Oscar Review and Setting recommendations

[kgtx]

Due to wife’s complaint about snoring, I did a Sleep Study, and the findings are consistent with Moderate Obstructive Sleep Apnea Hypopnea Syndrome G47.33. AHI=15.4 Overall. disease is noted to be more severe during REM with a REM specific RDI of 38.9 and oxygen nadir of 74%.  The sleep study was completed using WatchPAT.
When diagnosed, I started nasal rinse 2x day, Zertex at 6pm, and Azelastine HCL & Fluticasone Propionate nasal sprays.  Did this for three weeks prior to starting CPAP/APAP and slept better than I had in decades.

Using F30 for 7 days now (two days on the F20 killed my nose – very red and blisters).  The F30 doesn’t bother me much, and I sleep well (although I started sleeping good with the above routine – nasal rinse, zertex, and nasal sprays). Sometimes I wake up and it is leaking some, I just reposition the mask and all is good. 

I also use to breathe through my mouth, but now it seems with the F30 I am breathing mostly through my nose, except when the machine is blowing like crazy and my cheeks are big like a blow fish.

Attached are reports for two nights.  On Sunday I had lots of problems staying asleep the first hour or two – the mask was blowing tremendously even when I was awake.  I finally took it off and walked around for a few minutes.  When I first go to bed and after 1pm-ish bathroom trip, I start with supine sleeping (which seems is when I have the most problems).  Then after 30-60 minutes I usually rotate between sides.

Today I talked to a sleep coach, and they turned on my “Response to not abruptly blast me awake when it detects me sleeping”.

What settings do you recommend for me to try, and for how long till I repost new Oscar reports?

   
   

[JonathanBravo]

two days on the F20 killed my nose – very red and blisters

Do you mean the P20 nasal pillow? The F20 full face mask doesn't really touch the nose too much .. right? I had this same problem when I first started using the P20. It turns out that I just had the strap wayyyyy too tight. I found it actually only needs a small amount of tension to stay in my nose. In fact, it was so tight before that it was pushing on my nose and making it hard to breathe through my nose, with it being looser it was actually far easier to breathe. I personally prefer the F30 hybrid mask over the P20, despite the P20 being significantly smaller and intended to be less invasive. Even if you do mean the F20 and not the P20, I have found with many masks that overtight paradoxically makes the seal and breathing worse than a looser fitting. 

I know very little about the settings and I shouldn't be listened to for that, and i'm sure someone who knows settings will be along soon. I personally found that when the pressure was too low it was not providing me with enough air and 8cm min was far more comfortable. Again, I am not an expert and just sharing my experiences.

[SarcasticDave94]

Welcome to Apnea Board,

OK a few things to try, which you can do yourself:

Edit the settings to pressure Min 7 leaving 20 in place. This will help get you to where EPR 3 full time starts doing its thing.

Right now on Min 4, it's waiting to get to 7 automatically before EPR 3 can do anything. It's by design, because EPR means Exhale Pressure Relief, a way of reducing set pressure so exhale is easier. There's more though, EPR 3 in ResMed is equal to bilevel with PS 3. Right now you're missing a big benefit.

But 7 being higher than current 4 will be harder to handle, you're probably thinking. Not really. Because again Min pressure 7 with EPR 3 also equals 4. Try it. BTW 4 is for children.

I would also have you consider turning off the Ramp. It's delaying all therapy until it expires. And this is every time the start button is pressed.

Oh and no mask should be adjusted tight to cause discomfort or pain. This indicates the mask is not right, it may be the cushion size, the type, the model.

[kgtx]

I made adjustments 7-20, no ramp.  Still slept well.  I don't have any mask issues now that I am using the F30.

   

[SarcasticDave94]

It doesn't look bad. If does appear that the edit to Min pressure to 7 didn't lock in. At least it's not showing up on the OSCAR chart as such.

[kgtx]

Not sure how that setting wasn't saved, but I successfully changed it for last night.  Here are the results (Pressure 7-20).

   

[kgtx]

So, my nightly AHI range between 2 and 6.  The events come in bursts usually after I just fall asleep, often I start on my back and eventually roll between sides.  Here are the last five nights.  Any feedback or suggestions on changes?

   
   
   

[SarcasticDave94]

The clusters at first looked a bit like sleep wake junk (SWJ), but since it's there later in other segments, is possibly Positional Apnea. This is corrected with either restriction to the chin tuck type of external, physical choking off of the airway by thinner pillows or a soft cervical collar.

Getting rid of the clusters will likely permit you to sleep in one longer session, aiding in better rest.

Another item to consider, is Soft response a good mode for you? Have you tried standard?

[kgtx]

I tried using the response of standard, and I think it was waking me up.  I need to do more experimenting with that setting to verify.  

However, with the response of soft, I tried to focus on sleeping only on my side, because my events were mostly when I was sleeping on my back.  As far as chin tucking, when I sleep on my back, I do not use any pillow at all.  My head if flat on the mattress.

Here are two nights of predominately side sleeping.  On the second chart, the cluster of events is when I know I was sleeping on my back.  When I sleep on my side (rotating between both), it becomes uncomfortable, and I sometimes roll to my back...  Both night AHIs are good.  The first night was amazing 0.13 and with limited back sleeping, the second night was 1.80 also with limited back sleeping.

   
   

[Big Guy]

Do you mean the P20 nasal pillow? The F20 full face mask doesn't really touch the nose too much .. right? I had this same problem when I first started using the P20. It turns out that I just had the strap wayyyyy too tight. I found it actually only needs a small amount of tension to stay in my nose. In fact, it was so tight before that it was pushing on my nose and making it hard to breathe through my nose, with it being looser it was actually far easier to breathe. I personally prefer the F30 hybrid mask over the P20, despite the P20 being significantly smaller and intended to be less invasive. Even if you do mean the F20 and not the P20, I have found with many masks that overtight paradoxically makes the seal and breathing worse than a looser fitting. 

I know very little about the settings and I shouldn't be listened to for that, and i'm sure someone who knows settings will be along soon. I personally found that when the pressure was too low it was not providing me with enough air and 8cm min was far more comfortable. Again, I am not an expert and just sharing my experiences.

I initially started CPAP with an AirFit F20 mask. I did okay with it, but it pinched my nostrils shut, making it impossible to breathe thru my nose. That wasn't a big deal though, cause I'm a moth breather. 

I tried an AirFit F30 and it felt so much better than the F20. I'm going to try the F40 in the near future, as soon as I qualify for a new mask.