Montacute's Therapy Thread

[Montacute]

I have been using my ResMed autosense 11 for almost 3 weeks.  I just got my micro SD card yesterday (ordered the wrong thing at first) so I finally have a night of OSCAR data.   I am having an awful time with my CPAP.  I have a lot of sinus issues (2 failed attempts to straighten my deviated septum) and my right sinus was completely closed in Jan, leading my ENT to do a balloon procedure a few weeks ago to try to open it.  My sleep dr. gave me a nasal pillows mask (ResMed P-10), and the original pressure was set to 4 to 7.    They also gave me a chin strap which I have been unable to tolerate--I can't take the fabric against my face, so I have been taping my mouth.  I wake many times during the night, because I am having a hard time with timing my swallowing.  I feel like I am choking.  I also have issues with my cheeks puffing out with air and waking me up.   After an appointment with my sleep dr., he raised my pressure to 6 to 10.  This was awful.  It blew the nasal pillows out of my nose during the night.  I was so full of air I could not stop burping in the morning and had a stomach ache and a headache.  So I adjusted the pressure on my own to 6 to 9.   Still awful.  At the sleep lab the pressure used was 7.  I lowered it again to 6 to 8.  I also asked for a different mask because the fabric against my face was really irritating me on the P-10.  I think I have a couple of chemical allergies and I think I may be allergic to something in the strap fabric.  So they switched me to a P-30i.   No skin irritation and I do like the tube on top so I can move around.  My DME gave me a small and I am pretty sure I need a standard.  My nostrils are small, but my head is not.  I have varying levels of leakage.  Last night was bad.  I keep my machine humid because I have woken up a lot with dry mouth and nose, and through trial and error I keep the humidity on 5 and the heated tube temp on 82.  Any higher and rainout becomes a problem.  I am winding up falling asleep a lot during the day because I am so tired.  I don't see my sleep dr. again until Dec.!!!  He is too busy.   So, I am trying to figure out how to best help myself here.   I am including my initial sleep study numbers and all OSCAR screen shots.  Any help would be very much appreciated!!

Initial Sleep Study:
INTERPRETATION:

1. The sleep efficiency is lower than expected for a night in the sleep laboratory. Prolonged latency to sleep onset. Increased wakefullness after sleep onset time. Respiratory arousal index is increased. REM sleep relative to total sleep time is markedly reduced. Supine sleep accounts for 39.5% (116.6 minutes) of the total sleep time.
   
   
2. Physiologic atonia of the digastric EMG in REM was  appreciated.
   
   
3. The AHI and RDI are 12.6 and 12.6, respectively.  The polysomnography is diagnostic mild obstructive sleep apnea (ICD 10 G47.33).  
   
   
4. SpO2 was never below 90%.
   
   
5. Electrocardiogram data showed normal sinus rhythm
   
   
6. PLM index was 28.9 and PLM arousal index was 11.6. PLM index is abnormal. While elevated, the arousal frequency from PLM may not necessarily led to symptoms.
   

[TechieHippie]

One of the more experienced members can help with the fine tuning of settings. It looks like you are having a lot of centrals, especially when your mask /mouth is leaking more.

Have you tried a full face mask? I say that because of the air in the mouth. It's easier to regulate when the pressure is coming in the mouth also because then you aren't having to form the seal between the airway and the mouth. Sometimes mouth tape can help.

[Montacute]

Thanks for your reply.  No, I have not tried a full face mask.  Still hoping to avoid it but I may not be able to.  I do tape my mouth and it is still taped when I wake up--I use an elongated X.  When my cheeks puff up with air I think I push it out through the very corners of my mouth where the tape does not reach.   I toss and turn a good amount--maybe I am knocking the mask.  My leakage rate varies so much from night to night.  I do see Oscar showing me central apnea events.  I think these are treatment emergent.

[PeaceLoveAndPizza]

I cannot see the entire left hand chart to know your current settings, but from what I can see I suggest trying the following:

Min pressure 7
Max pressure 12
EPR 3 full-time
No ramp

That should help with those pesky remaining flow limitations, though as you noted it may increase your TECA for a bit until you get
used to it. Your description sounds like you do not have enough pressure, hence the air starved feeling. 

The “chipmunk cheek” effect typically goes away over time as you get used to therapy, but as noted a full-face mask can be considered though it does not solve the air in your mouth issue. That takes time and practice with proper tongue placement.

I also suggest trying a soft cervical collar to help with the leaks and some of the event clusters possibly from chin tucking. Even though you are taping a bit extra support should help keep things closed and will also help with keeping the airway open.

[Expat31]

Hi, 

I will try to help.
 
The 5 graphs you have sent are fine, but you have cut-off the top left hand corner with important information. 
Can you please repost so we can try to understand what is going on. See guidance tips posting graphs below:-

   In "Daily View" of Oscar, top left hand corner you will see "View" , then "Reset Graphs" , then "Standard" 

But for complete explanations on organising graphs, see  here
                               
 For additional information on  taking a screenshot of your Daily screen.
   * For Windows or Linux: Use the F12 key
   * For a Mac: Use Fn+F12

Thanks

[Montacute]

Thanks very much for the replies.  I am afraid I read the organizing your charts data and that was my result.  I manually moved the left hand box margin because of something about potential wraparound.  I think that is where I went wrong.  I did my best to move it back--changing to standard view did not seem to make a difference so I hope this works.  I added last night too

My pressure is set at 6 to 8 ever since my mask blew off at 10.   Last night I put my ramp down to 1.  No other changes.  One other thing I just realized--this is my second night with the P30. and air is leaking badly out of the top, where it connects to the heated hose.  I attached a picture for clarity.  I pushed and twisted and nothing I could do stopped air leaking out of this connection.  

Today I woke up completely congested.  On the bright side I had zero OAs.

[PeaceLoveAndPizza]

The P30i is supposed to “leak” from that elbow. It is actually venting the expelled gases whilst breathing so you don’t rebreathe them.

Your mask cannot “blow off”. The pressure even at max will not be able to blow up a child’s balloon, let alone a mask. The real issue is you are not used to the machine and your pressure is not correct.

I provided recommendations in my last post and you are welcome to use our it or not. It is your therapy, so do what is right for you.

[Expat31]

@Montacute

Can you send 2 more nights graphs, just to get a bit more data, to review in a few days?

Thanks

[HalfAsleep]

The issue with straps irritating your face....

You can trick out most any strap on headgear with strap covers. They're usually cotton. For me, those made the straps a lot more comfortable. Note that masks have different kinds of straps...they're quite individual in design. Also, you might find different parts of different masks annoying: I had one mask where the headgear piece at the back of the head was carving into my neck and un-adjustable. I got a padded cotton cover for it. Voilà, problem fixed.

I have a photo of a few different ones. I got them from a small business owned by the woman who sews them. They are specific to the mask. Ignore the grubby masks: I no longer use these.

[attachment=60494]

[Sleeprider]

I agree with PeaceLoveandPizza's pressure suggestions. It would really benefit your therapy, lower flow limits and improve how you feel. You can train yourself to manage therapy without tape or other weird crap. I have used the Airfit P10 since it was first released, and just started using the P30i. I can talk with my wife, watch tv, drink water, take a pill etc. It's all managing the air pressure. You can too if you want. Your pressures are next to nothing. It's easy, but you have to take some chances and practice to learn to control it, and end the problems of pressure controlling you.