[Treatment] First sleep, could cry.

[shantruss]

First and foremost.

I've been dealing with OSA for likely my entire life thus far (mid 20s), but never severe enough for me to properly worry about until I put on a ton of weight over the last few years. (Don't worry, it's coming off me now slowly but surely!)

Finally after hemming and hawing about the price I went and got a home test via the VirtuOx Nightowl and sure enough it picked up on an AHI of 76.8... Basically choking myself every time I get any modicum of sleep, waking up heart pounding, gasping etc... All the signs.
Snagged myself an Airsense 10 that just arrived today. I could hardly contain myself setting it all up and getting it started, spent a few hours sitting in bed getting used to the feeling before finally getting some sleep between 5pm and midnight-ish (Will be adjusting to a normal sleep schedule, I just needed to sleep then and there because I've been EXHAUSTED the last few weeks because of this.)

And sleep I had, 6 nearly uninterrupted hours. Up from about 30 minute intervals without the machine... I could cry. I still feel tired, but I imagine that's due to the YEARS of sleep my body and brain have to catch up on.

A huge thank you to everyone on this forum for the absolute monstrous wealth of knowledge and testimonials to get me into gear to get it all set up. Now it's time for fine tuning and most important of all: REAL SLEEP. 0.3 AHI. 0 WAKEUPS.

I downloaded OSCAR (bless FOSS) because I love poking around data, so I'll post a few graphs if anyone has any general recommendations while I go peruse more forum posts for info. It's much appreciated since I'm new to all this. 
(The gap from 7:30-7:45 pm was me I believe accidentally knocking the mask out of alignment, oops!)
 
As a note on the settings it shows in OSCAR: I didn't have any water in the humidifier, even though it shows a humidity level of 4 on the chart, I had it set to auto which I assumed would turn it off w/o any water. If this is harmful to the device please let me know! Every other setting is default aside from Ramp off

[AussieBobJ]

Hi - I'm far from being an expert - just a bit further along this journey of discovery perhaps?

Suggestions ...
Don't use ramp - notice how quickly the pressure shoots up as soon as it can?
Raise the minimum pressure to 8 - notice from the Time at Pressure graph that your pressure is mainly in the 11 - 14 range
Try turning EPR on - it might make exhaling easier - something I can find challenging during those moments before I actually fall asleep

I'd be delighted with an AHI of 0.31

[Expat31]

It's early days, but you have made a good start.

EPR is a good comfort feature, and should reduce your flow limitations and hence arousals.
 If you  do not have water in your reservoir, best to set humidifier at zero. 
The setting of climate control relates to a heated hose (if you have one), not the humidifier.

When posting graphs, best to show a full night's data, and therefore do not zoom in to particular data point unless you need to focus on an individual area.

AussiBobJ 's proposed settings are good to get you on track.

[Muggzy]

I don't have any advice, but I want to say wow for a first night that's pretty impressive!

My first night, and I suspect the first night for many, it was very difficult to tolerate the CPAP and get anywhere near a full night's sleep, let alone such a drastic reduction in AHI.

So great job!

[Sleeprider]

With a minimum pressure of 5.0 and maximum pressure of 20, your AHI was very good, but your flow limits are high. Since this is where we see respiratory effort and arousals, I'm gong to suggest the following changes to your settings. Minimum pressure 8.0, maximum pressure 16.0, EPR on full-time, EPR setting 3. This will turn your CPAP into a bilevel with 3-cm of pressure support. This difference in inhale an exhale pressure will assist inspiration and result in a significant reduction of flow limitation, which was at 95th percentile index of 0.16. The use of EPR should result in lower pressure overall, much better comfort and a flow limit of 0.05 or less. You will see a much smoother flow chart and the flattening you see at peak inspiration when you zoom in, should mostly disappear. Avoid ramp if you are able to tolerate the starting pressure. Good luck, and glad you have so quickly found a solution to improve comfort and your health.

[Deborah K.]

Wow!  You have made a fabulous start!  I'm so happy for you.    You will feel better and better as you adjust to your therapy.  I suggest that you move your starting pressure up to 7 and turn EPR on full-time at 3.  Do you not want to use water in the humidifier or did you forget to?  Most of us like the added moisture, but some don't.

