[CPAP] Another Newb Help/Oscar Post

[Gathermewool]

            I hope it's OK if a post a few concerns and share my first night of Oscar data. Mods, please let me know if I need to break it up into separate threads.

TL;DR: Initial AHI of 102; just got A11 APAP; requesting help with equipment and first OSCAR dataset.


Background:
My sleep study results showed an AHI of 102 and the 48 hr Holter Monitor showed that my heart had "paused" 8 times for greater than 5 seconds while I slept. I've been tired my whole life, but in the past few years I've gained weight (6', 220#) and my snoring was so bad and I was jerking awake so often that I decided a couple of years ago to start sleeping in the guest room to save my poor wife from having to endure that. Not only was the OSA waking me up, but I was forcing myself to sleep facing away from her and the anxiety of affecting her sleep was making it hard to fall back asleep.

I had to wait for 3 months after my at-home sleep study results came in to get my Resmed A11 (is it A11 or S11?). I was using a friend's old Transcend unit in the meantime, but it had no settings (just two buttons), the water tank leaked and so no heat, no humidification. Combine that with unknown pressures (the donor had no idea because it was so old), excessive fan noise, and weird EPR behavior, if you can even call it that, and the result was insane dry mouth and sores. I also got my F20 mask on Fleabay, which was giving me sores around my nose no matter how I adjusted it. It was better than nothing, though it didn't feel to be by very much most nights. The nights when it worked I woke up almost feeling buzzed and a bit light-headed; the good days made the bad days a little better since lack of sleep had a cumulative effect

I've had my A11 for about a week now and it's a marked improvement. I read on here how to access the Clinical settings and what the settings mean, but I haven't changed anything yet.


New mask issues:
The Airtouch F20 mask with the foam is infinitely better, but I'm still having trouble with fitment and air leaks. The tech who worked for the supplier helped me in her office, but when I got home the air leaked excessively unless I was very still. I was able to adjust a bunch of different ways, but now the mask is creating some problems: sores at the bridge and side of my nose, and my teeth actually hurt for five or so minutes after I remove the mask (not bad, but noticeable). Any suggestions?

A11 APAP issues:
1. For every single night except last night I was getting an error when I woke up: "Heating system error, Therapy may run without heating". The water tank level lowered by half from max the first night, IIRC, but stayed at the max level and gave me the same error when I woke up. There was no water on the plate any of the nights and I didn't split any water in that area. I also pulled and re-inserted the hose multiple times. It seemed to work last night, but I woke up to an empty water tank after around 8 hrs of use, but no error. The climate controls are all set to auto and I woke up without any of the above-listed issues from dry mouth.
2. My Rx is from 5-20 cm, which seems really wide. I learned from here that the lowest the APAP can go is 4, so my EPR setting of 2 is really a 1. The OSCAR data shows a med air pressure of 11.06, so I'm wondering if I should raise the lower setting. 

OSCAR data: See attached. Please let me know if I provided what you need.

[Gideon]

Welcome to the forum.

While your AHI is excellent your flow limitations are out of control.

Step 1 IMHO is to fully utilize EPR so

Set mon pressure=7 to allow the full range of EPR.
Set EPR=3

Use and repost. We only need that last chart for now.

In addition to the full night chart post a couple of 3-minute views so we can see breath by breath what is happening.

[Gathermewool]

@Gideon

I'll do that, thank you. I'll also have to lookup what flow limitations mean and how to refine the graphs in Oscar.

I just found out about Oscar last night and today is my first time playing with it.

[Gideon]

Think of flow limitations as untimed hypopnoea with a characteristic on misshappened or flattened tops / inhales on your breaths.

[Gathermewool]

Thanks for that, but none of it made sense to me.   

My engineering training supervisor used to tell us that we had to explain to him what we were getting a qual checkout on as if he was a dumb Idaho farm boy. He was very smart, but grew up in Idaho, and this was his ways of being self-deprecating and disarming. It worked.

So, please explain that again assuming I’m a dumb product of the public school system. Lol

I’ll look it up, too, so you don’t have to spoon feed me everything. 

[Gathermewool]

Pressure min changed from 5 to 7
EPR changed from 2 to 3

I don't know what the heck is going on, but I could not get a good mask fit all night. This was after tightening and loosening the mask multiple times (too tight seemed to help but was not comfortable. The hiss and air hitting my eyes kept waking me. Then the mask felt too tight, but it was the only way to stop the leak, seemingly. I tried the left side, back, and right side, but nothing worked. I do open my mouth badly when I'm on my back, so a chin strap might help, but I also like sleeping on my side, too. 

The leak and flow limit data don't seem to look very good.

Anyway, I don't feel good about how I slept last night. 

   

[Gideon]

Think of this. The doors in your home represent your breaths in that the represent your airway. Go through your entire home and every time you walk through a door or passage between rooms imaging it is 4ft smaller. Your passage or flow between rooms (flow) just became "limited" by the smaller size of the openings.

You(your breaths) just became flatter(flow limited) because of the smaller opening you need to go thru.

[Gathermewool]

Gotcha, like a throttle valve.

[Gathermewool]

       

Here is last night. You asked for 3 min period, but did you mean 30m? I've attached a 30m of one of the larger spikes in flow limit

The fit seemed to be better last night.

[Gathermewool]

       

I raised the min pressure up to 9cm last night. At 7 or lower the response time lagged too much on inhale, so I'd hear a bit of a popping sound. At 9cm that went away and I felt like I was getting constant airflow. I know I was always getting positive pressure, it's just that I was perceiving the delay as a lack of air and it was bothering me. Considering my median pressure is usually around 11, should I stick with 9 or go back down to 7 or 8. When my breathing rate is lower and slower, the delays don't usually happen.

I also had some strange dreams last night, one of which was based on something I read here, I think: I kept waking up thinking my belly was filling with air!   Funny now, but not overnight. I've noticed that now that I'm actually getting sleep (REM), I'm having a lot more dreams, and for me, that's usually not a good thing. As a funny anecdote, I often dream that I can fly, but I suck at it. For me alone, the air has a viscosity somewhere between air and water, so I have to work furiously to "swim" through the air.   (Wow, I've never seen this emoji, but it works!). And that's my GOOD dream...

Anyway, I'm sorry for misunderstanding you @Gideon when you asked for "breath by breath" and I gave you a 30 min snapshot. The attached should be better. I picked a spot where a cluster of events took place.


Thanks again for all of the help.