mouth tape before, but I didn't like it so I have switched the chin strap.

I am struggling a lot with the masks, as it seems like no matter which one I use, I am waking up with air blowing into my eyes (I am mainly a side sleeper and I am wondering if this has anything to do with it). I think my main complaint is that I feel like I keep waking up 5+ times throughout the night, which leads me to feel like I am not getting a restful sleep. Although I do think I am feeling a lot less tired, I haven't had much success with having a consistent AHI, most nights its been around 3.

Please note on my OSCAR report; I had to wake up to drop my partner off somewhere, and then went back to sleep, so that's why there is that large gap in-between ~5-7 ish.

I guess I am just looking to see if there's anything obvious from my report that could help me. I know that this takes a lot of time in terms of adjustment, I am hoping I am on the right track.


Hardware:

Resmed Airsense 11 Autoset

ResMed AirFit P30i


User settings:

Ramp Time: Off

Tube: Slim Line, with a tube cover

Humidity Level: 4

Pressure Relief: On


Clinician settings:

Max Pressure: 14.00

Min Pressure: 6.0

EPR: On

EPR Type: Full Time

EPR Level 3


Other things that might be important:

I wear a nightguard to help with teeth grinding/TMJ.

25F.

BMI 29.0.

251 feet above sea level.


Thanks in advance for your help, please let me know if you need any extra information from me!

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[Sleepy Quixote]

@JRBall

Welcome to the forum! 

Good job getting OSCAR up and running, lets make a couple of tweaks so folks here get the most data possible for analysis.

Tick the little triangle in the date field so the calendar goes away and frees up important info.

Get your charts adjusted this way ->  https://www.apneaboard.com/wiki/index.php/OSCAR_Chart_Organization

Repost your screen shots, someone far knowledgeable than I will come along in a bit and help you out.

[staceyburke]

You have a min 6 and EPR 3. With that setting you are NOT getting EPR of 3 - instead you are getting EPR 2.

To get to using EPR of 3 you have to have a min of at least 7. Because the lowest a Cpap can go is 4.

Min 6 - EPR 3 = 4. Min 7 -EPR 3 =4.

So I would suggest a min of 7 or 8. That would help your flow limits.

[Sleepy Quixote]

@JRBall,

I can speak to the Airfit P30i, its my daily mask. Did they give you a fit pack? If so, have you tried all three sizes under pressure using the mask fit feature? If not please request one (a fit pack). I find the sizing card they use to size us is a waste, I'm a medium sized kinda person and I use all three at any given time. I used the small early on when I was having fitting, adjustment, leaking issues. Use the medium as a daily for comfort and occasionally use the large when all else fails and I just cant get it seated.

For me the P30i is fairly finicky but once it gets a groove I'm good to go for awhile. For headgear adjustment, the mask seems to like not too tight not too loose. If the headgear is too tight if I sweat during sleep it will tend to push the pillows in too far and leaks develop around the nostrils, if it's too loose, the mask will seal fine during testing and early in the sleep but as I relax if I'm on the side it will push sideways a bit and I get a stream of air into one eye or the other.

I too have a deviated septum and used to mouth breath when sleeping. Chin strap, tape and training the tongue to seal the mouth from leaking all helped. You definitely have been doing your homework. Stopping mouth leaks is huge for increasing efficacy of therapy. Gaining consistency of therapy will come with time, believe it or not, using CPAP is a skill and needs to be learned, you are headed in the right direction.

I was in the same boat as you, all the gear, and hassle seemed to wake me up more than the apnea did, but found I was definitely less tired due to getting better quality sleep when sleep was happening. I eventually moved from being too exhausted to be irritable to being just tired enough to be irritable. LOL. Now adays my wife says, I'm the guy she married many years ago. It all comes with time and experience. 

As for the charts, there are some highly skilled folks at analyzing those on this board, someone should be along in a bit.

Good Luck! Keep at it, that's how we get good at it.

[JRBall]

You have a min 6 and EPR 3.   With that setting you are NOT getting EPR of 3 - instead you are getting EPR 2.

To get to using EPR of 3 you have to have a min of at least 7.  Because the lowest a Cpap can go is 4.

Min 6 - EPR 3 = 4.  Min 7 -EPR 3 =4.

So I would suggest a min of 7 or 8.  That would help your flow limits.

Thank you! I've increased it to 7 for tonight! Hopefully it goes well

[JRBall]

@JRBall,

I can speak to the Airfit P30i, its my daily mask. Did they give you a fit pack? If so, have you tried all three sizes under pressure using the mask fit feature? If not please request one (a fit pack). I find the sizing card they use to size us is a waste, I'm a medium sized kinda person and I use all three at any given time. I used the small early on when I was having fitting, adjustment, leaking issues. Use the medium as a daily for comfort and occasionally use the large when all else fails and I just cant get it seated.