OOPS! Just saw that Sleeprider responded. Do what he says. He's the best.

[shantruss]

Thanks all for your replies.
I'll give these new settings a try here very soon and check on the data to see how it gets on.

Comfort wise in terms of the first sleep, it might help that I spent the 2 or 3 weeks in between waiting for my Rx and delivery of the unit obsessively watching videos/reading posts to get a feel for what people prefer and what to expect, as well as wearing it with the machine running for 3 or 4 hours before I actually fell asleep (hence the shortened/zoomed in graphs, the first half is junk data from me fiddling with it).

As for the humidifier, I was honestly just so exhausted I didn't have the energy to go out and grab some distilled water for it. I have a ZeroWater filter, but I know using non-distilled water is not very highly recommended so I figured I'd skip it.

No sore throat or anything bad from the lack thereof though, just a bit extra thirsty when I woke up which I imagine is because I'm not sipping water to quell my racing heart every 30 minutes now. I'll experiment with the humidity next time I'm out and about and can grab a jug with the groceries, as it does sound appealing. I did buy the heated tubing which I imagine synergises well with that functionality.

I'm still in awe at the sheer drop in AHI, almost to a point that I can't believe it, but I have not slept continuously for 6 hours for longer than I can remember so I'll take the machines word for it!

Thanks again!

[Sleeprider]

I use tap water at home and zero-water at our cottage with well water. Either is fine and won't harm your equipment or you. If water is hard (calcium carbonate), you may get some scale deposits in the humidifier chamber if you let it dry out before rinsing. The Zero Water eliminates hardness and there is no problem with using most tap water supplies that are fit for drinking. Rinse and allow to dry daily. Distilled is recommended, but in 16 years I have rarely used it.

[shantruss]

Good to know on the water situation, I will try to use some from my water filter tonight and slowly ramp up the humidity over the week til I find something nice. Still no negative effects from having it off on my second night, but I'd like to try it regardless. Also thinking I'll start wearing my FitBit to bed so that i can get that juicy sleep data from the HR monitoring as well, I stopped long ago because it wouldn't even register that I was sleeping which to be fair is probably accurate hah!

I went ahead and programmed in the new settings, and things did seem to go smoother for most of the night aside from some mask seal issues at the end of my sleep due to a number of things, mostly old habits dying hard and me forcing myself back to sleep despite feeling rested resulting in frequent tossing and turning and mask fiddling. (And forgetting to silence my phone, woops!) I'm really liking the feeling of EPR, definitely more comfortable when I'm getting to sleep.

My Bleep Eclipse "mask" should be arriving today as it got delayed and taken off my original shipment, so I'll be able to hopefully solve that tonight and get a better looking graph next sleep!

Regarding the snoring indicated on the graph part way through the night, I assume this to mean I should definitely try a few solutions regarding chin strap/cervical collar/mouth tape which I expected, and honestly am surprised I didn't have issues with the first night. Adding that to the shopping list.

Still very happy to see such an impossibly low AHI given my tested number, and immediately noticing the results considering I was awake for essentially 20 hours straight yesterday without so much as a single nap on my couch (the average before being 3 or 4 long naps dispersed thru the day.) I don't intend to stay up that long every day, just wanted to get my sleep schedule back in somewhat alignment!

You're all awesome!

[Sleeprider]

I had expected more reduction of flow limits with EPR, but it looks like pressure is in an appropriate range, and therapy is looking good. Comfort and good sleep are keys to success so hopefully, the therapy is providing better rest. I don't see any breaks in therapy where you had to run to bathroom, so you're getting nearly 7-hours in. Not a bad start at all. You do not need a chin strap as leaks are very low, and the risk with a chin strap is that it may pull the jaw back increasing obstruction. If you are experimenting with a soft cervical collar, a relatively loose fit that supports the jaw or chin is ideal, and this may relieve flow limits and snores. Unfortunately, the Oscar data only tells us those issues are present, it doesn't tell us why.