Beginner in self treatment seeking advice

[sleepysloth]

Hello everyone,
 
I bought a Resmed Airsense 11 Autoset with an Airfit N20 without prescription after a home study (initiated by an ENT) revealed apnea and hypopnoea. A consultation at the sleep lab confirmed this based on the results of the home study. However, I still have to wait until next year for a regular sleep study, but the level of suffering is too high to wait that long.
 
Even though my AHI was only 10.1 during the home study, my spO2 plunged into the mid 70% range. Because of the length of the apneas/hypopneas and the drop in oxygen, the people at the sleep lab classified the apnea (OSA) as moderate.
 
Yesterday I had the first night using the device and woke up more exhausted and dazed than I have been in a long time, but the AHI dropped to 0.49.
 
Except for the maximum pressure, all settings are at factory defaults. The max pressure is currently at 7.
 
May I ask you to please look at my screenshots and give me some advice? Is there anything I can do to improve? Is the maximum pressure too low? Since the pressure was already close to 7 during the hypopnoea, my intention would be to raise it. What do you think?
 
I would be very glad to receive replies!

   
   
   

[gainerfull]

Your biggest problem right now is mouth leak considering you're using a nasal mask. You can see the table top looking leaks in the leak chart and you can solve this with mouth tape, chin strap, etc.

Next, your flow limits (which are less severe obstructive events) could use some work. In order to address them you'll need to increase your minimum pressure to 7cmH20, maximum to 11cmH20 and turn EPR on, full-time to 3. EPR or expiratory pressure relief lowers the expiratory pressure which makes it easier to breathe.

Lastly, you'll want to consider disabling ramp and have you thought about picking up an sp02 ring? I highly recommend the wellue o2 ring, if so.

[sleepysloth]

Thanks gainerfull for the quick and detailed answer! I have changed everything as described and will buy a chin strap. I am a little surprised, the device indicated me an excellent mask fit, but apparently the data from OSCAR is more accurate. Thanks for the recommendation regarding the Wellue oxygen ring. I've had my eye on it for a while and it will soon be my next purchase, along with the chin strap.

I will report back tomorrow.

[Millstone50]

You'll want to open up your pressure a bit, especially the minimum, and give EPR of 3 a try, while seeing if you can tolerate a disabled ramp. You may want to try minimum 7 and maximum of 15 to see how that works for you.

[sleepysloth]

Hello,

after this night I woke up again very exhausted and with heavy eyes.

Here are the screenshots.

Please note:

I was still awake until 2 am. I hid that session (45 minutes). I don't know if my nap yesterday (away from home/not using the machine) messed up my rhythm or it was because of the CPAP. I also suffer from insomnia. After yesterday's nap I felt a little better energy-wise.

   
   
   

I also slept (away from home/not using CPAP) for a couple of hours today, which at least took away most of the heavy eyes. But the unusual brainfog and exhaustion are still there.

You'll want to open up your pressure a bit, especially the minimum, and give EPR of 3 a try, while seeing if you can tolerate a disabled ramp. You may want to try minimum 7 and maximum of 15 to see how that works for you.

Thank you for your reply, Millstone50. If I interpret my data correctly, the maximum pressure last night was below 10. Is it then necessary to increase the max pressure to 15?

[sleepysloth]

or it was because of the CPAP. 

Since I can no longer edit my post, let me explain this in more detail:

It may be that I had difficulty physically adjusting to the new settings, but perhaps it was a mental thing. At some point I became hyperfocused on my breath and it felt a bit exhausting to exhale, so it would have been more comfortable to just stop breathing, if that makes sense?

[sleepysloth]

Hello,

for some reason I seem to have CA events. During the at-home study I only had one central apnea.

What is the cause of this and how can I fix it? I have read that EPR on can increase CAs - would it make sense to change anything about that or the pressure?

I already find it quite exhausting to exhale and unfortunately I still feel much more fatigued than before self-therapy.

Saturday/Sunday:

   
   
   

---

Last night:

   
   
   

[Gideon]

On the CA, that is not enough to work=y about.
If it makes you feel better you can reduce your EPR to 2, but that may, not will increase your obstructive events. It's a tradeoff typically, what decreases central events increases obstructive events and what decreases obstructive events increases central events.

[gainerfull]

Hello,

after this night I woke up again very exhausted and with heavy eyes.

Here are the screenshots.

Please note:

I was still awake until 2 am. I hid that session (45 minutes). I don't know if my nap yesterday (away from home/not using the machine) messed up my rhythm or it was because of the CPAP. I also suffer from insomnia. After yesterday's nap I felt a little better energy-wise.





I also slept (away from home/not using CPAP) for a couple of hours today, which at least took away most of the heavy eyes. But the unusual brainfog and exhaustion are still there.


Thank you for your reply, Millstone50. If I interpret my data correctly, the maximum pressure last night was below 10. Is it then necessary to increase the max pressure to 15?

I think your results look great and would not recommend any other cpap adjustments. There is air escaping from your mouth from 3:20 - 5:20a so whatever you're doing to prevent your mouth from blowing open at night when you go into REM, tighten the chin strap or experiment with tape placement so get a great seal on your lips as it's effecting your therapy.

Insomnia is tough to deal with but I also think you'd benefit from going to bed much earlier and making your bed time consistent to reel your circadian rhythm in. If you're starting cpap therapy past 11p you're only working against yourself.