Advice for new user

[drmaestro]

Hi,

I have been diagnosed with OSA in October 2018. My sleep study reveled a mild/moderate OSA (AHI:15). My pulmonologist was thorn between ordering CPAP therapy or letting me loose weight for some period before reevaluating, as I was overweight and I didn't have prominent symptoms (no daytime sleep, no excessive tiredness. Only symptoms were mild hypertension (140/95 mmHg max) heavy snoring and sometimes headaches in the morning). As I was curious about the effectivity of a CPAP unit, I wanted to try one. I was lent 2 units, each for 2-3 days, to determine the pressure levels. After that I started a diet and exercised regularly to loose some weight. I managed to lose around 20 kgs in 9 months, which helped with my symptoms, so I didn't get the CPAP unit. Then the pandemic started during which I started gaining back some weight, resulting in worsening in the hypertension and also my Fitbit Versa tells me that I may have high variability in oxygen saturation during sleep certain nights. I assume OSA is coming back.

As soon as the restrictions are lifted, I'll start exercising more and go on with the diet again but at the mean time I decided to pull the trigger on the CPAP therapy, as I feel like I have a tendency to regain weight periodically and a CPAP unit could be useful for these periods. I bought a Resmed Airsense 10 Autoset with Philips Dreamwear nasal mask 3 days ago and they will be delivered sometimes this week. Interestingly, it is possible to buy a CPAP unit here without a prescription, so it will be delivered without a set program. I'll of course consult with my pulmonologist on the recommended settings but I was wondering if I could use the machine while I am waiting for my appointement (which is not very soon, as due to Covid the number of patients accepted per day has decreased considerably). What I have in my hand is the results of the sleep study from October 2018 and the results of 4 days of using 2 different CPAP units (links: https://ibb.co/y8DDh5p and https://ibb.co/N1vQjVH)

My questions:
1) There are recommendations to start using the device at autoset mode between 4-20 cmH2O and after a few days, depending on the results, decrease the range. While it has been more than a year since I used these devices, does it make sense to set it at these levels or go lower, as my maximum pressure was around 10.4 cmH2O.
2) Does it make sense to use EPR at these levels?
3) The masks I have used during those tests were different. One was a full face mask, the other was a nasal mask. The dreamwear is smaller compared to both of these masks. Would I need to take this into consideration? 

Thanks...

[Gideon]

on 4-20, it is rare for that to actually work.  I'd rather see 6-20 with EPR=2 and being much more acceptable with review starting with your first night.  
4-20 is given under the assumption that the device is smart enough to optimize itself.  They are certainly good in lieu of a formal titration study.  For diagnosis, they are poor because they ALWAYS deliver at least 4 cmw of therapeutic pressure.

And I suggest starting with a Pillow Mask such as ResMed P10 unless there are clear reasons for a full face mask.

EPR is listed as a 'comfort' feature but it can impart considerable therapeutic value in treating hypopnea, flow limits, RERAs, UARS and snores.

[drmaestro]

Thanks for the answers.

The screen captures I posted are not visible, so I'll upload them again for better visibility:

   


   

[Sleeprider]

It's obvious how much better the Resmed Airsense 10 responded to your needs compare to the Philips which was way behind the curve resulting in more events. I think this result confirms your minimum pressure should be set at 6.0 and I think I'd rather see a minimum of 7.0 and EPR 2. Exhale Pressure Relief is comfortable and can help with hypopnea. The higher minimum will prevent events that arise when you are near minimum pressure. You chose your machine wisely, and for maximum comfort and efficacy it is best to start at a pressure high enough to prevent most events, and that minimized the pressure variation you experience and is less disruptive to sleep.

[drmaestro]

It's obvious how much better the Resmed Airsense 10 responded to your needs compare to the Philips which was way behind the curve resulting in more events.  

I didn't start using the S10 yet as it isn't delivered. Hope to have it by weekend. The first CPAP test was done by a S9. I also observed the lack of events compared to the Philips machine but because the AHI rates were quite similar between both machines,  I thought it was due to a setting on the Resmed machine not sending all the data or a limitation on the reporting function of the Resmed. Now, I feel much happier on buying the Resmed  
To be fair, the Philips machine was provided by another supplier, was quite  old and noisy, and the tube/mask they provided smelled heavily (probably used by a smoker), so I am not sure it was an ideal test.

[Sleeprider]

I see you trialed a S9 Autoset and Philips Respironics System One 60 Series Auto. The truth is the same therapy algorithms are stll used in the Airsense 10 Autoset and Philips Dreamstation Auto, with few changes other than the form factor.