[CPAP] Used for 60 days, want to eliminate RERA/awake [Reposted with correct format]

[a29988122]

Before everything - thanks apnea board, you've helped me alone the road. It's very valuable!

So, first thing first. I'm using Airsense 11 with EPR 3 full time, pressure 12~20 now. 

Two Main issues I'd like to solve:
1. N30i with frequent leak/unconsciously pulling off the mask issue. That'll bring subsequent awake, and disturbing sleep. 

2. Smart watches reporting awake during night - I know it's not as accurate as EEGs - but the time it shows conforms with the data OSCAR/Airsense is reporting(there'll be multiple events when "awake" logged by wearables. Sometimes I'm awake enough to memo down time I'm awake, and it also confirmed the fact. This issue will happen independently, even without any leaking.

Solutions tried:
1.a Already tried different looseness/tightness to N30i, am using taping technique from temple to chin on both sides of face currently.

Especially this one: https://www.apneaboard.com/wiki/index.ph..._Jeffy1958

It still cannot eliminate enough leak though - when the leak happens long enough, I'll be awake in the next 10~20 minutes.

2.a
I have no idea, I tried increase pressure every 10~20 days, but to this day (65th day), it's still not working well.


Sitrep:
In the first 20 days, I kept my pressure at 8 ~ 20, and this is what I got:
1.png - link not allowed, pls check attachment

Apparently it's as ugly as it can be. One typical day during this period:
2.png - link not allowed, pls check attachment

After that, I increased the min pressure to 9, this is what I got:
3.png - link not allowed, pls check attachment
4.png - link not allowed, pls check attachment

You can see that it's only marginally better. Subjectively, I did not feel any better compared to previous settings. The only thing about the pressure increase is that I have slightly lower AHI.

So in the last 10 days, I tried to significantly increase the low pressure to 9 to 12 - very aggressive and not recommended by the apnea wiki - but it yielded good results.
5.png - link not allowed, pls check attachment
We're observing much lower AHI.

However, the awake issue is yet to be resolved.
One typical day, where I fell asleep at 01:46am, and woke up involuntarily at 06:15:
6.png - link not allowed, pls check attachment

During the sleep, the watch reports from 0238~0327 I'm awake, and from 0428~0501 I'm awake. I DID WAKE UP and able to memo down one awake time, which is 0450.
7.png - link not allowed, pls check attachment

For the 0450 awake, I suppose it's due to a major leak and multiple CAs before 0450, causing me to awake.

For the 0238 awake to 0327 awake, this is the graph:
8.png - link not allowed, pls check attachment
TBH for my ability, I'm unable to pinpoint my awake reason during this time period. I can only observe the pressure gradually increasing, and multiple OAs appearing - but the major leak only happens after the watch reported awake period, that means it's not a mask fitting issue. I'm using standard autoset algorithm.

This is from 0428~0501 reported awake period:
9.png - link not allowed, pls check attachment
I can't pinpoint the issue here either - besides the apparent 1min 40s leakage, the pressure is stable and the leak rate is also stable. However there's a lot of CA events happening, with frequent Flow Limit - it also conforms with how my watch reported, that is I was semi-awake during this period. 

To recap my questions:
1. How can I do to improve the random / short, but significant leakages, that'll increase events and ultimately make me awake? (Taping already used as previously mentioned in the beginning of the article. Nasal cradle size is also measured/tried between s, m, sw.)

2. For the supposedly awake without leakage - I've raise two examples above. How do I solve them? Will increasing pressure AGAIN from 12 to something like 12.5(past 10 days avg) or even 15.3(past 10 days 95% pressure) likely to solve this issue?


Thanks so much, kind netizens from apnea board!

P.S. for some reason, I cannot put zip as attachment nor links. 
www dropbox com/scl/fo/00pfxjfvhol4kljr6nhlv/AOgBX0hv16kDb3DW6Rc8T0U?rlkey=kpucruve6kmmcdy293v6rozv1&st=kvq8c06s&dl=0

Here's the link to my dropbox if it works...manually add in the dots in the link between www dropbox com please.
Thanks all!

[OpalRose]

Please follow these instructions for Organizing a chart, taking a Screenshot, and using the Attachment Feature to post that Screenshot.  

http://www.apneaboard.com/wiki/index.php...ganization

https://www.apneaboard.com/wiki/index.ph...pnea_Board

[a29988122]

Sorry I did not read the rules well..thanks for not deleting my post.

Following the rules and instructions:
Here are the two typical day of 08/27 and 09/09 I mentioned in the original post, with correct (hopefully) oscar screenshot and correct zoom.
   

   

If you're interested, and willing to help in detail, here is the corrected version PDF with all the 9 zoomed in images - I believe that I zoomed the correct time and data, and there's necessary info shown on the Oscar screen.

The PDF should have better readability.

  Apnea board question post(backup).pdf (Size: 601.08 KB / Downloads: 5)

Again, thank you apnea board and all the admins!

[a29988122]

Did I provide anything wrong?

If there's any suggestions, it'd be greatly appreciated!

