New CPAP User - Advice Please

[Megatron]

Hi community,

I've been using a CPAP for nearly 2 months now. It's been very much a DIY job and trying to learn. Like many the tranisiton has not been easy. At home sleep study before soft tissue surgery showed AHI of 3. Unfortunately I didn't have a lab based study so no idea on RDI/RERA but consultant suspected likely high due to symptoms. DISE showed airway collapse. I have had symptoms of UARS for decades which I believe has stemmed primarily from lack of REM sleep. Soft tissue surgery included turbinate reduction which has helped nasal breathing; I am 100% nasal during day, but at night I usually get blocked or have issues with what feels like airway blockage as further discussed below.

 I've attached the last few nights of OSCAR data. Main areas of concern are as follows:

- I am waking quite often. Whilst I start with nose breathing I usually wake with mouth breathing and dry mouth

- When I try to sleep breathing through nose, I feel like when I am just nodding off I have a blockage which jolts me awake, however the charts do not seem to suggest the same. When I wake typically my lungs are empty as I initiate an in breath as I wake. Has anyone else had a similar experience? I don't know if this is something in my head or anyway to see this. After a while I usually transition to mouth breathing and fall asleep

- Pressures set to 6->11 with EPR of 3. Does this look suitable?


- Leak rate seems quite high? I'm using an F20 full face mask. I'm trying not to have it too tight as it's too uncomfortable. I sleep on side and find as head moves on pillow, it moves the mask slightly causing leak, especially when contact is lost at top of the bridge of the nose. I've mulled over a nasal pillow but think I need to be more comfortable with nose breathing before I can transition

- I've toggled on RERA and refreshed data but it is not showing on chart. Is this data available on an AirSense 10 AutoSet?

- I have a narrow palate and recessed mandible. I can't sleep on back as everything slides back and wakes me up. I can't suction tongue to palate as too narrow. CBCT shows a narrow airway top to bottom. I am pursuing potential solutions to narrow jaw as an aside. Has anyone anything similar?

Thank you

[gainerfull]

1.Your flow rate & events suggests your pressure range is too low. I'd recommend minimum 7cmH20, maximum 11cmH20 w/ EPR 3 full-time. Anything under 7cmH20 and you won't get EPR plus you may be waking up due to your low pressure.

2. Have you ever used the mask leak test on the CPAP to try and figure out where the leaks are coming from before going to sleep? Have you tried using a flatter pillow that doesn't jar your mask loose? Ideally you'd want to target 0.00 95% leak rate.

3. Resmed Autoset 10's aren't capable of tagging RERAs

[Megatron]

Thanks for the guidance it's much appreciated.

I'm titrating my min pressure up to 7, currently at 6.6 min (11 max, 3 EPR)

I tried the leak test. It seems the leak was caused by facial hair. A clean shave seems to have reduced the leakage from ~7l/min to 1l/min albeit I only have 1 night of data so far so we'll see.

Is anyone able to comment on the attached events? Do they suggest an issue in exhalation as opposed to inhalation or something else? Any suggestions for next steps?

[gainerfull]

Glad to hear the leaks are drastically reduced! I use a silicon F20 w/ beard and it seals well but I also wash the "pillow" with dawn every night before bed to make it tacky. There's another version of the F20 pillow called AirTouch which is lined with foam and good for closely shaved beards.

Can I see a one of those long obstructives zoomed in to a 5 minute segment but accompanied by flow limits, tidal volume and respiration rate? At first glance it reminds me of the long obstructive events I have when I wear my soft cervical collar too tight and lean my head left or right and block my airway. I do see a little sleep / wake junk during a presumed position change so some of them could just be breath holds after changing your sleeping position but they are very long and likely associated with flow limitation as well.

[Megatron]

Thanks for the further tips. What is a reasonable number for leak rate with an F20? I'm hoping to move to a nasal pillow if I can get nasal breathing nailed. Currently at 50% maybe.

I've attached some events over a 5 min period with data requested.

[Megatron]

Hi community,

Can someone help with a couple more questions please. I've attached 2 images

Image 1 - Earlier in the night I have lots of examples similar to the Clear Airway even shown where we see nothing; is this anything to be concerned about or anything I can do anything about?

Image 2 - Shows during what I think is heavy REM around 6-7am, the Flow Rate is very disorderly. Does this suggest I need to do anything with pressure etc?

Thanks