Seeking Advice/Help

[reddie]

Greetings all!

It started with my spouse commenting that I snore loudly when sleeping, and this then led to a visit to a GP, and to an ENT doctor. I eventually did a polysomnogtaphy test which diagnosed me with severe sleep apnea (RDI 35/h, Supine RDI 60/h, Non Supine RDI 7.7/h). Unfortunately, my ENT specialist told me that I should follow up by using a CPAP machine and should I need surgery, then go back to him else am on my own.

So as advised, I purchased a ResMed 11 Air Sense AutoSet with Philips DreamWisp Nasal Mask to start this journey on my own. I'm using OSCAR as my data analyzer as I was told this is the most comprehensive reader ever.

The only reference I know is the AHI factor where the lower the value, the better it is. Since on CPAP machine, I'm amazed that my AHI seem to be lower than 10 on most days, and in contrast to the value of 35 on sleep test. Is this expected?

Am providing reports from OSCAR in hope someone will be kind enough to have a look and let me know if my sleep apnea is indeed improving, am heading in the right direction, and most importantly, any settings I've got it wrong (or help optimize) 

ResMed 11 AirSense Settings
Mode: AutoSet
Pressure Range : 4.0 - 20.0
AutoSet Response : Standard
Ramp Time : Auto
Pressure Relief : Enabled
Start Pressure : 4.0
EPR : Enabled
EPR Type : Ramp Only
EPR Level : 1
Climate Control : Auto
Tube Temp : Auto
Mask Setting : Nasal

Overview Data

I was out of town from 1 Jan to 5 Jan 2024. I wasn't sure if I need the CPAP machine with me as I was also traveling light. However during those nights, I sleep normal except my spouse who has to endure my snoring.

   
   

Daily Data - 2024-01-22

   

Questions/Comments:

• I often find that I have to inhale/exhale heavily during the initial part when putting on the mask; a bit like gasping for air once the mask cushion covers up the entire nose area. Is it because the initial pressure is too low to start (4.0)?
  
• I often wakes up in the middle of the night to adjust the nasal mask probably due to leaking air from the nose cushion. This is especially so when turning sideways to sleep when a slight touch of the pillow pushes the nose cushion slightly to the opposite side. Does this mean I need to tighten the headgear tabs as opposed to be just comfort fit?
  

Thank you so much for your help/advice - greatly appreciate any insights on this tough journey ahead! Cheers!

[Melman]

Your AHI value shows you're off to a good start. You are correct in assuming the minimum pressure is too low. Most feel starved for air at a pressure of 4. Given your OSCAR data I suggest a minimum pressure of 7. You should change EPR to full time from ramp only and eliminate ramp unless you are uncomfortable without it. At 4 you get no EPR since 4 is the lowest pressure the machine can deliver. Are you staring the machine manually or is it set to start automatically when you inhale through the mask? If it's set to start automatically a fairly forceful inhale is required to trigger it. If you don’t know how to change the pressure see this link: https://www.apneaboard.com/resmed-airsen...setup-info.

See the links below how to organize and post your OSCAR data. It is helpful to see the flow limits and leak rate graphs.

[Crimson Nape]

Hi reddie!  -  

We prefer to see a complete Daily screenshot.  I will list the proper steps to obtain the screenshot we are looking for at the bottom of this post.  Before we get started, I wanted to say don't worry about the apnea classification of severe.  The bar is, in my opinion, too low.  In the U.S., a patient does not qualify for a CPAP until they have an AHI of 20, whereas severe begins at 35.  Many of us here had a tested AHI in the 90s. Thus, my reason for not placing faith in the standards.

OK, off my soapbox.  Your CPAP is currently set to the machine's pressure limits.  Based off your Daily screenshot, I would set your minimum pressure to 10cm and the maximum to 15cm.  Turn off the Ramp feature. It is not doing you any favors and could possibly disrupt your sleep when moves to therapy pressures.  Turn on the EPR, setting its value to 3, and make sure it is set to Full Time,  (There is a Ramp Only option).  The EPR will help with the Flow limitation.  .  .  if you were wondering.

Here are the steps to organize the Daily screen and take a screenshot.  I hope it will help.

1. Make sure that your display is set to the Standard view, your graphs are in the default order, and all graphs are of the same size.
    If not:
   • To reset the Default Graph Order:  Go to (View > Reset Graphs > Standard)
     (Note: Only the Events graph should be pinned.)
     
