[CPAP] What next for tweaks to setup

[Nick1]

Quite a few months ago I was diagnosed with sleep apnea AHI 30

I have tried several ResMed masks, but the only one I have found that doesn't leak is the F30. However, it does feel like the F30 nearly pinches my nostrils closed, so I'm not sure exactly how well suited I am to this mask. 

Masks tested:

F20Medium - a bot too narrow at the mouth, and movement of my lips caused a leak - it also leaked when turn over an lie on my side
F20Large - Way too long, it was either under my chin or on my forehead
F30Medium - has a very small mouth section and the nose section can pinch or even misalign with nostrils
Mirage Quattro - I felt like I could get a pretty good fit with this mask, but like all full facemasks, it tends to leak when I turn over. The problem with this mask is that I woke up with a sore head and the lack of magnetic clips made it a pain to adjust during the night.

The F30 is the only mask where I can get 6 or 7 hours of sleep with only minor adjustments whilst I'm half asleep.

I have always struggled to get the pressure above 11 or 12.

I am tired and groggy, and as an added complication have also been diagnosed with Hypothyroidism, which also causes tiredness, making everything a little more tricky to diagnose. I'd like to get my sleep apnea in as controlled a state as I can whilst I work with my GP to get my thyroid medication at the right level.

I've attached my Oscar detail in case there are settings I can adjust.

Some other details

UK (NHS provided equip) - but I can administer
52M
100kg
183cm
side sleeper
ResMed CPAP Max pillow 2.0

[staceyburke]

Welcome to the board...  Your numbers look good, but you said you are not feel very well.  I do have a couple of suggestions.

For posting, we don't need to see the pulse or O2 readings unless there is something you are worried about.  Also please include the flow limit chart.  flow limits are apnea but are not counted in the AHI because they are not timed and we can not see them without the chart.  Last take off the calendar by clicking the triangle in the date line.

The EPR is exhale pressure relief.  It does two major things.  1st it lowers the exhale pressure by the number 1, 2 or 3 cm of pressure.  Example Min 7 EPR 3 the inhale pressure is 7 the exhale is 4.

Your min is 4 and your EPR is 3 and the machine can not do this.  You are getting NO EPR because the absolute lowest any pap machine can go is 4 so your EPR does nothing.

EPR does a 2nd thing and very important -  it help control flow limits.  I already mentioned that flow limits are apnea but they also cause the pressure of the machine to go up.  Resmed uses the FL to raise the pressure to stop them from becoming larger events (O and H).  And flow limits can wake you up of stop you from going into deep sleep.

Again, we can't see the flow limits but by looking at the jagged pressure graph, it looks like you have quite a few.

I would suggest you try the setting Min 7 EPR 3 full time

Last I would suggest you turn off the ramp.  With these setting your exhale pressure would be 4 and that is as low as it can go.  While you are on ramp the machine will NOT adjust for apnea and will not record any - in other words you are not getting any therapy while you are on the ramp.

[Nick1]

Thank you @staceyburke

I will make the adjustments tonight and see what happens. I've also just rearranged the graphs and taken another screenshot. Apologies for not setting that up correctly.

[Nick1]

New chart after updating the settings as suggested.

Flow limit has been reduced 
The mask felt quite different, I could feel the pressure more.
AHI is up but still below 5
The leak rate has increased quite a bit, which woke me up quite a few times to fix

It's looking to me that I need to fix the leaks with the increased pressure and adjust my fit to suit the new settings.

[staceyburke]

Centrals are very inconsistent- meaning one day you have a lot the next day not nearly as many with the exact same pressures.

Give it a day or two If you feel ok and see what it looks like.