For me the P30i is fairly finicky but once it gets a groove I'm good to go for awhile. For headgear adjustment, the mask seems to like not too tight not too loose. If the headgear is too tight if I sweat during sleep it will tend to push the pillows in too far and leaks develop around the nostrils, if it's too loose, the mask will seal fine during testing and early in the sleep but as I relax if I'm on the side it will push sideways a bit and I get a stream of air into one eye or the other.

I too have a deviated septum and used to mouth breath when sleeping. Chin strap, tape and training the tongue to seal the mouth from leaking all helped. You definitely have been doing your homework. Stopping mouth leaks is huge for increasing efficacy of therapy. Gaining consistency of therapy will come with time, believe it or not, using CPAP is a skill and needs to be learned, you are headed in the right direction.

I was in the same boat as you, all the gear, and hassle seemed to wake me up more than the apnea did, but found I was definitely less tired due to getting better quality sleep when sleep was happening. I eventually moved from being too exhausted to be irritable to being just tired enough to be irritable. LOL. Now adays my wife says, I'm the guy she married many years ago. It all comes with time and experience. 

As for the charts, there are some highly skilled folks at analyzing those on this board, someone should be along in a bit.

Good Luck! Keep at it, that's how we get good at it.

Thank you! No, I did not get a fit pack, this is just a trial mask, and they fitted me as a small I believe. I still haven't decided which mask to ultimately purchase, but if I decide to go with the P30i, I will ask for the fit pack! I like this mask a lot because it barely touches my face and the hose is at the top, but I haven't used it enough to see if I really want this one. Did you try any other pillow masks before deciding on the P30i? This is the first one I have tried, I tried the F30i, which really did not work for me, and then a full face mask and 2 different nasal ones. I seem to be able to get one good night sleep with each mask, but then on the second night it never goes well and I ultimately switch to a different one, so I am having trouble with consistency. Which will be a problem since I do not want to spend the money buying 3 different mask types! I hope I can figure out which mask works for me soon!!

[JRBall]

You have a min 6 and EPR 3.   With that setting you are NOT getting EPR of 3 - instead you are getting EPR 2.

To get to using EPR of 3 you have to have a min of at least 7.  Because the lowest a Cpap can go is 4.

Min 6 - EPR 3 = 4.  Min 7 -EPR 3 =4.

So I would suggest a min of 7 or 8.  That would help your flow limits.

So, I changed my min to 7.0 and EPR to 2 and slept pretty well! Thank you for the suggestion. Here is my OSCAR from last night https://imgur.com/a/Me2vPbQ

---

@JRBall

Welcome to the forum! 

Good job getting OSCAR up and running, lets make a couple of tweaks so folks here get the most data possible for analysis.

Tick the little triangle in the date field so the calendar goes away and frees up important info.

Get your charts adjusted this way ->  https://www.apneaboard.com/wiki/index.php/OSCAR_Chart_Organization

Repost your screen shots, someone far knowledgeable than I will come along in a bit and help you out.

Hopefully this is looking better? 
   
   

[Sleepy Quixote]

@JRBall,

Chart arrangement looks good.

I think Stacey was suggesting an EPR of 3, the flow limits still look a little high at 2, EPR is what helps minimize Flow Limits, that said if you had a good nights sleep, that's the best indicator of progress,

Yes I tried several nasal masks before settling on the P30i, N30i all sizes were just to hard to keep seated for me, leaky, leaky, leaky, The F30i was a total bust for me too.

Glad to hear things are improving!

Good Luck! Keep at it, it's how we get good at it.

[JRBall]

Hi everyone, I have noticed that I have a lot of Clear Airway (CA) events, and I am just wondering what this could mean. https://imgur.com/a/bYWt4IX

I have attached some photos from 6 nights where I have some higher CA's. I have quite low obstructive apneas (OA) most nights. My sleep doctor said I have OSA, I never got to look at my full sleep report, just the summary of it. 

Hardware:
Resmed Airsense 11 Autoset
Autoset for Her
ResMed AirFit P30i

User settings:
Ramp Time: Off
Tube: Slim Line, with a tube cover
Humidity Level: 4
Pressure Relief: On
Mask: switching between a nasal, pillows or a full face mask

Clinician settings:
Max Pressure: 14.00
Min Pressure: 8.0 (just changed it to 8.0 as of July 01, used to be 6 and 7 before)
EPR: On
EPR Type: Full Time
EPR Level 3

[zynsa]

welcome! I am also new and just started using CPAP 10 days ago.
I am also still adjusting to it and get up multiple times in the middle of the night.