     
   • To reset Graph Heights:  Go to (View > Reset Graphs Heights)
     
2. Resize the Daily screen's left panel's width, so each channel parameter only uses one line and does not wrap the data.  This allows more information to be displayed.
   
   
3. Make sure you are at the top of the Daily screen and have not scrolled down.  Also, make sure you are displaying the complete day's data, and not zoomed in to any specific time range. (Take a guess as to why we mention all this. . .)
   
   
4. To take a screenshot of your Daily screen, select one of the following:
   • For Windows or Linux: Use the F12 key
     
   • For a Mac: While holding down the Fn key, press the F12 key.
     
5.  Follow the steps here to post an image: https://www.apneaboard.com/forums/Thread...ttachments
   

- Red

[reddie]

Are you staring the machine manually or is it set to start automatically when you inhale through the mask? 

Hi Melman! Thank you so much for replying to my post and really appreciate your kind insights/advice!

I am starting the machine manually as I found it quite weird that whilst am trying to adjust the nasal mask before going to bed, the machine starts to operate by itself. Hence, I disabled the Auto Start function. Maybe I'm old school but once I am all setup for bed, I will turn around looking like Darth Vader, and press the Start button.

Thanks for the tips on how to organize and post OSCAR data. I will certainly follow the guidelines. As and when I do that, should I post a new thread or simply reply back to this post? Thank you.

[reddie]

Helloooo Crimson!! Thank you for the very warm welcome! I am certainly blessed to find such supportive and kind people here!   

I have noted your advice on the importance of daily screenshot and will certainly follow your guidelines on this. I do have a question on this though... after resetting the graphs to show Standard view, I can only see "Event Flags", "Flow Rate", "Pressure", "Leak Rate", "Flow Limit", "Snore" and 1/4 of "Tidal Volume". I note there are 14 graphs in all so you won't be able to see the rest. If I can only show 6 graphs, any preference on which ones to show?

I will setup the machine to min pressure of 10 (Melman suggested 7?), and max of 15 and see what happens. I shall lookup with is "Flow limitation"   

I shall report back in a few days and hopefully with some good results :

Thank you so much for helping around. Your kindness is greatly appreciated!

Cheers!

[Crimson Nape]

The default order of the graphs are in order of importance.  You can set the default height of the graphs in the Preferences > Appearance > Graph Height setting.  The Preferences can be located in either the File menu on a Windows or Linux platform, or OSCAR on a Mac.  The Graph Height value is dependent on your monitor's resolution.  The number of graphs and the ability to comfortably view them is determined on your monitor's vertical height, too.  The vertical height is the second value in a monitor's resolution listing (Horizontal x Vertical).  These values represent the number of overall pixels in a given direction.  I'm getting into detail for the benefit of someone reading this post that may not be aware of this.

I have been trying to develop a procedure to help provide a starting point for a graph height value.  While less than perfect, here is the closest to date.
(Vertical resolution * .9) / (# of graphs +1) = Graph Height Value.  Rarely will you ever have a whole number. In this case, round up to the next whole number.
This will get you close.  After viewing your screen, you can adjust up or down as needed.

Some examples are:
A Desktop monitor, displaying 7 graphs on a 1920 x 1080 screen, uses a setting of a 130.  
Laptop screens having vertical resolutions of 800 and 768 can use a 118 setting to comfortably display 5 graphs.

I hope this may help.
- Red

[BoxcarPete]

The best lines to show in a chart in my opinion are Event Flags, Flow Rate, Pressure, Leak, Flow Limit, and Tidal Volume if you can fit it in. It's nice to have at least one of the respiratory stats because it can make it easier to suss out your sleep architecture to see if there are any problems moving through the stages of sleep, but showing more than one of them doesn't often help too much unless requested.

Try to breathe normally. By this, I mean to use your diaphragm to push your guts towards your feet, then relax yourself to let the natural elasticity your chest and rib muscles expel the air. You may feel a little more "full" than normal, but after several easy steady breaths your body should get accustomed to the new "zero point" for pressure and breathing should feel almost completely like breathing atmospheric air.

Looks like you are off to a good start! I agree that you will need some more min pressure, and could consider enabling EPR to try and reduce flow limits.