Help - Mask change causing fatigue?

[coffee9724]

Hi, I've been using CPAP since early November 2023. I suffered from extreme daytime sleepiness my entire life and spent years searching for answers. I had immediate relief when I started CPAP and have used it religiously ever since. 

I started out using the ResMed AirFit N30i nasal cradle. It was fine, it sometimes woke me up a couple times a night if I moved too much and it got pushed out of place/leaked. I used this with the "Nasal" setting on my CPAP although I just read 5 minutes ago on the ResMed website that I should have used the pillow setting, oops. The problem was that I started experiencing a dermatitis reaction and extremely dry skin anywhere the cushion touched my face. I tried a cloth liner, but with the cushion just having two holes it makes it very hard to position accurately and felt like I was suffocating. I did get silk liners for every part that touched my face except the cushion, but nothing helped my skin. 

A few days ago I got a ResMed AirTouch N20 with the memory foam to hopefully help with my skin reaction. I am still using it on the Nasal setting. TBD on if it helps with my skin, but after 5 nights of use, I am feeling a lot more daytime sleepiness than I was with the AirFit N30i. (My neck/shoulders also hurt, but that's a separate issue.)

To my own eyes, my OSCAR data doesn't seem super different between the two masks, but I was hoping someone with more knowledge could take a look. if anything, I feel like I am actually sleeping through the night better with the AirTouch (not waking up as much from mask movement), but noticeably more tired. It also doesn't feel like I'm getting as much pressure with the AirTouch so maybe I need to increase the minimum? I own my CPAP outright, so I am able to make pressure/setting changes if that would be helpful. 

This is the graph with my old mask, the AirFit N30i nasal cradle. It won't let me attach both graphs here so I will try to add the second graph in another post. Thank you in advance for any help!!!

   

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Adding the second graph here - this is with the AirTouch N20. 
   

[jcp519]

It looks like your tidal volume and minute vent went up somewhat while using the new mask. It also looks like your flow limits increase a little bit as well. Leaks could be better, but they aren't terrible. Your inspiration and exhalation times don't seem to be lined up very well. Looks like you have short inhales with longer exhales.

Right now you're on the default 4-20 pressure settings as well. You could try upping the min pressure to 6 to see if that helps with the feeling of not getting as much pressure. I'd also say that you should bring down your max pressure to somewhere around 12 since your pressure doesn't ever go near that high. I feel like EPR also might help you out a little bit with the flow limits too. I would also suggest turning off ramp because for 45 mins you are getting a lower pressure than you need.

You could try these settings
Min: 6 cmH2O
Max: 12 cmH20
EPR: 1 Full time
Ramp: Off

See how those make you feel and we can see what other changes might help out.

[coffee9724]

Hi, sorry for my late reply but I wanted to say thank you so much for responding!! I adjusted the settings like you recommended and I think it has definitely helped - I'm not noticing as much fatigue with the air touch. 


I'm shocked you were able to tell that I short inhale/long exhale from that data. I have definitely noticed myself doing that. I don't know if that's a bad thing but I'm guessing it's not a good thing lol.

Thank you again x1000 for answering and helping me!!!

[jcp519]

That's great to hear that you're doing better! If you take a look on the side, it actually tells you the inspiration/exhalation time.

Post some more recent OSCAR charts and we might be able to optimize the settings even further. It usually takes a few tweaks to get everything dialed in well.