[CPAP] Best results in the first two weeks but not as much now

[ninjax99]

Hi all, I've joined you all on the CPAP therapy train and I've had a lot to read up on in my ~2 months of using CPAP.

I have been playing around a lot with the settings but I feel like I'm starting to make things worse for myself. I've posted screencaps of some of the data I've got from OSCAR from the first 2 weeks on CPAP and more recently (only attached the nights where I stayed on CPAP for longer than 4-5 hours). 

I've started feeling more lethargic in the past 2-3 weeks. When I was first starting CPAP, even though I would wake up constantly in the middle of the night to adjust, I would be full power getting out of bed. Now when I wake up I feel like I want to keep staying in bed and that tiredness carries on throughout the day. It is no where near as bad as prior to starting CPAP (I would feel like fainting after lunch, now its just general lethargy).

I've seen a lot of mixed responses on EPR, I did have to have it on when I was first starting but maybe I should dial it down or even take it off? Appreciate any help thanks.
I am a chronic mouthbreather and experience a lot of dryness so I have humidity and temperature dialled up.

[Deborah K.]

I see a few things that should help.

Turn ramp off.  You've been at this long enough that you don't need it, and you get no therapy during ramp.  Plus, if you get up for a bathroom break, ramp restarts when you return to bed, robbing you of therapy.

You need to raise your pressure to 9-20, at least for now.  That will show us what your body actually needs.  Your median pressure is over 11, but let's start with 9 first to get you accustomed to slightly higher pressure, then raise it if needed.

Leave EPR where it is for now.  Your flow limits are quite high even with the EPR.

Did you have a lot of CAs in your sleep study?  If not, yours are treatment-emergent and will lessen on their own as time passes.

Your leaks are not terrible, but bad enough to need fixing.  Is your mask very tight to your face?  Too tight can actually cause leaks.  Your mask should be just sitting lightly on your skin.  Then when the air flows in, the mask fills and presses a little to your face.  Try that and see if it helps.

Best of luck at getting enough and better sleep!  

[ninjax99]

Thanks for help, I've gone ahead and turned off ramp.
I've left min pressure at 8 because the machine was louder than what I'm used to but I'll up it tonight.
My CA results were 0.5 in supine and 0.24 in non-supine based on the home sleep study

Unfortunately the first 2 nights after the changes were really bad on the leak front probably just from me adjusting, I can never get it perfectly right and I've tried having the mask be looser or tighter. Last night I had the most success with having it loose with air pressure blowing then tightening up the straps a good bit.

Not gonna make any judgements from wednesday/thursday nights since the leaks were really bad but I do feel that the changes are working out for me better even though my AHI is higher now.
I'll up the min pressure up to 9 tonight and hopefully keep the mask on without too many leaks and see how it goes.

[Deborah K.]

With so few CAs in your sleep study your CAs are treatment-emergent and will lessen in time as you adjust to your therapy.  

Your leaks are pretty bad.  Might you be over-tightening your mask?  This can actually cause leaks.  Your mask should just sit gently on your face, then when the air starts to flow it fills and presses down slightly on your face.  It should not feel tight.  Give yourself time to get this mastered.  If the leaks continue, you may need a different mask, but take time to see if you can get it adjusted well first.

Good luck!  

[HalfAsleep]

—Are you able to get issued a different mask? If so, request one. Then you can experiment. Not every mask is suited to every face. You could try an FFM that goes under nose instead of over nose.
—Also, you could try sleeping with a cervical collar and see if it helps with leaks. It can keep your jaw from shifting. Wear it loose.
—Use a very slim pillow if you’re sleeping on your back.
—If you’re sleeping on your side, position the mask off the edge of the pillow.