[Diagnosis] trblnfxn - Therapy Assistance

[trblnfxn]

Hello, I am a medical doctor who has joined your community after undergoing a polysomnography test, prompted by my wife's persistent encouragement and my newly developed hypertension. 
The results showed an AHI of 62.5/h, a supine AHI/non-supine AHI ratio of 1.20:1 (yes, it seems one cannot always be their own doctor). 
Following titration, I was advised to use an APAP device, and the recommended equipment is the Philips DreamStation Auto CPAP with a DreamWear mask. As of today, I will start using it. 

Unfortunately, DreamMapper is not available in Turkey, but I will monitor my progress using OSCAR, and I am excited to share my good results with you. Greetings to all from the beginning of a new life.

PS: I would be happy to receive your advice (except for device change recommendations for now, lol)

[trblnfxn]

On my first night with a CPAP, unfortunately, I had trouble adjusting. My movements caused leaks in the mask, and I woke up to drink water and go to the bathroom, after which I found it difficult to fall back asleep. The result is as shown in the attachment. I think I need to be more careful with the mask adjustments tonight. Normally, I sleep on my side, but the pillow seems to cause air leaks. I believe I'll need to make the pillow smaller and lower. (Some of the leak data might be due to me taking off the mask and leaving the device running when I woke up.) I would greatly appreciate your advice and suggestions.

   

[DaveSkvn]

Hi trblnfxn,

That looks like a dreadful night - you must be pretty shattered.

As you say the main thing to focus on at the moment is the mask. It should be tight but not too tight - not a helpful phrase. You should be able to lie on one side and shift to lie on your other side and the mask stays in the same place. If you shift and the mask moves, you have to tighten it. Obviously the mask should be centred, which is not too difficult to work out, but you have to work out where is "too high" and "too low". Too high and the air will go into your eyes - and leak. Too low and air will leak from the bottom. The key location is the "bridge of the nose" (between the eyes). The top of the mask seal should sit on the "lowest" part of the nose between the eyes. The bottom of the mask seal should sit between the chin bone and the lower teeth. If, when you put the top of the mask seal on the "bridge of the nose", the lower seal does not sit comfortably between the lower teeth and chin bone then you need a different size mask. You have to avoid overtightening. That pushes the jaw backwards which starts to block off the airway.

Next thing to consider is the pressure. You can set the mask up to seal well with a pressure of 4 but it may be blown off your face when the pressure rises above 12. You have a high AHI which would tend to mean you are a "heavier" guy which in turn means you will typically need a pressure of 12 to 20 to deal with the apneas. The machine will ramp up the pressure into this range pretty quickly so you have to prepare the mask FOR THAT PRESSURE not the pressure you experience when you switch the machine on.

You machine is set to start with a minimum pressure of 4. That is too low to have any impact on adult apneas. You need to raise the minimum pressure. I would say, as a guess, that you are heading to a minimum pressure of around 10. Don't go there immediately. I would set it to 'minimum 7' today. Leave it there for a few days and then increase it to 8 and so on. Take your time to get used to the mask and the machine. I personally would also reduce the max pressure from 15 to say 9 for a while. THIS WILL NOT TREAT YOUR APENAS but it will let you get used to the mask without the pressure spiking through the night. Once you get used to sleeping with the machine you can gradually increase the max pressure back up to 15. The pressure setting are in a hidden "clinician menu" (see the "setup manuals" link at the top of the forum). When I had a Respironics machine the routine was (a) unplug the machine, (b) press and hold two buttons © when still holding them, plug the machine back in. This gets you to the clinician menu where you can change the settings.

Have a go at setting your pressure to Min 7, Max 9. Try tightening the mask. Gradually increase the pressure to min 10, max 12. Once you get there and the leaks are sorted post another Oscar screenshot and we'll see where to take it from there.

Getting used to CPAP is a bit of a journey but it can be transformational when you get it tight. Good Luck.

[trblnfxn]

Thanks for the suggestions, I’ve noted them all. 

Below are the results from the second night. I think I’ve solved the mask issue (I also reduced the number and size of pillows). 

The specialist mentioned that to avoid issues while falling asleep, we should start with low pressure, and our actual goal for the first month should be between 7-14. Therefore, at least for now, I don’t think I’ll be changing the settings.


Detailed information about my situation can be found at the "newly diagnosed breath-holder" post

[Crimson Nape]

trblnfxn - I have merged your 2 threads that relate to your CPAP therapy.  It makes it easier for those that offer advice to see your history in one thread. To provide a more inclusive title, I have renamed it to "trblnfxn - Therapy Assistance".

Going forward, please use this thread to post your therapy related questions and OSCAR charts.

Thanks!
- Red

[DaveSkvn]

That looks much better! Lets hope the improvements keep coming at that pace. Good Luck.

[trblnfxn]

trblnfxn  -  I have merged your 2 threads that relate to your CPAP therapy.  It makes it easier for those that offer advice to see your history in one thread. To provide a more inclusive title, I have renamed it to "trblnfxn  - Therapy Assistance".

Going forward, please use this thread to post your therapy related questions and OSCAR charts.

Thanks!
- Red

Thanks. It's better than before