Need some help/advice - here's my symptoms and machine settings

[Dormeo]

I think you may be worrying too much about leak rates. You should worry if (a) leaks are waking you up, or (b) you are having a fair amount of leakage above 24. Below 24, the machine can still compensate for the leakage. So I would say go with the mask that feels most comfortable to you.

The CAs may reflect the tossing and turning. During those times, you may be taking some deeper breaths that wash out enough CO2 to briefly stop the "breathe-now" signal. Or you may be fully awake and just pausing your breathing, as we often do while awake.

Either way, I'd suggest sticking with EPR of 1 for now but trying 2, and then 3, later on, if you see the CAs coming down some. The body often adjusts its "apneic threshold" so that the "breathe-now" signal isn't bothered by a little deep breathing. Be aware that CAs can really vary from one night to the next, so you have to keep an eye on longer-term trends.

As for pressure settings, if the current ones are comfortable for you, I'd keep them. You're still getting a few OAs, but only a few. Comfort is very important to the goal of helping you sleep better.

[bbillingsley1985]

Sounds good.  Thanks for the info.  I'll leave EPR at 1 for now and will look to increase as I get used to it as suggested.  At 5 it felt a little low on air for me when trying to go to sleep so I think I'll just bump it to 6 minimum (it spends most of the night above 6 anyway) and leave it at that going forward.  The sleep quality isn't any better than before cpap, but its really not worse either so I think I'm just gonna stick with the same mask for a while and try to get myself comfortable and used to it going forward.

On a side note, if anybody reads this now or in the future, I can't stress enough how important it is to pay attention to what your insurance actually pays and don't go off what the cpap supply people tell you.  Very long story short, I paid $540 for everything (my invoice is on a previous page in this thread) and when I got my EOB from insurance, Insurance actually covered all but about $150 of it.  My insurance, which is just standard middle range insurance actually covered everything except the machine and the humidifier (still dumbfounded on how/why they can charge me separately for the humidifier when it comes with the machine but anyway) and it still significantly discounted all of that.  It actually paid 100% of my masks/cushions/heated tube so now I don't have to worry about the fact that F30i masks are expensive online because my insurance is covering it.

But I say all of that to say that I actually had to call my cpap supplier's billing department, wait on hold for over an hour and finally get somebody on the phone to make them look up what insurance paid and actually get them to refund the difference.  I'd like to say they would of eventually refunded it but who knows?  I know a lot of people don't pay attention to the EOB's your insurance sends....my advice is really make sure that you aren't overpaying and if the prices don't match, find out what's up.  The EOB I got went line by line on what insurance was billed, what they discounted/paid and what I should owe.  I'm gonna get somewhere close to $390 refunded back on my card and I think I will only pay about $30 per month for 9 more months until I own the machine (they had me down for $44 per month before I called).  I get it that cpap companies want to cover themselves but why wouldn't they contact insurance first and get all of that sorted out beforehand?  I had to wait over a month anyway on a machine seems to me that they could of easily worked that out.  I know there's a lot I probably don't understand about it.....not sure who to blame but just upset at how bad our health industry is right now....oh well rant over on that....but really check that stuff out.

[Dormeo]

Thanks for the information about your experience with insurance, and congrats on persevering successfully.

I think raising your minimum to 6 makes sense. Lots of people feel air-starved at 5. You'll see, but you may even want to raise it to 7.

[bbillingsley1985]

Good morning.  Just thought I'd give a 2 week update.  I had been exclusively using the F30i which works fine but I would notice in the middle of the night while tossing and turning leaks mainly around the nose area and chart would show constant leaking.  Not over the red line bad, but just consistent small to medium leaking the whole night.  My AHI would average between 2 and 3 each night.  Since it was really cheap on Amazon and offered free returns, I spent around $42 to piece together a full face Phillips Dreamwear mask.  Figured its about the only mask similar to the F30i.  What I noticed was for one I really was able to get a handle on the leaks.  It's just finding the balance of not getting it too tight.  If I get it really tight I'll have 0 leaks but its uncomfortable.  Too loose it'll feel great but have more leaks.  The other thing was now my AHI is pretty much at 1 or below for the 10 days or so I've used it.

As far as quality of sleep....man its still not much better.  I would still say exactly the same as before I used CPAP.  I've been at this roughly 40 days or so.  I'll fall asleep, sleep pretty soundly for a bit but then just toss and turn the remaining half of the night.

Couple questions I Have are:

1.  I've just left pressure at minimum of 7 with a 1 EPR setting.  Should I try tweaking any of that?  The fact that my AHI is under 1 indicates I probably don't have a bad problem with centrals which is a good thing there.

2.  Any other ideas/tweaks I should consider in the settings to try to sleep better.  Anything I'm missing in the charts to indicate a setting I should change?  The numbers to me look fine so its discouraging that my quality of sleep is still no different than before CPAP ~40 days out.  At what point do I give up on CPAP?

3.  So I used the Dreamwear full face for about a week straight and I think every result was under 1.  Just to expirement, Sunday night I went back to the F30i and my results were above 2 again.  Is that normal?  Just seems odd to me that similar masks would show that different of results.  Maybe the dreamwear just fits me better and allows air to flow more freely.

I'll attach the last 3 charts....all using the Dreamwear full face.

[Gideon]

Just looking at improving comfort,
Bring Min Pressure up to 8
If that doesn't work try 9

Personally, I use 11 Min, plus a bunch of PS

[Dormeo]

When you bring your minimum up to 8, as Gideon suggests, give yourself EPR of 2. I think you'll like how it feels. And if CAs continue to be sparse, raise the EPR to 3.

I notice that your bedtimes are not consistent and that you sometimes seem to be sleeping for only 5 hours. Please pardon me if I already pasted in these guidelines earlier in the thread, but here goes:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

I was convinced these measures would be of no help to me, but eventually in desperation I tried them. Lo and behold, they helped. Maybe they will help you too.

[bbillingsley1985]

Thanks for the tips.  I'll give 8 a try with an EPR of 2.  

As for the 2 nights of 5 hours, those particular nights I took the mask off in the middle of the night because I had it so tight it felt like it was compressing my head lol.  Slept a couple of hours later on both nights after I took it off.  Other than those nights, I've been very consistent about keeping it on the whole night.  As you suggested earlier, I'm going to worry more about comfort and not so much about leaks going forward.  I'm finding that very tight = no leaks but uncomfortable so still adjusting a little after each night trying to find that balance.  Since I toss and turn so much its always fine when I first lay down but never really know until the next morning how it did.  The only time it wakes me up is when I hear it coming out of the nose and blowing up towards my eye so that's been the primary focus.  Anyway, how I had the straps last night worked pretty well for me.