==
As an added context, I started using pressure 12, upped from 9, already for 4 days.
In one of the night, I got jolted awake midnight. It's not because of outside sound/light/movement, so I guess it's due to the pressure induced awake. Prove is that I had a giant/long burp soon after the awake.

Not that uncomfortable, but I wonder if this means anything. The other nights with pressure 12 is also not that uncomfortable.
Because my AHIs in the 9 pressure was from 11~7, and for the pressure 12 it is now 5~3, very stable, so I have no idea if I need to change anything back.

Thanks, any kind of reply is appreciated very much!

[SarcasticDave94]

It's possible that your OSCAR chart indicates patterns of clustered events from Positional Apnea. This would be caused by thick or several pillows forcing a chin tuck position. This chin tucking kinks your airway externally. If you suspect this, you'll either need to get a thinner pillow or physically block the chin tuck with a proper sized soft cervical collar. If this type of Positional Apnea is applicable, there's not enough CPAP pressure to prevent this. It's an external physical cause, and needs an external physical fix.

[OpalRose]

Let's back off that maximum pressure down to 12cm, and go back to minimum pressure set at 9cm.

For now, raising the pressure does more harm than good. It's causing an increase in CA's. Dave is correct in his assessment of some Positional Apnea, where you are sleeping in a way that's cutting off your air. This results in "clusters" of apnea. It's not excessive, but it's there.

Higher pressure usually won't correct this, so take a good look at your sleep position and if you're tucking your chin into your chest area and what may be causing that.

Once you can correct the Positional issue, we can look at pressure adjustments, if needed.

https://www.apneaboard.com/wiki/index.ph...onal_Apnea

Note: Higher pressure in some folk can result in more leaking. Work on your mask fit.

http://www.apneaboard.com/wiki/index.php...ask_Primer

For myself, I prefer nasal pillows, which ultimately means I use tape to control leaks. It does take some getting used to, but it is very effective.

[holden4th]

What brand of tape do you use Rose? Is it specifically for CPAP? I tried one from an online company and it didn't stick properly and was not wide enough.

[OpalRose]

I have tried cover roll tape, but it just wouldn't stick.  There was another brand too, but can't remember the name, but found it coming off in the night and in my mouth!  Not good!  I think it also depends on your skin texture.  Some folk have more sensitive skin than others.  

I've switched to Kinesiology Tape.  It's a bit more expensive, but worth it if you're not fighting with it.  Plus, I usually have it around the house as I use it to tape my ankles for swelling issues.  That's a whole other issue!  

Some brands I've tried and like are Theraband, KT Tape, Stark Tape and CureTape all found on Amazon.

For the mouth, 2" wide.  Cut long enough to extend at least 1 to 2 inches past the corner of your mouth.  I think 5 inches is average.

What I've found in my case, that over time, my leak rate was directly responsible for most apneas.  I've never had high AHI numbers, but with the tape, I'm at an AHI of 1 and under, many times 0.  I don't particularly chase a low AHI, but needed to address the waking up every couple hours with leaks and the very dry mouth.  So taping it is!  As we get older, things just change.

Good luck, it does take getting used to.

[a29988122]

Hi, here's a follow-up: I tried use a very low pillow, with head reclining chin lifting, like a cpr ready head positon.


Shape something like this. But the pillow is really low like only 4~5cm, and your head is reclining to clear airway with this pillow

With the new settings:
2024年9月26日 2024年11月10日 46 days
AHI 5.23 AirSense11AutoSet (39523) EPR: Full Time 3 cmH2O APAP Min 9.6 Max 15.8 (cmH2O)

With stats like this
   
   
   

Seemingly no progress, and feels like the clustered events are from physically blocked throat in supine position, as you mentioned in the previous replies. Am I interpreting them right?

Question:
What are my next steps ideally?
Should I be increasing maximum pressure, since sometimes my pressure increase to over 15.5 and there's still OA seen in the charts?
Or should I be just start using soft neck brace, and learn to deal with it because it can help sleep better?
Or, two of the above?

===
On a side notes, is there subjective study about own-evaluated satisfactory score and awakeness, compared with AHI~=0 and AHI<5 APAP users after treatment?
I just wonder if using a soft neck brace is really worth it...

Thank you all!

[OpalRose]

The Positional Apnea (clumps of Obstructives) has never really resolved.   You asked if raising the max pressure would help..... generally, no, as long as the obstruction is due to head/neck position. It's the same as a garden hose with a kink in it. No water gets through.

Of course you can go ahead and open the max setting to 20 and see for yourself.  What usually happens is the pressure will rise to the max pressure set in an attempt to clear the apnea, but it is seldom successful.

Have you tried sleeping on your side?

A soft cervical collar may be the answer.  You need to measure correctly, circumference plus a couple inches.  Also measure bottom of chin to sternum area.  Not too tall, or it will be uncomfortable.  Not too short, as it would be the same as not wearing one at all.  The collar should be snug, but not so much that you can't insert a couple fingers under it.  

Try Amazon, they have lots of choices.

https://www.apneaboard.com/wiki/index.ph...onal_Apnea

http://www.apneaboard.com/wiki/index.php...cal_Collar