New user looking for guidance.

[kinkade]

Hi,

I have been using my resmed air sense autoset 10 with p30i nasal pillows for about 2 months now. I have been unable to do a titration due to covid ( the technicians not mine)

I was encouraged to experiment and find therapeutic values and have currently settled on 8.2 to 9.6. however with these values I seem to do a lot of mouth breathing judging by my dry mouth and the flow rate line in OSCAR  even though I have a chin strap and my mouth is taped. Lower values I have experimented with (5.2 - 7.7 cm) seem to cause less mouth breathing.

My sleep study showed an AHI of 12.1 with 20 in supine and rem sleep. it was dominated by hypopnea with a small number of central and only 1 OA. I have no hypopnea now, a very small number of OA and some CA most of which come later in the night.

I notice my AHI is very low for the first half of the night and then increases in the latter parts, by the time I am waking up it can be between 8 and 15 for that part of the night and I wonder if that will affect how well refreshed I feel.

Even though I am dramatically less tired now that I am on CPAP I have a fingertip pulse oximeter that is not compatible with OSCAR that still shows nmy O2 looking pretty jagged thought the night


I'd really appreciate any insights around my setup and any suggestions for improving it

[kinkade]

Just an additional bit of info. my SS showed 2 CA per hour

[Nigel]

I could never get on with nasal masks (just blows air into my nose and out my mouth causing dry mouth and severe rhinitis). Full Face F20 or F10 masks work for me.

[staceyburke]

To see what  is going on we need data.  We get data from OSCAR.  It is a totally free download from the top of the site.  You need a SD card (one may or may not be provided to you in the machine), they are quite inexpensive.  The SD card can be from 2 to 32 gb in size.  Get the cheapest one you can fine.  Sleep with it in the machine and post your charts.  We can tell a whole lot for those charts and see why your AHI is and help with most all settings.

[kinkade]

To see what  is going on we need data.  We get data from OSCAR.  It is a totally free d

Thank you I have post my Oscar charts in the original post

[kinkade]

Here is my sleep study if this helps

[Dormeo]

When you experimented with a lower pressure range, what happened to your AHI?  I would want to know the answer before making recommendations about your settings.

The increased number of CAs during the second part of the night might be the effect, not the cause, of whatever is making you feel unrested during the day.  Zoom in on your flow rate to see whether you see the kind of pattern in the attachment.  The attachment shows a brief arousal, which involved deeper breathing, which washes out some CO2, which reduces the drive to breathe, which causes a pause of 10 seconds or more between breaths -- voila, a CA.  The problem is the arousal, not the CA.

[kinkade]

MY OA and Hypopnea numbers stay the same on pretty much any pressure including when I had it in the range 5.2 - 7.4. what varies is the number of CA. I'm attaching a screenshot from OSCAR from last night.

I think it shows the arousal and washout you refer to. 


Thank you so much for your help

[Dormeo]

Yes, the CAs do appear to be the effects, rather than the causes, of the unrestful sleep. Let's put them to one side for now.

I do recommend that you increase your EPR from 1 to 3. This might reduce your flow limitations; they may or may not be making a contribution to your feeling less rested than you'd like. So let's see whether more EPR will help a little. Also, you might just like the way it feels. The EPR might also increase your CAs some, but unless they go crazy, I wouldn't worry too much about that.

As for your pressure range, please use the settings that are most comfortable for you, though making sure your minimum is no less than 7, so that you'll have consistent EPR all night.

Your leaks are well within the ability of your machine to compensate, so the only question in my mind is whether they tend to disturb your sleep. Do you know whether they do?

About your O2 -- very short downward spikes are likely to reflect a brief partial loss of contact. Keep an eye on it for a little while longer, just to make sure you're not seeing more prolonged levels below 90.

When you post your next chart, could you turn off the calendar (click on the triangle next to the date) and then stack all and only these graphs into a single screenshot:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

I'll be eager to hear how things go.

[kinkade]

Thank you, I feel like the leaks often cause me to wake up with a very dry mouth so I had assumed it was mouth breathing despite he chinstrap and mouth taping.

Ive attached the updated OSCAR screenshot