[CPAP] New CPAP user, what are some settings/tips/optimisations I can use to better it?

[Determinism]

Hello everyone my first post here Last month I got diagnosed with almost severe apnea. Post my sleep study at a hospital my AHI was about 29 odd. My doc recommended that I immediately get on CPAP therapy. In India, insurance does not cover sleep studies and equipment related to it. Everything is paid up by the patient. I mention this I see a lot of posts here asking people to not tamper or modify the settings of the device by the doctor/hospital/provided. That isn't the case for me. I paid for the device in full and I'm free to do whatever I want with it. My doc asked me to put the minimum pressure at 4 and a maximum for 14. Thats the only setting she recommended. She said most people dont need a humidifier but said it isn't a bad option to have in the device so I got the one with the humidifier, Resmed Autosense 10.  She asked me to use a full face mask since I've been a mouth breather all my life. I got the full faced mask and felt very claustrophobic and anxious so immediately removed it and told her about it. She asked me to get the nasal mask or pillow. I got the pillow and its been my mask so far in my therapy. Since I mouth breath, I could feel it that lots of leaks were happening because of my mouth. Since 10 days so, I started to tape my mouth (Buteyko recommendation) and I dont mouth breath anymore during nights.  I dont feel any discomfort and I somewhat mentally feel better I sleep a little bit better with a taped mouth. One thing that is bothering me is the leaks. Not sure why they are happening. I have the Resmed P10 nasal pillow. Also, I subconsciously remove the pillows for  some time in the night. But its becoming lesser and lesser. I was doing it much more in the early days.

What EPR, Ramp, min-max pressures would you recommend after seeing my charts? Thanks in advance for any help you may be able to provide.

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[SarcasticDave94]

First, welcome to Apnea Board.

IMO the numbers aren't bad, but if this were me, I'd think bumping your low side up to 6. This typically helps with getting you a bit more air and should help address the mask removal. I used to do mask tossing because of a lack of air early on too.

Having said that, when the gurus chime in, I'll defer to their answers.

(If y'all need anything else from me, I'll be in the break room getting coffee.)

[Crimson Nape]

Your numbers are looking very good.  Don't strive for an AHI of 0.0.  While they occasionally happen, they are the exception and not the rule.  

Pressure range; Your upper pressure limit is fine, I think I would increase your lower pressure to about 9.0cm.   You probably are feeling air starved at 4cm.  Increasing the lower pressure will eliminate the starved feeling and put you closer to the therapeutic pressure you seem to require.  

I noticed that you are having some flow limitations.  To address this, you may wish to experiment with the EPR feature.  Each EPR increment (1-3) reduces your exhale pressure by that value in centimeters.  If you decide to use the EPR then you will need to increase your pressure by the EPR value you try.  Example: Using the 9.0cm I recommended above and you set the EPR to 3, then you would want the low pressure to be 12cm (12cm-3EPR = 9cm). .  Also, you may get some CA events when using the EPR.  Don't worry.  Some, if not all, of them will diminish as your body gets accustomed to the pressure difference.  

Good luck and keep us posted.

[Walla Walla]

Pretty good advice from a guy with a laser sword.

[Crimson Nape]

I have my moments.

[Ron AKA]

First off, you have excellent results, and I see no opportunity to make any improvement in AHI. As for maximum pressure if anything I think you could reduce it to 13 cm, if those two posted nights are typical. I agree with Crimson Nape that 9 cm would be a good minimum pressure. It doesn't look like it would improve your results, but it would reduce the variation in pressure through the night.

You seem to have your EPR set to Ramp Only, which I think is a good idea. But, it does not appear that you have the ramp turned on. I really like the Auto Ramp feature in the AirSense 10, but the key to it is to set the Ramp Start pressure to a pressure that you feel comfortable breathing with while awake. I would suggest something in the range of 6-7 cm. If it feels like too much air, then lower it, and if it feels like you are not getting enough air, then raise it. I currently have mine set at 7.6. That gives me lots of air, and the EPR setting of 3 that I use brings it back to just over 4 cm on exhale.

I tried the tape on the mouth trick, but that is not for me. My most recent attempt to stop mouth leaks is to use a chin strap. They are often sold to prevent snoring, and are quite cheap on eBay. See the picture below. What I do is put my AirFit P10 pillow mask on first, and then put the chin strap on next. It not only holds my mouth closed, but it also holds the P10 mask in place. I also had trouble with it coming off in my sleep. The chin strap did not stop all leaking due to an open mouth, but it seems to have significantly reduced it.

EDIT: I just noticed that you have your minimum pressure set at 4 cm. The ramp can't work with that minimum setting.

[Determinism]

Your numbers are looking very good.  Don't strive for an AHI of 0.0.  While they occasionally happen, they are the exception and not the rule.  

Pressure range; Your upper pressure limit is fine, I think I would increase your lower pressure to about 9.0cm.   You probably are feeling air starved at 4cm.  Increasing the lower pressure will eliminate the starved feeling and put you closer to the therapeutic pressure you seem to require.  

