Franko39 - Therapy Assistance

[Franko39]

Hi everyone,

I was diagnosed last week with a mild OSA(AHI score of 10). I decided to go ahead and try a CPAP machine (based on my symptoms and on the encouraging info I received from similar individuals in my situation).

The sleep clinic that did my study is offering an AirSense 11 for $1800 USD. I found an online website that offers the same product for half the price. Some questions I had:

1. I'm likely going to buy the CPAP unit online and just figure it out myself. I'm a bit worried about getting things "correct", though. In your experience, was it manageable to learn and figure things out on your own/with the help of the internet, without "professional" guidance?
   
2. I'm debating between an AirSense 10 and an AirSense 11. The AirSense 10 is about $300 US cheaper than the 11 (I could get either the 3G or the card to cloud model, for the AS10). For me, I'm happy to spend a bit more for a better quality machine, so the cost difference is not a concern. I've heard pros and cons of both models and am just wondering which model you'd recommend, if the price weren't a factor.
   

TIA! I am very much looking to a good night's sleep, once all is said and done.

[Deborah K.]

A lot of us think the ResMed AirSense 10 is the better machine.  I would for sure get that one if it were me.  I have recently been told that the card-to-cloud version is both better and cheaper than the other version.  Others who understand that better will hopefully come along soon.

Also,

[Franko39]

A lot of us think the ResMed AirSense 10 is the better machine.  I would for sure get that one if it were me.  I have recently been told that the card-to-cloud version is both better and cheaper than the other version.  Others who understand that better will hopefully come along soon.

Also,

Thank you for the info! Can I also ask why you'd choose the 10 over the 11?

[Franko39]

Hi everyone,

Brand new CPAP user here! I was diagnosed with mild OSA with an AHI score of 10. I did a CPAP trial with an AirSense 10 AutoSet, ClimateLine tubing and P10 nasal pillows, EPR at 3 and ramp on.

Attached are some of the "good" nights I had with my CPAP trial - the Dec 31 data being the best (I slept a full 7 hours with the CPAP mask on). Any observations/advice would be appreciated!

Some of the primary issues I've had with the trial are:

1. Troubles falling asleep - obviously it takes some adjusting to sleeping with the CPAP on. I found it hard to focus on keeping my mouth closed (as I'm used to having it somewhat open during sleep). The concentration required to keep my mouth closed made it a bit harder to sleep. I was able to somewhat get around this issue by using sleep aids such as trazodone/zopiclone (this would just be short-term of course, until I'm acclimatized to the CPAP).

2. Waking up with a feeling of being unable to breath - during many of the nights, I'd wake up and almost subconsciously rip the mask off due to a feeling of being unable to breath through my nose. I'm not sure what the exact cause of this is. My RT who was following me suggested it may have been that I opened my mouth and thus there was a small air leak and not enough air making it into my lungs. Any ideas about this problem would be much appreciated too.

Thanks so much for your help!

Franko

[Sleeprider]

With CPAP settings of 4.0 to 20.0 (wide-open default), and EPR full-time at 3. your results look pretty good. The major problem with these settings is the minimum pressure combined with EPR do not allow the machine to respond appropriately to obstruction. We always want to set the minimum pressure at 4.0 (the minimum capability of your CPAP) plus EPR (the amount of pressure relief in cm-H2O), or in this case 4.0 + 3.0 = 7.0 minimum pressure. With a minimum pressure of 7.0, the pressure range becomes 7.0/4.0 to 20.0/17.0 (inhale/exhale). The reason this is important is that we need the exhale pressure to rise in the event obstruction is detected. This responsiveness is important to the proper operation of an auto-CPAP to minimize events.

