Clear Airway Events Only - New User Help

[pacc815]

Hi - I am a new CPAP user and have been using my AirSense 11 for about a week now. During the first few nights I was using the N30i mask and while my AHI was close to 0, I could not get used to the exhale pressure and couldn't make it through the whole night. I switched to the F30i and the comfort is miles better in terms of the exhale pressure, however my AHI has climbed a little bit - with only open airway/central apnea events. I am new to reading the OSCAR charts, but from what I can tell I am having some mask leaking. I suspect that this is due to being a side sleeper which is pushing the mask into the pillow. However, the timing of the OA events do not seem to directly align with the leaking. Is this cause for concern? Is there anything in the OSCAR chart that I'm missing?

   

[PeaceLoveAndPizza]

I see nothing there that is a cause of concern. I suggest continuing to use it as is for a few more days and then check if anything has changed.

[SarcasticDave94]

The leaks are a small issue, probably one that will be easy to address by avoiding the mask deflection. Therapy looks good otherwise. CA despite being higher than anything else, are still very low. Grade this as minor, not even worth taking action about them. Most everyone will have a few of these CA, so again pretty good overall.

[pacc815]

I see nothing there that is a cause of concern. I suggest continuing to use it as is for a few more days and then check if anything has changed.

The leaks are a small issue, probably one that will be easy to address by avoiding the mask deflection. Therapy looks good otherwise. CA despite being higher than anything else, are still very low. Grade this as minor, not even worth taking action about them. Most everyone will have a few of these CA, so again pretty good overall.

I've added a chart from when I used the N30i. Even though these results with the N30i are better, am I correct in thinking that my results with the F30i are still good enough and I should continue with the F30i if it provides improved comfort? Or are the results with the N30i worth pushing through the discomfort?

   

[SarcasticDave94]

Any details on the nasal mask discomfort? Is it requiring tightness to work? If yes, that's not going to be ideal.

I did see in your charts you're using default pressures 4-20 and probably trying EPR. Getting away from default is by itself a reason to edit settings. I would consider Min pressure 7 to allow full time EPR 3.

EPR will reduce exhale by the setting number, but it cannot reduce below 4. So your minimum pressure to get EPR working always is this:

Min pressure 5 EPR 1 equals 4
Min pressure 6 EPR 2 equals 4
Min pressure 7 EPR 3 equals 4

Follow this as minimums, your pressure minimum can be more than these, but not below these line examples if you want EPR to work without waiting for pressure to increase first.

[pacc815]

Any details on the nasal mask discomfort? Is it requiring tightness to work? If yes, that's not going to be ideal.

I did see in your charts you're using default pressures 4-20 and probably trying EPR. Getting away from default is by itself a reason to edit settings. I would consider Min pressure 7 to allow full time EPR 3.

EPR will reduce exhale by the setting number, but it cannot reduce below 4. So your minimum pressure to get EPR working always is this:

Min pressure 5 EPR 1 equals 4
Min pressure 6 EPR 2 equals 4
Min pressure 7 EPR 3 equals 4

Follow this as minimums, your pressure minimum can be more than these, but not below these line examples if you want EPR to work without waiting for pressure to increase first.

I didn’t have discomfort with the actual nasal mask itself but with exhaling while wearing it.  With the nasal mask I felt a much stronger resistance when exhaling even though I had ESR set on 3 with this mask. I guess because all pressure is directed right up my nose with the nasal mask. Whereas with the full face hybrid, I was able to tolerate ESR of 1 because I had a much easier time exhaling than I did with the nasal mask. Since I had an easier time exhaling, I was more comfortable and able to sleep through the night with the full face hybrid (hence the longer session time noted in the snip).

[SarcasticDave94]

OK, makes sense on difficulty exhaling when expecting EPR to help but it can't with default pressures. Give those edits a try, it might make that nasal mask work better too.

[Deborah K.]

I started with the F30i, but it leaked and was uncomfortable.  Then I used the N30i for a short time but switched to the P30i and found it much more comfortable and it rarely leaked. It uses the same headgear as the N30i so you only need to obtain the mask if you want to try it. Just something to consider.

And yes, you need to set 7 as your minimum pressure.  Lower than that is not comfortable or therapeutic for most adults, and 4 is only there for small children to use.

Good luck!

[PeaceLoveAndPizza]

I take a bit of a contrarian view on things…

A minimum pressure of 4 as has been stated is too low for most, but not all. Your chart shows quite a few arousal breaths which may or may not be related to pressure set too low. You have almost no flow limitations as well, which points toward your settings working well. Your AHI is fine. The leaks are nothing significant and as you noted may be from disturbing the mask against the pillow.

However, if you do not feel rested in the morning then actions need to be taken as pointed out by Deb and Dave. Typically to manage the arousal breathes it requires more pressure, but not too much as it may cause other problems.

I suggest going after things systematically and try increasing your pressure to 5 with EPR=1 (as Dave pointed out). From there you can see how things feel and how the chart looks to decide if further actions need to be taken. You can always add a bit more pressure and EPR depending on what is happening. If you go to more EPR and you get more centrals, then you need to back off EPR and/or increase pressure a wee bit.

If you wish to experiment, you may give CPAP mode (fixed pressure) a try with min=max=6 to see how you react to it. If needed you can even add EPR=1 to that.

The goal is to manage the OSA with as little pressure and pressure support as is required. Everyone is different so what works for one may not work for another.

[pacc815]

I take a bit of a contrarian view on things…

A minimum pressure of 4 as has been stated is too low for most, but not all. Your chart shows quite a few arousal breaths which may or may not be related to pressure set too low. You have almost no flow limitations as well, which points toward your settings working well. Your AHI is fine. The leaks are nothing significant and as you noted may be from disturbing the mask against the pillow.

However, if you do not feel rested in the morning then actions need to be taken as pointed out by Deb and Dave. Typically to manage the arousal breathes it requires more pressure, but not too much as it may cause other problems.

I suggest going after things systematically and try increasing your pressure to 5 with EPR=1 (as Dave pointed out). From there you can see how things feel and how the chart looks to decide if further actions need to be taken. You can always add a bit more pressure and EPR depending on what is happening. If you go to more EPR and you get more centrals, then you need to back off EPR and/or increase pressure a wee bit.

If you wish to experiment, you may give CPAP mode (fixed pressure) a try with min=max=6 to see how you react to it. If needed you can even add EPR=1 to that.

The goal is to manage the OSA with as little pressure and pressure support as is required. Everyone is different so what works for one may not work for another.

Thank you for the detailed response. I will try setting pressure to 5 with EPR = 1. How do you identify the arousal breaths? Also, I have ramp function turned on, is this advisable to leave on or turn off?