I noticed that you are having some flow limitations.  To address this, you may wish to experiment with the EPR feature.  Each EPR increment (1-3) reduces your exhale pressure by that value in centimeters.  If you decide to use the EPR then you will need to increase your pressure by the EPR value you try.  Example: Using the 9.0cm I recommended above and you set the EPR to 3, then you would want the low pressure to be 12cm (12cm-3EPR = 9cm). .  Also, you may get some CA events when using the EPR.  Don't worry.  Some, if not all, of them will diminish as your body gets accustomed to the pressure difference.  

Good luck and keep us posted.

Thank you Crimson Nape! Thanks for the wishes. I will use your recommended numbers for a week and report back On a site note, my ramp time set to auto and EPR Type to Ramp Only. Start Pressure(under ramp time) is at 4.0. Should I change this pressure to 12 as well?

Pretty good advice from a guy with a laser sword.

Thanks for chiming in

First off, you have excellent results, and I see no opportunity to make any improvement in AHI. As for maximum pressure if anything I think you could reduce it to 13 cm, if those two posted nights are typical. I agree with Crimson Nape that 9 cm would be a good minimum pressure. It doesn't look like it would improve your results, but it would reduce the variation in pressure through the night.

You seem to have your EPR set to Ramp Only, which I think is a good idea. But, it does not appear that you have the ramp turned on. I really like the Auto Ramp feature in the AirSense 10, but the key to it is to set the Ramp Start pressure to a pressure that you feel comfortable breathing with while awake. I would suggest something in the range of 6-7 cm. If it feels like too much air, then lower it, and if it feels like you are not getting enough air, then raise it. I currently have mine set at 7.6. That gives me lots of air, and the EPR setting of 3 that I use brings it back to just over 4 cm on exhale.

I tried the tape on the mouth trick, but that is not for me. My most recent attempt to stop mouth leaks is to use a chin strap. They are often sold to prevent snoring, and are quite cheap on eBay. See the picture below. What I do is put my AirFit P10 pillow mask on first, and then put the chin strap on next. It not only holds my mouth closed, but it also holds the P10 mask in place. I also had trouble with it coming off in my sleep. The chin strap did not stop all leaking due to an open mouth, but it seems to have significantly reduced it.

EDIT: I just noticed that you have your minimum pressure set at 4 cm. The ramp can't work with that minimum setting.

Thank you Ron Aka for your help! I will get the chin strap and see if it helps. With the taping so far I feel great with no discomfort. I'm assuming that I turn a lot in the night and its during these turns that the seals are getting stressed and leaking some air. Maybe I should just train myself to sleep on my back all night. I've been a side sleeper mostly all my life. You mentioned that it appears EPR ramp is not turned on. How do I check this?  I have the ramp time set to auto and EPR Type to Ramp Only. Start Pressure(under ramp time) is at 4.0.

[Reznik]

Don't ignore the humidity settings.  I find a major difference in congestion and airflow at different humidity levels.  It took me weeks to dial in the right humidity setting.  Once I found that, the pressures that I needed to maintain an open airway dropped as well.  Also, dropping the pressure eliminated my need for a chin strap since it became easier to breath through my nose.

If you do need a chin strap, pay attention to when you are breathing through your mouth.  If you're breathing OUT through your mouth, EPR or Bi-Level might help, since that will lower the pressure on expiration.  If you're breathing IN through your mouth, then your pressure might be too low, or you might be suffering from nasal congestion, which can be caused by the wrong humidity levels....

[Sleeprider]

Your results are excellent, and the advise above is pretty good. I am going to add a suggestion to try EPR (exhale pressure relief) to increase comfort. Your only events are hypopnea, and EPR can actually work to minimize that, but in your case the event rate is already low. EPR for you will be a comfort setting. Along with your new minimum pressure of 9.0, try EPR Full Time at 2. You can increase or decrease it according to your comfort. I see no drawback to using EPR and I think you will like the results.

[Ron AKA]

Thank you Ron Aka for your help! I will get the chin strap and see if it helps. With the taping so far I feel great with no discomfort. I'm assuming that I turn a lot in the night and its during these turns that the seals are getting stressed and leaking some air. Maybe I should just train myself to sleep on my back all night. I've been a side sleeper mostly all my life. You mentioned that it appears EPR ramp is not turned on. How do I check this?  I have the ramp time set to auto and EPR Type to Ramp Only. Start Pressure(under ramp time) is at 4.0.

If you set the Ramp Start to 4 cm it will not do anything as that is the minimum pressure the way you have your machine set up. If you change your minimum pressure to 9 cm, and keep the Ramp time on Auto, I would suggest setting your Ramp Start to 6 or 7 cm, or what feels comfortable to you when you are awake. It will hold the pressure at that say 7 cm and apply the EPR during the ramp time, but when you go to sleep it will ramp to 9 cm at 1 cm per minute.