In spite of this error, your obstructive event rate was very low, from 0.5 to 0.8 events per hour. The balance and majority of events were CA. About 15% of new CPAP patients experience therapy onset central apnea, and most of these will naturally resolve as the patient becomes more adapted to the increase in ventilation. Leaks are present at below the large leak threshold. While they are not ideal, they should not be an issue in your therapy. In your case, we could reduce EPR to 2 and it should take care of any issues with CA, which is more likely the reason you felt "unable to breathe". This is the result of CO2 wash-out and a reduction of respiratory drive. It is actually pretty easy to resolve with lower EPR. Our objective with new CPAP users is comfort for efficient sleep and efficacy to minimize events. My recommended changes to your settings are a minimum pressure of 6.0, maximum pressure of 12.0 and EPR at 2.

[Franko39]

Thanks so much for the detailed analysis, Sleeprider. I'll try out your recommendations. A couple follow up questions:

1. Where do you see the central apnea occurrences vs. obstructive occurrences, in the OSCAR data? I had some central apneas during my initial sleep report, so I'd like to monitor this further.

2. If the 6-12 pressure and EPR 2 settings still leave me with the feeling of breathlessness, would you suggest further dialing down the EPR?

Thanks again,

Franko

[Sleeprider]

Events are marked in the charts with different colors, with the default being CA purple, OA light blue and H dark blue and are quantified in the summary at left. PAP therapy is best considered a trial and error experiment where we know the usual response to changes in pressure, EPR or pressure support and other changes. Let's not get ahead of ourselves. We'll assess the results from the suggested changes, and hopefully arrive at the best solution. CA events are typically lower with less EPR or PS, but be aware they can simply be arousal or sleep stage changes rather than related to pressure. I think we can get it sorted out, and your incidence of CA is pretty minor.

[Franko39]

So quick update - I tried a couple days with the recommended settings you suggested (6-12 pressure, EPR = 2). I raised the max pressure to 14 after seeing that the machine came close to 12 the first night, following a leak.

Attached are the two days from OSCAR. I used a sleep aid medication both nights to help me stay asleep (will stop using this in a few weeks or sooner once I'm more acclimatized to the machine).

I felt great after waking up from the first night of sleep (Jan 8). I felt more tired (normal) after waking up from the second night of sleep (Jan 9).

From the looks of the data, I'm having some leaks that are corresponding with increases in machine pressure to compensate. It looks like my AHI score has increased as welll, from the earlier trials.

I recall having a partially open mouth at some point in my sleep (felt the air running through) and also tossing and turning a bit, which may have dislodged the nasal pillow a bit.

Any further insight into the data would be appreciated. I'm not sure if  a chin strap may be the next step, if the opened mouth continues to be an issue.

Franko

[Franko39]

Update: I'm slowly adjusting to wearing the CPAP. Still having some leaks due to (I suspect) my mouth opening while asleep and/or the nasal pillows coming soon as I toss/turn.

How do these OSCAR results look? TIA!

[Sleeprider]

The reason I didn't suggest higher pressure is that the Resmed Autoset responds very aggressively to flow limitations, but in your case it is an over-reaction when above 12. There are no OA events, so my thought was to keep it a bit lower and it would not result in more events. On Jan 8, you had a period of flow limits and pressure peaked at 12 cm and sure enough, no OA, and even after you raised pressure, it still didn't go above 12. Anyway, I was more interested in seeing if a reduction in EPR might reduce the CA events, and so far, there are no changes in your event rate. So your original settings at 6-20 with EPR 3 actually look better because there is less pressure variation from the flow limits.

I think low pressure is going to be what you need. When we look at Dec 31, the exhale pressure remained at 4.0 most of the night and the 95% pressure was only 7.4, and other than a few OA events on Dec 28 with pressure 5.0 to 10.0 you have not had obstructive apnea. So I think low pressure has shown the fewest events. A pressure of 6.0 to 10.0 looks pretty good and seems to have minimized CA events. Perhaps with EPR at 2 and pressure 6-10 you can minimize CA and OA. Don't worry if the pressure reaches the maximum, it is the intention of these settings to avoid high pressure which trigger more CA for you.