[Diagnosis] 2.5 years trying to figure this out.

[bwca1963]

Hello, just joined this forum today.

I'm embarrassed to say I have been wearing a cpap mask for 2.5 years now and still not sure what to do. I was snorting and snoring extremely loud so took a at home sleep test. Don't think I slept at all that night but the results were Obstructive sleep apnea in supine. I have been sleepy during the day and not a good sleeper so I was kinda happy that I was going to start feeling more alert during the day. The company that issued the sleep test got me set up with all the equipment and said the machine takes care of everything set at 4 -20. 
Struggled for a long time and just started experimenting on myself after watching videos online. 
I paid for someone to look at my Oscar report and I was really struggling with leaks but he quickly diagnosed me with UARS and ended up getting a Bi-level machine with a pressure of 18/13. At that pressure, I really struggle with leaks and I'm not really sure the higher pressure really makes me sleep better than say a set pressure of 8 or 9. I have always been using a nasal pillow mask with three pieces of tape ( one horizontal and three vertical) but that still does not stop the leaking. The only way to consistently stop the leaking is to wear a full face mask ( it's kinda nice to just put on the F20 without having to tape the mouth shut).

Last night I lowered the pressure and used the F20. It looks like I had a few short sections of the oscar that didn't look to bad ( see attached Osace report). 

So this is what I'm wondering.

Do I really have upper airway resistance syndrome.
Could I tell if I really need to wear a cpap if I use a device to stay off my back and wear a blood o2/ heart monitor and try a few night without cpap
Should I stay with the F20 mask and start raising the pressure bilevel or cpap ( I own both machines).

After 2.5 years of messing around with masks, tape, pressures and different machines, I'm ready to just start from scratch again and looking for suggestions from people that have already figured it out.     Thank you
   

[PeaceLoveAndPizza]

Fair play to ya for making it this far. It is not an easy path going it alone. 

To your questions…

Could you have UARS? Maybe. Not enough data to determine that.
Do you need to use a CPAP? I would need to see your sleep study to better determine that. From the looks of things my feeling is you need to do so, unless there are other changes you can make to deal with the symptoms.
Should you stay with the F20 and start raising pressure? I am not a fan of guessing and recommend a more thoughtful approach. As to the mask, that is a personal preference. If you have any nasal issues, then a full-face mask is the simplest path. If no nasal issues then a nasal pillow mask may be more comfortable, but you may need to use tape or a soft cervical collar to stop mouth drops causing large leaks. 

Do you take any meds OTC or prescription? Any recreational drug use or alcohol consumption? Any physical things going on we need to know? 

For now, I suggest going back to basics and working forward from there. Self-titrating will provide a lot of data we can use to tweak things.

Mode VPAPauto
EPAPmin 5
IPAPmax 15
PS 3
No ramp

That is a range which should tell us quite a bit. If the pressure swings due to flow limitations or other events, we will adjust the pressure or pressure support to deal with it. If you feel oxygen starved, we will do the same, but approach it slightly differently.

Give it a go for a few nights and let’s see where you end up.

[bwca1963]

Thanks Peace Love & Pizza!
I really appreciate the response to my word salad. One good thing about all this cpap stuff is I don't take sleep for granted anymore and have come to realize it's about the most important thing in the world as far as health and well being. That's why I haven't given up. 

You asked about health.
Just turned 61 and I'm 6' 1" 185 and in perfect health (as far as I know) except sleep apnea ( I think ).
Zero prescription drugs and zero alcohol ( a very boring person). Sometimes I get crazy and have a cup of coffee if it's free at a hotel breakfast. 
Blood pressure is nice and low usually around 115/ 65 ( I thought I heard people with UARS have high blood pressure)I play pickleball and lift weights.

I can breath ok through my nose but usually one nostril or the other has resistance or is blocked. 
When using a nasal mask, I feel I can breath well due to the pressure opening up the nose but ( it seems) all hell breaks loose when I fall asleep and there in no amount of tape to stop my mouth breathing. 

At this point, I like not messing with all the tape and just simply slip on the F20 which also eliminates leaking except when I really ramp up the pressure to 18/13 and it turns into a wild animal on my face and I also swallow lots of air. 

Last night at 10/14 I had no problems ( I seem to feel pretty good but the Oscar report doesn't look clean)  but if we need to go up to those higher pressures I will probably need to go back to the nasal mask and lots of vertical and horizontal tape to prevent the dreaded gas. 

If people need to deal with all the inconveniences and cost of using a cpap, then it would be reasonable to hope that it will help them get a super great nights sleep on most nights ( good looking clean Oscar reports).  

I went into the machine to move to your suggested pressures and noticed that I was in S mode?

Here is my settings for tonight!
VAuto
Ipap 15
Epap 5
Ps 3
Ti Max 2.3s
TiMin .3s
Trigger Med
Cycle Med
Full Face Mask
Ramp off

I will try these setting for a few nights and then post some OSCAR screenshots.

Thanks again! 

Steve

[PeaceLoveAndPizza]

You do not drink coffee? Alas, then you may not belong here. We drink an espresso as a warm-up to the real coffee of the day.

I agree with your full-face mask assessment. I used nasal pillows for a few years, but got tired of the mouth leaks. Switched to a FFM (F&P Evora) and have not looked back.

One important point to keep in mind is do not equate a "good clean" OSCAR report with a good nights rest. Some can have all kinds of wonky artifacts on an OSCAR report, but still feel well rested. Others with the slightest bump on the report and they feel terribly. It is an individual thing. 

Sleep is so much more than things a CPAP machine may help correct. It is not a miracle cure, just one step in the process of correcting sleep disordered breathing (SDB). Read the following and see if something resonates with you.

https://www.sleepfoundation.org/sleep-hygiene

And give the settings a go for a few nights. We should learn quite a bit.

[bwca1963]

Thanks, really good information. 
That Evora looks like a good mask. 

I will get back in a few days!

[bwca1963]

Forgot to move the SD card from my computer back to the CPAP. 
I will return in a day or so. Thank again!

[bwca1963]

Good Morning!
Here are a few Oscars on the test settings. 



I appreciate your time.

[PeaceLoveAndPizza]

Thanks for giving that a go. We are trying to find the sweet spot for pressure and pressure support which will give you enough information if you decide to go back to static pressures. Personally I prefer using a smaller range for movement rather than pure static pressures, as even 1 or 2 cmH2O headroom is enough to resolve many apnoea events. 

You can see as you reach deeper sleep states your flow limitations increase which in turn drives up pressure. Both nights are consistent that way. What we learned is that you need more pressure support than 3.

I suggest giving the following a go.

Mode VPAPauto
EPAPmin 8
IPAPmax 15
PS 4
No ramp

Let’s see how that goes and will adjust further. Sorry that it is not a quick fix, but finding the proper pressures takes a bit of experimentation and patience.