[CPAP] Newby not sure if CPAP is the right machine for me

[tcinoz]

Two weeks in to trialing a CPAP machine, currently monitored solely by a sleep centre (in it for the money) who don't offer any alternatives to the machine they provide. Even at pressure levels of 5.0 or less, my mouth is filling with air as my breathing slows to a stop. I think my apneas are all central now (was disagnosed with mixed - thinking I may even be getting extra treatment-emergent apneas) and am thinking maybe I need to get an ASV machine from somewhere. Do they cope better with the mouth filling with air because of breathing stopping? Thank you if you can help me through this wilderness!

[PeaceLoveAndPizza]

Without seeing a sleep study report or OSCAR data from your machine, it is difficult to offer much advise regarding what machine would be appropriate.

If you have a sleep study, please redact your personal information and post it. If not, is there an SD card in the CPAP machine? if so you can use OSCAR, assuming it is a supported machine, and post some charts. You can always add an SD card to it without impacting anything the sleep center is doing.

Air in your mouth is typically a matter of proper mask choice, mask fit, and getting used to the machine. There could be other things impacting it, but they are far less typical. 

As you noted, the sleep centers are in many cases only interested in getting paid. There are some good ones out there though. Once you get a machine (we typically recommend a ResMed Airsense 10 or 11 Autoset as a starting point, unless you sleep study calls for something different), we can then use the OSCAR data to fine-tune your settings.

[CPAPfriend]

You're using a nasal mask, and your complaints are not uncommon for new patients. There are a couple things you can try to fix the mouth issues, beginning with just switching to a full-faced mask. Soft-cervical collars and chinstraps (knightsbridge one preferably) are the next line of solutions I would recommend.

Keep in mind that it's common for new PAP users to develop central apneas with the onset of treatment. We can help you a lot more if you post your OSCAR data for us to see. At first glance, jumping to ASV seems overkill and there's likely some easier troubleshooting steps to attempt first.

[tcinoz]

[attachment=58971][attachment=58972]

Thank you both very much - very helpful, especially the links. I'll work my way through all the material in due course but for now I prioritised getting some data off my SD to show you. I'm uploading just the last two nights. If anything useful can be deduced from it, I'd very much appreciate your insights. Thanks again.

[Deborah K.]

Your chart is difficult to read.  We can help you better if you put the following items on the right side, under Event Flags, in this order:

Flow Rate
Pressure
Leak Rate
Flow Limits

[tcinoz]

Your chart is difficult to read.  We can help you better if you put the following items on the right side, under Event Flags, in this order:

Flow Rate
Pressure
Leak Rate
Flow Limits

OK, thanks for the tip. I'll work on it (brain fog permitting!)

[SarcasticDave94]

It would already appear your Philips Respironics pressures are not optimized. 4 cmH2O is very likely going to be too low. These PR machines are slow to get up to the right pressures and requires you to set it pretty much where it's needed.

When we see easier to read charts it's then going to be verified settings will be a big issue.

[PeaceLoveAndPizza]

Consider starting with a more reasonable setting. Something like:

Min pressure 7
Max pressure 15
Flex 2
Ramp off

Once you have a few nights post a chart and folks can help fine-tune things.

You also show some good sized leaks that you need to address. They could be mouth or mask leaks, but until you post a more readable chart as Deb suggested we cannot see the details.

[CPAPfriend]

We can see there are still many events. Repost your charts in the format Deborah laid out and we'll get started.

[tcinoz]

Thanks again, everyone.

For some reason, opening the report on OSCAR didn't result in the nice coloured grid on the right-hand side that others seem to show. Instead I got the mess that you see in the reprots I posted above, and I have no idea how to format that to look like the others, even after following the instructions in the Chart Organisation guidelines. I'll have another crack at it later in the week if and when I get some decent sleep, but for now I've transposed selected info from the Statistics tab (for the last week) below. Hopefully that's enough to draw some conclusions from.

Therapy Efficacy
AHI  5.1
OA Index  0.86
CA Index  0.51
Hypopnea Index  4.27
Flow Limitation (FL) Index  0.83
RERA (RE) Index  1.58

Leak Statistics
Average Leak Rate  3.66
95% Leak Rate  11
% of time above Leak Rate threshold  4.53%

Pressure Statistics
Average Pressure Set  5.29
Min Pressure Set  4
Max Pressure Set  10.1
95% Pressure Set  8.1
Average EPAP  5.23
Min EPAP  4
Max EPAP  10.1

A few notes:

• Hypopneas are my main problem. My breathing gets so shallow once I start drifting off that even at low pressure my mouth fills up with the air that's not going down my throat. Wouldn't higher pressure make that problem even more severe? 
  
• I tried tying a bandage around my head to cover my mouth last night but it didn't stop me waking up almost every time my breathing slowed to nothing.
  
• I'm unsure about the Leak Rates and what they signify. Does the fact that I leave my machine blowing air into the room whenever I go to the bathroom affect those stats?
  

But really, the main question remains: is an ASV machine likely to deal more effectively with mouthfuls of air waking me up than my CPAP? I will gladly do and pay whatever it takes to get few hours uninterrupted sleep. Right now even two hours seems like a luxury. Any advice more than gratefully received!