Formula - CPAP Analysis Help

[Formula]

I was diagnosed with OSA about 18 years ago (2005) at age 16, I don't have my medical records handy, but at age 16 I was average weight and had what was considered severe sleep apnea. I was prescribed a CPAP and hated it. Couldn't get used to it, so I never used it. At the time an ENT did not recommend tonsil or adenoid removal. 
A few years later, I tried a mouth piece that pulled my lower jaw forward and it worked to reduce my apnea count, but was very uncomfortable, so again, I didn't use it. 
Several years later, in about 2011, I felt the need to go back to the doctor and was given a new CPAP machine. Again, I tired several masks and could never get used to it. I even went to see a therapist about my mental block of using it. I remember ripping it off unknowingly in the middle of the night. The only reason the insurance company allowed me to keep it is because I was working with a therapist and they wrote a letter saying I am trying.  
That machine was a ResMed S9 with EPR, not sure of more specifics as I am not home. 
Fast forward to a couple of weeks ago and something clicked in my brain, not sure if its the fact that I was falling asleep while driving, or I was getting night sweats and waking up every half hour, or that I now have two little kids I want to see grow up, but I have been using my CPAP for the past 18 days averaging about 6 hours per night. I am still not comfortable with my mask, tried both full face and nasal. My face HURTs when I wake up, but tightening it has been the only way to stop the air leaks. I still wake up occasionally throughout the night. And I have been waking up at about 5am which for me is a bit early. But, I have been using it and am a little proud of myself because of it. I haven't been taking naps when I get home from work, I haven't been driving drowsy, my brain feels like it works faster and I am noticeably less forgetful. My goal is to be comfortable sleeping and maintain these feelings. 

So for some background on my machine settings, I think my pressure was set to 8 from the doctor. It also had the expiratory pressure relief (EPR) setting on. 
The first night I was still snoring with my machine on, so I upped the pressure to about 15, the second night the EPR was keeping me from falling asleep so I turned it off. 
The third night I felt the pressure was too high so I lowered it down to 13 and have been keeping it there ever since. 

I searched for a sleep doctor (pulmonologist specializing in sleep) and made an appointment for about 2 weeks from now. 
I would like to get a new machine, and new mask as all my equipment is from 2011 or older. 

-What machines do everyone here recommend. I want to go to the doctor INFORMED not just use whatever brand rep takes him to dinner the most. 
For context I would like one that is quiet, don't have to fill the water tank nightly, but also I would like to take it camping in my popup camper and run it off a battery if possible. Would 2 separate machines be better for this maybe? I have insurance but I doubt they would want to buy two machines for me.
-Will my face always hurt? Specifically my upper lip under my nose when I am using a nasal mask, all around my mouth when I am using a full face. I do have a short and neatly trimmed beard. 
-What other information should I bring with me to the doctor? I would like to avoid doing a sleep study if possible unless they can give me a real good reason to do it, I KNOW I have OSA. Do they still do titration studies if the machines are auto-titrating?   I would like to bring a sleep report with the data from my SD card in the machine to the doctor. Not sure if this will help them help me, but attempting to find the software is what led me to this forum. I will download when I get home! 
-What questions should I ask the doctor? I am mainly there for me to get new equipment, but Id like to take advantage of their knowledge while I am there. 
-Anything else you might want to give me advice on I am open ears. 

Any other information you need from me that would be helpful let me know! Thanks in advance. 

Thank you, 
Dennis- Trying to keep with this.

[staceyburke]

Welcome to the board.  There are many people here with a lot of knowledge that can and will help  you.   BUT we can'/t do much with out seeing data.  That data is from OSCAR (program) which is free at the top of the site.  There is no charge for anything here.  

You will need to see if your machine has a SD card in it - you need it to store the data from oscar.  They are inexpensive and you can use 2gb to I think 8gb.  The 2gb will store a few years worth of data.

