Therapy Beginner Help

[papercupprincess]

Hi all,
I'm about 2.5 weeks into therapy and just wanted to see if there are any adjustments I could make- still hitting a late afternoon brick wall that has me nodding off, feeling exhausted, and not quite comfortable at night yet (but I know these are early days). I feel like I'm working overtime to breath and can't quite get enough air at first, even after I turned off ramp. A few days ago I switched from a 3B Siesta Nasal Mask to the AirFit N30i because the Siesta exhaust was aimed directly at my partner and making them feel like they were sleeping in a wind tunnel. While I really like the AirFit frame and headgear, I'm still getting use to the cushion (can't tell if the S or M is the better fit for my nose so trying both). I have one screenshot from the AirFit and one from the Siesta, and a flow rate zoom in from the first OA on the 26th if that helps at all. Also, OSCAR stats show AHI overall .89, OA .31, H .05, CA .52, and average leak rate .89. I'm a data person and would normally love to jump right in to all these fun OSCAR charts and graphs myself but I'm a stay at home mom with a 1.5 year old, a 4.5 year old, and apparently many years of OSA under my belt...my brain is currently fried.  I'd really appreciate any insight or suggestions, and am happy to add more screenshots or zooms as needed. Thank you so much!

[G. Szabo]

Your minimum pressure is too low. It should be at least six or better, 7, to mitigate obstructions and have a more peaceful night.
You are also inhaling dry air when your hose's setting is 27 C and humidity 4. Dry airways could cause discomfort and might contribute to obstructions. I would increase the humidity setting to 5 or switch to automatic humidity control.

[Phaleronic]

Szabo is spot on with raising your min pressure to at least 7cm since you have EPR set to 3. Therapy looks good though.

[staceyburke]

I agree that your min should be 7 or 8, that will make you sleep better because you will not have as much pressure swings.  IF you look at your pressure chart you can see the ups and downs which make you wake up or not be able to get into a deeper sleep.

[papercupprincess]

Thanks, all! Here's the data from last night after bumping my minimum up to 7- I definitely woke up feeling bloated and gassy, and tossed and turned (although it was the cushion that was bothering me; tonight I'm going to try going back to the small N30i cushion). Also I do usually have automatic humidity control on but when I took out the SD card the hose was detached so it says humidity 4 (but it's really automatic). I did feel more comfortable breathing as soon as I put the mask on, which was nice. Should I try 6 or 6.5 tonight?

[PeaceLoveAndPizza]

The aerophagia will abate over time. You can help it by not fighting the machine pressure and relaxing. I suggest staying with the current settings and giving yourself a chance to adapt. You could drop down 1 cmH2O, then start creeping it back up by 0.2 a night. 

Overall things look good. You do have some arousals, but they seem related to the small leaks that pop up on occasion. Nothing to worry about at this time, but keep an eye on them over time to see if they increase or you notice more morning fog.

[papercupprincess]

Thank you so much! I'll give it a few days at 7 to see if I adjust and then drop down and creep back up if I'm still uncomfortably bloated.

[staceyburke]

You still have some Flow Limits and EPR is what is used to keep it low. I would NOT lower EPR.

FL are apnea just like O and H events. The machine raises pressure to stop them come becoming O or H events. Higher pressure will give you more air in your stomach, keeping EPR would help the problem.