Clear Airway -RERA and other questions

[SwissLady]

Hi Guy's

This is my 3rd week on "trialing" CPAP eg having a machine on rent through my provider.

First two weeks I had a Fisher and Paykel Auto and now the Resmed.

I made earlier a Post about the Clear Airway I can see on the Resmed Sleepyhead Data. When I had my study I was not diagnosed with CA, "only" OSA and Hypo ones.
On the Sleepyhead Data I can see though more Clear Airway and RERA Events than anything else. So I wonder what you guy's think of it?

I attached two screenshots, one from last night where I changed the EPR to 2 (found on this forum that might help ) and the night before EPR was on 1. I must say I like it on 2 better. It seems to be easier to exhale? Or generally breathe? (Oh I do have a F20 full mask on).

The pressure settings also, do you think they're ok? I am still snoring apparently...

Leaks, time over leak redline, it used to be 0% on EPR1...why did it go up now?

Also, regarding Mask...I am a mouthbreather, even through the day I catch myself often to breathe through the mouth. I do have a high palate and a deviated septum. Two years ago I underwent Orthodontics that did widen my palate a bit and with that it dropped a little so I watch that during the day I have my tongue on the roof of my mouth to train myself using my  nose more often. However, during the night its still easier to breathe through my mouth, and it seems that my snoring gotten worse since the Ortho treatment. Anyhow I wonder with the Nasal Mask and Chinstrap how that would be working? Like I'm worried that I dont get any air or feel like not getting any ....I can tell my tongue drops back and then the back of my mouth goes floppy and I feel like I don't get any air through my nose. I assume the pressure of the machine through the nose would eliminate that? Any suggestions of what mask I might should trial?

My full mask I just had tried that one F20 one, never been given another mask to try. It seems to be ok but, besides the marks in the morning....

[Gideon]

Your numbers are good and you don't have a leak problem.  I would keep an eye on your CA numbers, but they are not a problem at this time.  
You "treat" CA on CPAP by lowering pressure, and on bilevel by adjusting PS.  Your EPR can be used as PS but only with the values of 1, 2, or 3 cmH2O

On your mask, read the Mask Primer.  A lot of information in there.
I would start by trying Pillows, the P10 has a lot of followers on this board.
On mouth breathing I would stay away from a chin strap because the tend to push the jaw around, feel free to try but with your surgeries I am hesitant.
Many are finding a soft cervical collar works well to manage their mouth breathing.

[DeepBreathing]

Yes, excellent numbers to start with. The number of central apneas is not a problem, and it's possible they are false positives anyhow.

The EPR is expiratory pressure relief - it drops the pressure temporarily while you're exhaling. The fact you found it easier to exhale is proof that it works!  As bonjour mentioned, you can reduce the number of central apneas by reducing EPR - it's a trade-off between apneas and comfort. In your case I'd go for comfort as the number of apneas isn't a worry.

.I can tell my tongue drops back and then the back of my mouth goes floppy and I feel like I don't get any air through my nose. I assume the pressure of the machine through the nose would eliminate that? Any suggestions of what mask I might should trial?

Yes, CPAP is designed to apply air pressure to splint your airway and prevent the tongue and other tissues causing an obstruction. It doesn't really matter whether the air pressure is applied via the nose or nose & mouth - they are all connected. However if you can't seal your mouth during the night, air pressure will escape unless you're using a full face mask.

There is a bit of received wisdom here that pillows are superior to full face masks. In my view it's a case of finding whatever works for you and stick with it. I started with a full face, tried pillows and went back to full face. It works for me and I don't need to worry about chin straps and all the other nonsense trying to get pillows to work. If you find the F20 works for you then stick with it.

[SwissLady]

Thank you guys ?

The EPR defs works, in my case anyway it feels like breathing without mask so I will keep it like that I think.

The CA's is what I don't like as I wasn't diagnosed with them. So in theory I could try to lower the upper pressure? Wouldn't that bring more OSA again?

And then regarding the mask, I don't mind generally the full face mask, just the marks on my face are annoying, like this morning it took nearly 2 hours for them to fade ?

Time over leak redline , what does that mean? It used to be 0% but last night with changed EPR it registered a number?

[DeepBreathing]

The CA's is what I don't like as I wasn't diagnosed with them. So in theory I could try to lower the upper pressure? Wouldn't that bring more OSA again?

A lot of people get central apneas induced by CPAP pressure as the body adjusts to different levels of O2 and CO2 in the bloodstream. Quite often they just go away by themselves. Also, there can be false positives where the machine diagnoses an apnea when it's just a pause in breathing caused by swallowing or changing position. In your case the number of centrals recorded is very low, so I wouldn't worry about them at all.

And then regarding the mask, I don't mind generally the full face mask, just the marks on my face are annoying, like this morning it took nearly 2 hours for them to fade ?

