Looking for opinions

[OttSteve]

I am a relatively new forum member looking for some insight into my sleep data.  I am a 70 year old male retiree.   In general I tolerate the treatment and sleep reasonably well.  I wake up several times per night.  I have had some issue with mouth leakage and now wear a chinstrap which has helped.  Lately the leakage has been increasing.  After starting to use Oscar and this forum, I have learned quite a bit, but am still pretty new at this.

Data

• diagnosed with apnea in 2019, started treatment in February 2019
  
• machine prescribed - AiSense Autoset for Her. (why the for Her model I have no idea)
  
• 5-15 cmH2O, EPR 3, N30i mask, nasal cushions
  

I have included screen shots from Oscar that are relatively typical.  I generally have an afternoon nap, but didn’t on this day.

What I see in the data:
AHI is low.  Average year to year is about 2
Leakage is pretty high.  I am not sure exactly why.  Some of it is a result of me moving the mask to scratch my nose.
Flow limitations are frequent.  I am wondering if some of this could be positional in origin.  Perhaps I am tucking my head to my chest?

Any insight is appreciated.

   

[SarcasticDave94]

Due to high flow limits, you're going to want EPR 3 to get to work faster. Your min pressure of 5 prohibits this until your pressures pass 7. I would increase this min pressure to 7 to help correct this.

I would also consider turning off the Ramp, even though yours is on auto. Ramp removes almost all therapy until it transitions to therapy pressures.

[OttSteve]

Thanks. I don't understand the point about EPR. By the time the apneas and flow limitations start, the exhalation pressure is above 7 anyhow. All that increasing the minimum pressure would do would be to raise the pressure in those few intervals where it currently drops below 7. I assume that the pressure is dropping because the machine figures higher pressure isn't needed. Am I wrong?

Not sure about the ramp. Some of it is while I am awake, and for the rest there aren't any apneas to treat in any of the data that I have looked at.

[Deborah K.]

Dave is right.  You need the extra pressure both to make the EPR 3 work properly and to help overcome your high flow limits.  You need to turn off ramp also, as that fights with your effort to overcome high flow limits.

[staceyburke]

Flow limits are apnea just like Oa and H events.  The Oa and H has to be 10 seconds or longer in duration.  A flow limit no as long as the other events and Resmed mechines raise pressue as fast as they can to top them from becoming Oa and H events.  Also if they pressure start up a little (like 7 instead of 5) it can stop the flow limits quicker and they may not be classified as an H event.

[OttSteve]

Thanks all. I will try the recommendations tonight.

[OttSteve]

Since my last post in this thread I have tried a number of options.

• I increased the minimum pressure to 7 cmH2O as recommended and then to 8 cmH2O.
  
• I turned off the ramp
  
• I tried a soft cervical collar and bought a fancy CPAP pillow.
  
• I tried nasal pillows instead of my usual nasal cushions
  

With the exception of the pressure change and the ramp, I tried these changes one at a time.  None resulted in a discernible change to the data.  The flow limits remain high - higher than I have seen in any other charts in the forum recently. Going through what data I have since i started therapy suggests that these recent results are fairly typical. I continue to wake every one to three hours.

I have attached several screen shots of recent data.  they include:

1. An overall look at all of the data, including an afternoon nap
   
2. The nighttime data.
   
3. A zoom to show the detail of the flow rate graph.  This pattern is typical.
   

I understand that the ResMed AS10 is supposed to raise pressure to deal with flow limitations.  I do not see this happening in the data.  I also wonder why the pressure never rises above 13 when I have the maximum set for 15. 

Any insight is appreciated.
           

[SarcasticDave94]

I can't determine if the leaks are the cause of higher pressure and flow limits, or if flow limits required higher pressure and leaks result. Either way, your leaks needs attention.

There's another item maybe at play, let's get some feedback from others more knowledgeable about this. The For Her settings might be another source of hindered therapy.

[staceyburke]

The Flow limits are bad and you are at the max of EPR 3.   The Resmed bilevel might be what is needed to get them down but as Dave said the For Her mode may make some difference.  I would suggest you change it to the normal setting to see if it helps..

[OttSteve]

Will do tonight. Thanks