[CPAP] Huge noob here. Really POed at Resmed/DME and could use help now!

[debhona12]

Thanks to all of you for the help. For reference, I'm 29f, 5ft3, 130lbs and was diagnosed via home sleep study with mild sleep apnea, AHI 6.0

I had a home sleep study last year and have been using CPAP off and on for a few months since end of 12/21 (few failed months with a MAD before). I wasn’t feeling great a while ago, and turned to Reddit, where I tried things like adjusting the settings on my own and such using Youtube tutorials. 

However, when that didn’t work, I contacted my DME - who chewed me out for bypassing the clinician settings and also for not having had a fit test on my mask (which was their fault, because I hadn't gotten one at the first appointment, and my sleep doctor - who wasn’t affiliated with DME or with the home sleep test company - was virtual and her note was “yeah sure go get a device insurance will send you one” and then left for another practice). All of it was very disjointed and left me feeling like I’d fallen through the cracks.

And then, when I went to dig a bit deeper and downloaded OSCAR, I was incensed that my Resmed 10 had “conveniently forgotten“ to come with a memory card! So in early 3/22, I bought a card and tried to be patient, stuck to the DME’s pressure settings and new mask (the nasal mask is much more comfortable so that has helped), and wore it when I could tolerate it. 

At this point, almost three months later, I’m still seeing no change in sleep quality or daily symptoms, and would like advice to make sure I’m going in the right direction or if I’m really at the end of my rope. 

I have a couple of screenshots of the past few days, and can also post the 3 month Overview/Statistic pages as well (not sure how helpful they are….). Would really appreciate some advice, as well as knowing what settings I am “allowed” to change on my machine so I don’t get chastised by the DME again. Please let me know what things I need to add to my post or change, still trying to understand it all. 

   
   
   

Thanks so much!
-Deb

[staceyburke]

Welcome to the site there are a number of very good people here that can and will help.

I will give you 2 things to change.

Min 7
Turn off the ramp.
Other than that work on your mask fit. You have to many leaks and some mouth breathing that is causing problems.

[debhona12]

Thank you very much! Do you mean keep the pressure at 7 and turn the ramp off? Why is that better? (curious)

With mouth breathing, is there any fix besides tape that would work? And how do I fix the leaks around the mask itself?

[StratCat48]

I use a full mask and was having issues of mouth breathing which caused dry mouth. I found a chin strap on Amazon that helps to keep my mouth closed. The one I got is similar to this one....
https://www.amazon.com/Snoring-Breathabl...25&sr=1-10

The reviews don't match up with the chin strap by a long stretch, but you get the idea on the chin strap.

[staceyburke]

Your min pressure is now 4. Set it to 7. The why takes a little while. 

Your EPR (exhale pressure relief) is set to 3 full time. That is fine but the min set to 4 does NOT allow it to do anything. 

The absolute lowest the machine can go is 4 so the EPR can’t work. (Min - EPR is your exhale pressure).  Min 7 - EPR 3 = 4. 

EPR does several things, helps stop flow limits, H events and makes it easier to exhibit. 

As far as the mask and mouth breathing- http://www.apneaboard.com/wiki/index.php...ask_Primer

[sunsaffron]

I see you have the AirFit N20 mask. Depending on your sleep movements and overall face structure there could be leaking that will be hard to alleviate. If you don't open your mouth while sleeping I might recommend a nasal pillow mask like the AirFit P10 or the AirFit P30i. I had to go through many types of masks before I settled on those two. But those masks obviously don't work for everyone.

[debhona12]

Thank you for the advice. I'm still a bit confused as to what EPR is, but will look into it, and ask if DME can send some more potential masks for me to try.

[staceyburke]

I tried to explain EPR but looks like I failed. You can go to wiki at the top of the site and search EPR. It gives info there.

[RainbowFish]

The people here give great advice and are far better at reading the OSCAR than another newbie like me, but I have a couple thoughts. And it does seem like you are having some mask/leak issues. So, I thought I would weigh in on the MAP.

I have mild to moderate sleep apnea (AHI 15-20) myself and freaked when I was told I needed CPAP. So, I too ordered a MAP to try to avoid the machine. But it took forever to get the MAP, and I got an APAP fairly promptly, so I started with the APAP first. I asked for a full-face mask because I mouth breathe a lot. And both the Airfit F20 and the Fi30 work well for me. And I feel great on the machine. But I also still had dreams of using a MAD instead, so I went ahead and got it too. By the time it arrived and was fitted I was settled on the APAP using the full-face mask successfully.

For me the custom MAP is very comfortable, but it is not effective enough to replace the APAP, and cannot I use it comfortably under a full-face mask. BUT the MAP opens my throat enough that I can now reliably use a nasal mask with minimal leaks.

So maybe that could be helpful for your leaks too.

[Sleeprider]

I agree with the advise to minimize or eliminate the ramp, and to use a minimum pressure of 7.0. EPR is expiratory pressure relief, and your setting of 3 means the exhale pressure reduces from the inhale pressure by 3-cm. This is good because it helps with hypopnea and flow limitations which is really the source of your sleep disordered breathing. EPR is the same as "pressure support" in bilevel therapy, and the increasing pressure during inhale physically helps you to get a satisfying full breath, even if your airway is partially restricted. We can see on the graphs, that the times where your pressure falls below 7.0, your flow limitations increase. Increasing minimum pressure to 7.0 will help stabilize the pressure you experience through the night, improve your therapy results and reduce disruptive pressure swings.