DeadBatteriesBunny Therapy Thread _ Newbie Help

[DeadBatteriesBunny]

I'm a 39 Female 125lbs just diagnosed with mild sleep apnea starting on APAP. Day 7 of trying to use it, only able to get 1-2 hrs on therapy.

Background: I've been tired for years and I thought it was anxiety, then I thought it was COVID (I work in healthcare), but its gotten to the point where I need a nap every day. 6 years ago I fell asleep while driving home from work on the highway. I woke up mowing the grass in the median. Thankfully they only thing hurt was the car. My PCP had me do a sleep study, she thought it might be narcolepsy. 

My sleep study came back with an AHI = 5, but also showed arousals, based on heart rate data, at a rate of 8 per hr.
Heart rate fluctuated from 50-125 during sleep. and lowest oxygen level was 85.
I don't have my sleep study data. But my smart watch does show my oxygen sometimes dips below 90 at night. 
I got a ResMed AirSense 10 AutoSet with Humid Air and Dreamwear nasal mask

the first night or two was hard to fall asleep, i felt like it was hard to exhale. I woke up feeling like I was suffocating and took the mask off. 
The third night, I turned on EPR at 2 to see if that helped. It was easier to fall asleep, but I woke up 2 nights in a row with a belly full of air. 
Last night I turned EPR off and had the same 1am wake up with a belly full of air. I should mention the first two nights I was on my back, and from there have been on my side. 

Should I try mouth taping or a chin strap?
Do I need a lower pressure? 
What does my data mean?

"Full" Night data: 
   
closeup of average waveforms for me: 
   
Closeup of hypopnea event 11/17:
   
Not pictured: an event scored by my CPAP as RERA

[DeadBatteriesBunny]

Hi I reformatted the overview data
   

[Sleeprider]

Welcome to the forum. Your problem is going to be easy to resolve and you're really going to be more comfortable with the settings I'm going to offer. My wife has a similar mild sleep disordered breathing and she is now going on 6 years on the Airsense 10 Autoset, and is due for a replacement machine. Your discomfort comes from flow limitation, which is related to upper airway resistance (UARS) which is why you have hypopnea without CPAP and why your respiration wave has those downward sloping jagged peaks. The settings I want you to try are below, and if you don't know how to access the clinical settings, look at this tutorial https://www.apneaboard.com/resmed-airsen...setup-info
Autoset Mode
Minimum Pressure: 7.0
Maximum Pressure: 10.0
EPR: On Full-Time
EPR Setting: 3

With EPR enabled your machine will deliver bilevel pressure starting at 7.0/4.0 (inhale/exhale). This pressure difference will treat flow limits and make inspiration easier eliminating the resistance that is disrupting your sleep. Your current EPAP pressure is over 7.0 and with this, your pressure will stay lower. You will work less to breathe and should wake up feeling a lot better. This pressure difference may take a while to get used to, but you will never look back. Give it a try and post some new charts tomorrow and we can show you the difference. I expect your 95% flow limit statistic will drop from 0.11 currently to less than 0.02.

[DeadBatteriesBunny]

I will try those adjustments and post tomorrow! Thanks for the advice! And the positivity!

[DeadBatteriesBunny]

Much better! I made it 6+ hours! And no belly pain! 
   

[Sleeprider]

Much better! I made it 6+ hours! And no belly pain! 

Well I said I would do a comparison, and here it is.  Your flow chart has smoothed out and you went from 1:37 hours of therapy to 6:16. The 95% flow limitation index dropped from 0.11 to 0.04. Median pressure was 7.26/4.26 vs 7.76/7.76 (inhale/exhale) and your 95% pressure dropped from 10.4 to 9.0. Lower pressure and more comfort as promised.  Interestingly your respiration rate increased from 13 to 16 breaths per minute and minute vent slightly increased while tidal volume was lower.  No obstructive events, but two clear apnea with the EPR is insignificant.  The most important metric of all is your improved comfort and longer time in therapy. Well done!

[ancheero]

Hey DeadBatteriesBunny - so glad to see this fast update and chage! How has your progress been since the last post?

[DeadBatteriesBunny]

Thanks so much for checking in! Ugh, I wish I could say its been smooth sailing. I'm still struggling with feeling tired & no energy during the day. I am still having aerophagia, mostly mild, but one night recently was really bad. My flow limits are averaging ~0.15 so not terrible but I feel like I am still not getting refreshing sleep. My flow rate is still all over the place and looking the same as previously posted. I also had my follow up with my sleep doctor, which was a JOKE. So disappointed. She barely looked at my data; she didn't like how I was putting my mask on, how I had my mask set up (i took one ear plastic off, for me that was the best fit) and recommended I switch to a small frame with a medium cushion. ->> She said, "Yeah, I figured you would need a small, but the fit pack only comes in a medium" 
So why have me wear something she knew probably wouldnt fit? Or give me the option to get both? TERRIBLE. 

And guess what? The medium cushion leaks. I'm giving it a few days so I can honestly say I tried, but I'm probably going back to the small soon. I may have to try another mask tbh. This dreamwear cushion seems to have a hard time sealing around my nose at any size, since the air opening on the cushion is short and wide, and my nostril openings are tall and narrow. 

Any mask recommendations out there for a petite person with a small nose? my friend says its like the noses of the cartoon people in the puffs commercials from back in the 90s

Here's some screenshots from last night.
   
   

[Sleeprider]

Increase EPR from 2 to 3, and hopefully residual flow limit will be reduced. You may need to increase minimum pressure to 8.0 to maintain an effective exhale pressure.

[ancheero]

Hey DeadBatteriesBunny - in addition to Sleeprider's advice, curious if you've ever tried a nasal mask like the Resmed N20 instead of a nasal cushion or pillows? I couldn't tolerate the pillows or cushion because of how my nostrils are angled and a deviated septum. It either felt like I wasn't getting enough air, or it was blowing in the wrong direction, etc. The N20 mask really helped. (I mouth tape and have a soft cervical collar.)

On the aerophagia front, do you have GERD? This is completely anecdotal, but I have GERD and was googling solutions for aerophagia - I've read some people with GERD commenting that they struggle with aerophagia because their esophageal sphincter is not great at staying closed, and some products like reflux bands are modeled around the idea that light pressure under your adam's apple can help. That might be something to explore if you know you have GERD. (I saw some people mention they just rolled up a thin sock to layer under their cervical collar in that area to mimic the same effect, but I wouldn't recommend trying anything like that on your own - seems a little dangerous.)