[Treatment] New user, help please :)

[throwaway1242]

I'm using Resmed P10 Nasal pillow. I keep ripping off the mask without me knowing, from the machine I only use it for around 45 min -1.5 hr per night. This is going on for an entire week. I have mouth tape.
For the first week, I used pressure from 7-12.  On the sleep summary, there are days I have 0 AHI, But there are days when I have like 8 AHI/hr with just 25 min of usage. It seems that the are all central apneas. The pressure was too much.


Once I changed my setting from 7 -12 to a fixed pressure of 6.6. My high central apneas went from 8-12 to just There are days where I can actually get above 5 hrs of usage.
I will post the data of 2 days. One where I have 6 hr of usage, the other is 1.5 hr of usage (I keep ripping the mask off)
All my apneas are central. EPR is 1 on ramp, 0 off ramp.

Help would be appreciated


Data from good and bad days are posted below            

[Nightynite]

Hello throwaway, sorry you’re having such a hard time, don’t get discouraged! You will get there.
It’s not unusual for the beginner to have problems starting out. You can’t blame your body for trying to get that contraption off your face so you can breathe. What you need to do is try using it for short periods of time during the evening, let the body get use to it. Take a 1/2 hr. nap , read a book or something. Just get some time in wearing it and adjusting.

If you have the results from a sleep study, post up a redacted pic of those, that will help people giving you suggestions on settings. Also, keep everything in this one thread so we can look back on your progress.

[staceyburke]

Let me suggest the following settings. 

EPR FULL TIME
EPR 3
Max 9
Min 7

I know you think that is high pressure BUT with EPR on full time set to 3 makes the exhale pressure the LOWEST pressure the machine can go. 7 is the inhale pressure almost the same you have now and it will NOT raise pressure IF you don’t have any events at this pressure. 

Please give it a try, you will do much better on this setting.

[throwaway1242]

Let me suggest the following settings. 

EPR FULL TIME
EPR 3
Max 9
Min 7

I know you think that is high pressure BUT with EPR on full time set to 3 makes the exhale pressure the LOWEST pressure the machine can go. 7 is the inhale pressure almost the same you have now and it will NOT raise pressure IF you don’t have any events at this pressure. 

Please give it a try, you will do much better on this setting.

Hello Stacey, thanks for the help!
I have used your suggested pressure + EPR full time 3, but I'm still having problem keeping the mask for more than 1.5 - 2 hrs. Can you see what I can do from the graphs below?

[Deborah K.]

I read that some folks put tape from their mask onto their skin.  Then when they start to pull it off the tape wakes them enough to help them keep the mask on.  It might help and I can't see that it could hurt anything.

[UnicornRider]

Debora K, That is an interesting concept that I have not heard before, but after 16 + years of *PAP therapy I am open to many new ideas. I have been guilty of removing my mask in the night without conscious awareness.

 Tape may resolve that issue.    

[throwaway1242]

Let me suggest the following settings. 

EPR FULL TIME
EPR 3
Max 9
Min 7

I know you think that is high pressure BUT with EPR on full time set to 3 makes the exhale pressure the LOWEST pressure the machine can go. 7 is the inhale pressure almost the same you have now and it will NOT raise pressure IF you don’t have any events at this pressure. 

Please give it a try, you will do much better on this setting.

Hi Stacey, I'm still having trouble adjusting to the settings you recommended. I learned from another member that increasing EPR and pressure can lower my 95% flow limit, but I'm still having problems with this setting. My old setting was EPR 1 to off (ramp time), constant pressure of 6.8. The data below is with the setting you suggested.
Can you look into my data for the last few days and give some suggestions?

[staceyburke]

When I look for problems with people waking up or taking off their mask I usually see one of 2 things.  first to low of min pressure.   7 to 9 is the lowest most adults need to get enough air through the mask.  When it is lower than that they fell like they are air starved.  Your min is 7.  You could try to move it up to 8 or 9 and see if that helps you.  The second is Flow Limits causing an increase in pressure - you have got that well under control.  So the min increase is all I can see that might help.

[throwaway1242]

When I look for problems with people waking up or taking off their mask I usually see one of 2 things.  first to low of min pressure.   7 to 9 is the lowest most adults need to get enough air through the mask.  When it is lower than that they fell like they are air starved.  Your min is 7.  You could try to move it up to 8 or 9 and see if that helps you.  The second is Flow Limits causing an increase in pressure - you have got that well under control.  So the min increase is all I can see that might help.

Hi Stacey, thanks for the suggestion!
There are 2 problems I see. In the graph, each time the pressure increases from 7 - 8 -9, my central apneas increase exponetially from 0 to 6-7. I can try to sleep with the default pressure from 8, but I'm worried it would create more problem than it helps.

Second. There was another board member who advised me 95% flow limit should be below 0.03, but my 95% flow limit is around 0.05, with 99.5% being in 1 to 1.5 range. I increased the pressure from fixed 6.8 to 7-9 range, and increased EPR to 3, but no luck.

[Deborah K.]

Did your sleep study show a lot of CAs?  If not, your CAs are probably treatment-emergent and will lessen on their own as time passes.  In that case, don't worry about the CAs anymore.  

Also, are you feeling better about your sleep? Are you more comfortable? These are important issues when one has sleep apnea.