Have you got the straps too tight? You might be more comfortable and less marked if you loosen them a bit. If loosening then causes too many leaks the you might want to use a fabric liner which goes between the mask and your skin. I quite like pad-a-cheek while others like Remzz. (Do a search)

Time over leak redline , what does that mean? It used to be 0% but last night with changed EPR it registered a number?

All masks are designed to leak a controlled amount to expel your exhaled CO2. Unintentional leaks over that controlled amount can be a problem it they get excessive. On Resmed machines the unintentional leak red line is 24 L/min. If it goes over that the machine can't properly diagnose events and maintain pressure. Quite often you'll see a short period of leaks over the red line if (for instance) you roll over and the mask is dislodged momentarily. This is OK so long as the time over the red line is short. The change in EPR won't make any difference to the leak rate.

[ajack]

It may just be pressure/excess o2 when people first start cpap, waiting for the co2 to build up to trigger taking a breath. Or a deep breath beforehand can do it, like a sigh. Zoom in and see what they look like. Clear Airways can settle down in a month or two. 2 per hour really isn't an issue.

If it was my chart, given the low AHI, I wouldn't raise the max pressure till you are happy with the CA settling. I would increase the minimum to 8.

[TexasTiger]

Hi Guy's

This is my 3rd week on "trialing" CPAP eg having a machine on rent through my provider.

First two weeks I had a Fisher and Paykel Auto and now the Resmed.

I made earlier a Post about the Clear Airway I can see on the Resmed Sleepyhead Data. When I had my study I was not diagnosed with CA, "only" OSA and Hypo ones.
On the Sleepyhead Data I can see though more Clear Airway and RERA Events than anything else. So I wonder what you guy's think of it?

I attached two screenshots, one from last night where I changed the EPR to 2 (found on this forum that might help ) and the night before EPR was on 1. I must say I like it on 2 better. It seems to be easier to exhale? Or generally breathe? (Oh I do have a F20 full mask on).

The pressure settings also, do you think they're ok? I am still snoring apparently...

Leaks, time over leak redline, it used to be 0% on EPR1...why did it go up now?

Also, regarding Mask...I am a mouthbreather, even through the day I catch myself often to breathe through the mouth. I do have a high palate and a deviated septum. Two years ago I underwent Orthodontics that did widen my palate a bit and with that it dropped a little so I watch that during the day I have my tongue on the roof of my mouth to train myself using my  nose more often. However, during the night its still easier to breathe through my mouth, and it seems that my snoring gotten worse since the Ortho treatment. Anyhow I wonder with the Nasal Mask and Chinstrap how that would be working? Like I'm worried that I dont get any air or feel like not getting any ....I can tell my tongue drops back and then the back of my mouth goes floppy and I feel like I don't get any air through my nose. I assume the pressure of the machine through the nose would eliminate that? Any suggestions of what mask I might should trial?

My full mask I just had tried that one F20 one, never been given another mask to try. It seems to be ok but, besides the marks in the morning....

Hi SwissLady - welcome to the forum and all the wonderful help here.  I'm new also with similar problems that were greatly minimized by sleeprider + others.

I too had only a few CAs in my sleep study and am now plagued with way too many (last night running 3/hour)
Was running over 5 AHI with over 50% being CA which is not good.
I'm using the same machine as yours and had leak problems (tried Nasal, Pillows, & Hybrid that did not work for me (chin strap was a problem too).

Now using FFM (AirFit F20) with soft collar and all is getting better.

I have finally wound up with lower min./max. on APAP with no EPR (it seems that CAs don't like EPR)
I'm still "fine tuning" with average under 5 AHI but some days still over 5.0.

Not trying to at all change your settings....  Just a note of encouragement to stay with it and work with the really smart people on this forum.

[Whacked]

I use a nasal pillow mask, and a mouth breather.
chinstrap is a must
some use a cervical collar

initially, when I put the mask on if feels like i'm not getting enough air until it ramps up
I have since changed the starting pressure from 4 to 5 cmH2O

My left nostril has a deviated septum. Frequently if feels clogged or restricted. Funny how that seems to always happen just before bedtime
once the machine is at therapy pressure, its all good.

If you can, give a nasal mask (of some sort) a try.
I am glad I can use them and glad for no more strap marks.

[PaytonA]

SwissLady,

Nice job. Your results are looking good. I think that if you increased your min. pressure from 4 to 6 or 7 and kept your EPR at 3, it might improve your results.

Best Regards,

PaytonA

[rooy1960]

Hi, SwissLady--

I'm a newbie (18th night on CPAP tonight). Just wanted to share that I'm having great results with a soft cervical collar.  In addition to helping me keep my mouth closed/airway straight, my neck feels like a million bucks!  I've always been a curl-up-in-a-contorted-ball sleeper (complete with head in a tucked down crazy position).  The collar has worked very well after having tried the chin strap which caused jaw pain and didn't keep my mouth closed.  Best wishes in your PAP journey.