New to Apnea and APAP, looking for OSCAR feedback

[myklu]

Got my APAP, ResMed AirSense 11 this week and have been trying to make it work.

I have the climate hose (with a cover) with the humidity and temp set on auto.

Some historical details, I am a side sleeper and have a tendency to roll on to my back unconsciously which usually results in awakening (palatal prolapse). I also suffer from allergies/plugged nose from a deviated septum which makes my nasal breathing a bit more difficult, though I am not a normal mouth breather.  Additionally with the palatal prolapse it would seem that the later in the night things went, the more "worn out" my palate felt and it started to become near impossible to get back to sleep unobstructed.

My at home sleep test came back with a diagnosis of mild apnea (AHI 4%: 12.0), though during the test I did not roll onto my back (likely aware of the hookups) and the fixed recording is set to stop after 6 hours which did not capture my primary struggles.

Currently on my 4th night now with the machine.

First 3 night summary:

Default settings 4-20
First night I switched my F20 AirTouch mask to a medium from a large as it was leaking near my eyes unless strapped down hard (very uncomfortable)
Breathing in more difficult than anticipated
Waking on my back and rolling back onto my side (would do this without machine as well)
Slightly increased level of gas/flatulence
Very stuffed odd feeling nose when waking that would seemingly persist thoughout the day
Overall poor sleep quality feeling more tired than before the machine


Last night after reading about pressure and testing with the equipment setup app to feel the higher pressure, it seemed more comfortable, and I opted to adjust my minimum pressure to 8, leaving the EPR untouched at 1.

This was the first night I slept halfway decently, definitely not great but I remained mostly on my side which is unusual. 
I had a large increase in gas in my stomach not quite to the pain level but definitely not comfortable, I had way more flatulence and even some burping.
Breathing in felt much more natural, I woke with a mostly open nose, not difficult to breathe through.

Attached are my OSCAR results for last night, hoping someone can help provide some feedback on what may be going on or improvements.

[PeaceLoveAndPizza]

Based on the one chart, I suggest the following settings:

Min pressure 9
Max pressure 12
EPR 2 full-time
No ramp

The reason for the changes is that your median is around 9 with an EPR of 1, so starting at 9 will help with the pressure swings. Increasing the EPR from 1 to 2 gives more pressure support and will reduce some of the flow limitations that are driving up pressure. Hopefully that will help with reducing aerophagia as well.

Aerophagia takes a while to abate. As you get used to the pressure and relax the airway, less air will get swallowed, but it takes time and patience. Even with the full-face mask, try to breathe through your nose more as that will help as well. Practice proper tongue placement keeping it against the roof of your mouth. 

You are doing quite well. Keep up the good work and the results will be worth it.

[myklu]

Thank you for the feedback.

I read that EPR is not good for palatal
prolapse so I was hesitant to adjust it up from 1 to 2 especially at arguably low pressure. I did the myAir test to simulate how things might end up if I wound up on my back and the higher pressure (7, 10) seemed to be better when I relaxed my throat for keeping the area clear. Since I was able to stay primarily on my side last night hopefully an additional point of pressure drop is ok.

For the first couple nights my pressure did not get as high as last night (10-11) with the auto 4-20 it maxed at around 8.5 with a 95% of around 7.5 and a med of about 6.. are you able to explain why bumping it to 8 resulted in further increases of the max pressure?

[PeaceLoveAndPizza]

When and how were you diagnosed with palatal prolapse? Do a 2-3 minute zoom on an area where you think it shows up. 

If at all possible, try to stay off your back whilst sleeping. There are many ideas from folks on how to avoid it, so start with this thread and see if anything seems like it would help.

Without seeing other charts, it would be a guess as to why the pressure max is different. Usually flow limitations cause pressure to rise as the machine works to keep the airway open. If could be as simple as a stuffy nose, but without data I would be taking a SWAG.

[myklu]

I was going based on my at home sleep report I attached the section.

I also attached the previous two days worth of data for reference to the pressure increase.

Please note the pressure of 7 on 4/24 as I adjusted that at the end of the night for testing as I was having the stuffed nose/difficulty breathing, on 4/24 I also turned the machine off and on in the middle of the night as I woke up with a weird event and felt like I couldn't breathe into the pressure maybe?

Thank you again.