New to Apnea Therapy

[pholynyk]

ResMed was supplying a regular 2GB SD card, but these are pretty hard to find. Any SDHC card up to 32 GB will work, but 8GB seem to be the cheapest that are easy to find. The machine will probably want to format it, so don't use a camera card that has pictures you want to save.

[SarcasticDave94]

ResMed was supplying a regular 2GB SD card, but these are pretty hard to find. Any SDHC card up to 32 GB will work, but 8GB seem to be the cheapest that are easy to find. The machine will probably want to format it, so don't use a camera card that has pictures you want to save.

Given that my new ResMed ASV came with a SD card, I count myself fortunate. Penny pinching like this seems odd to me.

Esq. Sounds like you're getting set up well. Hope to hear good progress soon.

[Esq.]

Well, my first night was kind of rough. I fell asleep in 20 minutes or so, but woke up at least half a dozen times during the night. Sometimes I got right back to sleep, other times it took some time. I'm exhausted today.

When laying on my back, I felt like I was breathing fine and the pressure was comfortable. When I would lay on my side, however, I felt starved for air to the point that my only means of falling back asleep would be to turn to my back. I read of others having a similar issue with the DreamWear mask here, so I guess I'm not the one. Am I somehow overcompressing the sides of the mask so that it's cutting off air flow?

I must have had a few mouth-breathing incidents because a few of the times I woke up I was burping air. That issue seemed worse on my side than on my back too, maybe because I wasn't getting enough air in through my nose on my side?

I also have a weird soreness in the upper middle of my back, but that could be from not really relxaing at all and staying on more back more than normal.

I plan on getting the SD card and SleepyHead set up this evening, so my stats today are rather limited. The myAir app noted 7 hours 47 minutes of usage, a "good" mask seal (leak rate of 9.6 L/min), and an AHI of 6.2 (higher than my sleep study results of 5.7). I looked at the onboard stats this morning, and noticed that both OSA and CSA events were caught, but I don't have that in front of me at the moment. My two-night sleep study caught only OSA events, and no CSA events, so that was a surprise.

All in all, not off to a great start. I don't plan on changing the settings at all yet, at least until I have a week or so under my belt and SleepyHead data to post. Is this the best approach?

[Esq.]

Well, night two is down and I slept, perhaps, a little better. Here is the SleepyHead data:



I continue to struggle with sleeping on my side with this mask. I just can't breathe on my side. I'm spending most of the night on my back, which is not my norm. I woke up several times again, but perhaps a bit less than the first night and I fell back asleep a little easier.

My AHI has gone up even more. Thoughts on settings? Should I try another mask?

[Sleeprider]

Success at this CPAP therapy is largely a matter of getting comfortable. A different mask is often a part of that equation. I find the Resmed Airfit P10 is not affected by my sleep position and will hold a seal and not be affected by compression of the headgear on your pillow; however if you are prone to mouth leaks, it wil not fix that.

I previously encouraged you to obtain copies of your sleep studies. That remains an important task for you, and it would help if you related the results here for perspective whether the centrals were part of your Dx, or are a new phenomenon.

To improve results, particularly central apnea, reduce your maximum pressure to 10.0 and increase minimum pressure to 8.0. Cut EPR to 1.

[Esq.]

Success at this CPAP therapy is largely a matter of getting comfortable.  A different mask is often a part of that equation.  I find the Resmed Airfit P10 is not affected by my sleep position and will hold a seal and not be affected by compression of the headgear on your pillow; however if you are prone to mouth leaks, it wil not fix that.

I previously encouraged you to obtain copies of your sleep studies.  That remains an important task for you, and it would help  if you related the results here for perspective whether the centrals were part of your Dx, or are a new phenomenon.

To improve results, particularly central apnea, reduce your maximum pressure to 10.0 and increase minimum pressure to 8.0.  Cut EPR to 1.

Thanks. I do have my sleep study results (just not in front of me at the moment). The sleep study showed absolutely zero central apneas. They were all obstructive. Now it seems I'm showing predominantly central apneas? As noted, I've also seen my AHI go up from 5.7 from the sleep study to 6.2 on night 1 now to 7.3 on night 2. Is it possible these centrals could be a false positive or something?

In any event, I'm going to contact my provider today about trying another mask. I'll also look at making those changes to the settings. Just curious - 10 seems pretty low for max pressure, but then again I pretty much know nothing. Why is that a good setting for me?

Also my current min is set at 8. I think SleepyHead is showing 5 as the lowest last night because I used ramp.

[Sleeprider]

What we are seeing in your results is CA with very minimal OA and H. The purpose of limiting maximum pressure is to hopefully lower CA which often increases with more pressure and more pressure support (EPR). Your event rate is not very high, and could resolve on its own as you adapt to CPAP therapy. CA is often simply a phenomenon of sleep disturbance, restlessness and movement. If it continues to increase beyond 15 CAI, that will probably get your doctor's attention, but for now the focus is on comfort and minimizing disruptive effects of pressure fluctuations. On your posted graphs, more CA occurs when the CPAP increases pressure above 10. If the pressure limitation allows more OA, then we can adjust, but for now most of your events are CA.

[Esq.]

What we are seeing in your results is CA with very minimal OA and H.  The purpose of limiting maximum pressure is to hopefully lower CA which often increases with more pressure and more pressure support (EPR).  Your event rate is not very high, and could resolve on its own as you adapt to CPAP therapy.  CA is often simply a phenomenon of sleep disturbance, restlessness and movement.  If it continues to increase beyond 15 CAI, that will probably get your doctor's attention, but for now the focus is on comfort and minimizing disruptive effects of pressure fluctuations.   On your posted graphs, more CA occurs when the CPAP increases pressure above 10.  If the pressure limitation allows more OA, then we can adjust, but for now most of your events are CA.

Got it. That all makes sense. I was reading some things online that people often register higher CA events during their first few weeks of therapy while they adjust, even when CA was not detected during the sleep study. Hopefully that is my situation and it resolves on its own.

I'm going to pick up the AirFit N20 mask this afternoon from my provider and give that a try as well. When I spoke to them I mentioned the CA events and was told they usually don't worry too much about that until the patient gets comfortable with a mask and is sleeping through the night for the most part. I'm clearly not there yet.

In the interest of changing one thing at a time, I think I'll give the new mask a few nights and see if I'm sleeping more soundly with it. If I am but the CA events persist, I'll adjust the settings as recommended.

Appreciate all the help.

[Sleeprider]

Sounds good to me. This issue is not a big concern early in therapy, I'm just offering the usual tools and approaches to minimizing events. As you have noted, this usually resolves on its own in time.

[Esq.]

I picked up the AirFit N20 yesterday and slept with it last night. I think it made a huge difference compared to the DreamWear. I found the N20 more comfortable, WAY less noisy (like almost completely silent), and it stayed in place much better. I was able to sleep on my side some without major leaks and without feeling starved for air. The only issue is I feel like I had more mouth breathing incidents than the prior two nights. I woke up a few times from it and have that bloated feeling this morning. I'm using a chinstrap and working on tongue placement but I'm still having some issues with it. It seems harder to control on my side than on my back.

The SleepyHead data seems to show improvement:

[url=http://imgur.com/GKRKqy9][/url]