New APAP/CPAP User - Help with optimizing treatment

[battlesnore]

Sorry, I didn't mean to imply they didn't notify me about it. They did. I have regular remote appointments with the clinician where they download the data, optimize the treatment, and then notify me through email regarding their findings and adjustments to treatment.

What I meant that to say is that they didn't say anything about me changing around the settings. I thought they were going to ask me why I changed the settings, but did not.

[battlesnore]

Well, I decided to try the constant pressure at 18.6 and EPR still at 3. My AHI seems to be getting better. Any suggestions for further improvement?

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[ShaunBlake]

No suggestions for furthering your improvements (I'm only qualified to cause confusion and consternation) but I admire your progress, and have an important question: how do you feel?

My results have gotten about as good as yours, and if it weren't some comments from the gurus, especially Sleeprider, I'd be just enjoying my satisfactory numbers.  And I did experience a week or so of a long-forgotten feeling of well-being, alertness, and vigor which I'd like to re-experience and hopefully make permanent.  Sadly, the folks here have triggered my OCD and I'm on a mission to keep trying for the perfect night's sleep.  I suspect that you can relate.

[QiuWen]

I believe you might benefit from a BiPAP machine, have you spoken to your doctor about that? 17cmH2O pressure sounds like a very high pressure setting.

[JesseLee]

Pardon me if I have missed it, but have you considered using a Full face mask? I know it goes against the grain of minimalistic approach and the popularity of the mask you are using, however, chin straps and collars are more items to acclimate to. I see that you exhale through your mouth on occasion still and, while you aren't doing it as frequently, it still happens. If you ask your DME, assuming they are decent, they may have a mask that you can trial without commitment. I'm not saying its a solid solution, but the full face mask can be a comfortable option. The reason I suggest this is the mouth exhalation and the frequent adjustments, along with the extra gear that may or may not complicate therapy unnecesarily. Hopefully, your DME is cooperative and considerate and if you request a trial, you won't be committed to buy or switch. Sorry if I have missed this conversation, again.

My position on nasal pillows is that they are great, if you are comfortable with using them and also don't have any issues with the other equipment potentially required. I find that many users are okay with full face masks, like myself.

Edit: I should recognize that a soft cervical collar is a good remedy in many cases of positional related obstructive apnea, and may also be a useful tool even while using a full face mask.

[Sleeprider]

First, I am in agreement with Qiuwen that bilevel therapy might be better, but you're making progress here. Remember you had some very clipped exhale breathing that looked like you were exhaling around the mask at the beginning of this thread. Your AHI is moving under 2 AHI and that's not so bad. A few sporadic leaks are not a concern and your apnea is pretty well controlled. At this point we start looking for comfort and sleep quality.

[battlesnore]

Hi, checking in after a while of nice treatment. The average AHI over the last 30 days is 1.96. But recently I've been really tired throughout the day, even with low AHIs. I do have large leakages though. Is there a way to tell when I am awake during the night. I suspect the large leakages are waking me up, which may be contributing to me being tired. I remember adjusting the nasal pillows several times in the middle of the night.

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[Sleeprider]

Battlesnore, the next step may be bilevel. Your AHI is good, but your pressure is near the top of CPAP range. Being uncomfortable with these high pressures is one of the criteria doctors will consider to approve BPAP, where more pressure support is possible to make these higher pressures more tolerable.

Considering your pressure, I don't think leaks are bad unless they are disruptive to sleep. Overall, you're doing pretty good here, but as I said, your pressure is pretty high, and higher pressure support might be more comfortable.