I suspect you have large flow limits that cause the pressure to go up and cause leaks but without seeing data we would just be guessing.

[Formula]

Wow, the data is insightful! 
I forgot I tried wearing it in December for two nights. Its no wonder it wasnt working, my AHI was about 30 when I had the pressure set to 8, which is was what the doctor set it to years ago. Now my AHI is under 2 for the past week. 
Here is some of the Data...

   

   

   

[staceyburke]

That looks pretty good. You are not using EPR - it makes exhale easier. You can set it to 1, 2 or 3. What it does is allow you to exhale at a lower pressure. It controls flow limits but your flow limits are not to bad

A variable setting allow the machine to raise the pressure to control your apnea. And I would suggest you give it a try, you can always go back.

You might try these settings and see if you like them.

Min9
Max13.5
EPR full time set to 3

[Formula]

I lost a significant amount of weight, on my old S9, my pressure was a fixed 13.4 when I was 305lbs.  When I got my new Airsense 11, the doctor set it to minimum 11 max 17. 
My weight is now down to 215lbs and I lowered the minimum to 7 and kept max 17, I lowered because I felt I was leaking at the higher pressure. Mask is the Resmed P30i. 
The one issue I am finding is that I struggle to wear this for more than 4 hours per night. 
Besides for that, my wife finds the machine (and lack of mask leaks) much quieter so thats good. 
Any suggestions? Should I drop my minimum pressure down even more? 
Thanks for the help!

   

[BoxcarPete]

What makes you struggle to get through a night? Keep in mind that at EPR 3, your min pressure is actually only 4, during the exhale cycle. It doesn't look like minimum pressure needs to be lowered because the machine adjusts itself back up whenever it's getting close to it.

[Crimson Nape]

Formula - Since both your threads deal with your therapy, I have merged them. I also changed the name to be more inclusive. The new thread name is, "Formula - CPAP Analysis Help". Please keep all posts that concern your therapy in this thread. It helps the reader looking back at prior posts in order to help.
- Red

[PeaceLoveAndPizza]

Things look really good, so these are fine-tunings to consider…

Three things stand out to me. First is to work on getting the leaks under control. Given the length of the leaks they are likely mouth leaks. While not all are in the danger zone of > 24 l/min, they still will impact sleep quality. If you look closely there are arousals in the same time frame as the leaks, so getting those under control should be a priority. A soft cervical collar or mouth tape would help.

Second is the pressure. I would not change your minimum, though I think you can change the max to 10. If your IPAP bumps up against it at 10 then raise it to 12. Do not drop the IPAP min of 7 as the min EPAP allowed is 4 (IPAP of 7 minus EPR of 3 equals EPAP of 4), so if you set IPAP below 7 you lose an EPR of 3. I suggest your effective range to try is 7-10 EPR 3. 

Third, do you really need ramp? It is my own thinking that ramp at lower pressures impacts therapy, so why use it unless you really need it.

Give it a go and let us know how it works out.

[Formula]

What makes you struggle to get through a night?

Not sure, there are times I wake up in the morning without even realizing I took it off.  Looking at more data, it seems that in the past 30 or so days my max therapy use time was 5.5 hours and my average is a bit under 5 hours. There are also times that when I wake up and the mask comes off. I feel wide awake well before its time for me to wake up. Ive tried laying there with my mask on but that feels torturous. Thank you for the advice. 

Give it a go and let us know how it works out.

Thank you for the advice. I will have to look into the mouth tape. With my old machine I had my wife listen for leaks and she said they were coming from my nasal pillows, not my mouth. I will try and see if she can catch that again. 
I will keep my minimum where it is, the EPAP differential of 3 is something I didn't know or consider and the reason I was looking for advice here. Thanks again. 
As for the ramp, I had always used it and it came on the machine preset, I don't think I need it at this point, ill try it without it. 


Crimson Nape, Thanks for the merge. I didn't consider the old data related much to the new data. I will keep all therapy posts in here.