Newbie - worse with Apap

[Jane9999]

Ok, I could l write a long story, but short version for now.

I did not have sleep apnea symptoms, but saw a Dr for something different and she jumped on Apnea.
Home testing showed issues but also showed false info (for snoring and position) so while it snowed mild/moderate AHIs, I am not convinced yet there is a sleep apnea issue.  I was hoping the software used with the Apap would give better information (it didn't come over with a SD chip, one is on the way).

However, I am sleeping horribly with the Apap. I do sleep about 7-7.5 hours a night after the first night, I wake tired, two nights as if I hardly got any sleep at all and those were the worst ones for mask fit (1st night and last night). The AHIs don't reflect my poor sleep (no clear correlation).  I have played with range settings and mask fitting and that has helped some.

ISSUE:  I am getting a pulsing at the end of my out-breath.  Sometimes when the out-breath is finished (I typically pause a few seconds between out-breath and the next in-breath) and sometimes it starts 1-2 seconds before I have finished with the out-breath.  It feels like someone lightly tapping on my face.  It is occurring in the soft part of the mask that is next to the face.  Besides being annoying, I bet this affects my ability to sleep deeply.
While it seems most often in the situation above it can also happen with one pulse in the middle of a breath.
I can force it to happen if I just don't breathe.

Apap is now set up for 4-11 and I think I sit around a 10 for my max (hard to tell with only the MyAir at this point, SD chip on the way).
The pulsing happens with EFR at 1 & 3.  
Apap should be at level 4 initially, so it happens then. 
I just changed the settings to 6-11 and it happens at 6 also.


Anyone have that issue with an Airsense 10 and Airfit F20?

Thanks, Jane

[Sleeprider]

You need to change your minimum pressure to 7.0 to use EPR 3. That results in an exhale pressure of 4.0 and inhale pressure of 7.0. The pulsing you feel is the Resmed Forced oscillation Technique (FOT) used to determine if an apnea is central or obstructive, and it starts about 6-seconds after the machine detects flow that is low enough to qualify as apnea.

Upgrade your Sleepyhead software to the current OSCAR and post a chart. I’m sure we can get you dialed in pretty fast.

[Jane9999]

You need to change your minimum pressure to 7.0 to use EPR  3. That results in an exhale pressure of 4.0 and inhale pressure of 7.0. The pulsing you feel is the Resmed Forced oscillation Technique (FOT) used to determine if an apnea is central or obstructive, and it starts about 6-seconds after the machine detects flow that is low enough to qualify as apnea.

Upgrade your Sleepyhead software to the current OSCAR and post a chart. I’m sure we can get you dialed in pretty fast.

Sleeprider thanks for the reply.
Isn't the airsense 10 smart enough to know what level the apap is at it will just kick in at that time?  E.g.  Range is 4-12 but epr kicks in only at level 7 or above?  It should be that smart.
That pulsing happens during breaths all the time - in the middle of breaths with one pulse.  It happens at the end of a breath or within 1-3 seconds (not 6) of ending a breath many times.
Maybe I have a faulty machine.  I should try to call resmed directly.
I can't do software until I get an SD Card.  One is on the way and should be here in a day or three. 
Jane

[Hydrangea]

I have experienced that. And it bugged me so much!

I switched off EPR, and have slept so much better ever since!

[Jane9999]

Hydrangea,  !!!

That was it.  I turned off EFT and no more pulsing.  I would not have guessed that setting caused the pulsing.

Last night was a bad night.  The nights I have some mask leaks I feel like I got no sleep at all and it just wrecks me.  That is probably what most people with sleep apnea feel without their cpap.
None of my nights with a cpap has been a good nights sleep and before the cpap I had good nights regularly.

I am taking a break from the cpap tonight because I need a good nights sleep (yeah kinda backwards).
I will try again in 2 nights.

[Sleeprider]

Jane, whether you do better with EPR off or increasing pressure, the reason you need higher than minimum pressure when using EPR is that it keeps your exhale pressure too low and makes the pressure support (difference between inhale and exhale pressure) inconsistent. When you start at 4.0 cm with EPR at 3, the machine detects obstruction or flow limitation and increases pressure, but the EPAP does not change. You start at 4/4 (IPAP/EPAP) move to 5/4, 6/4 and 7/4 before the EPAP even begins to move. From 7/4 the EPAP moves with the IPAP or CPAP pressure to maintain a constant 3-cm pressure difference. People using very low pressure like this don't often benefit from the use of EPR at all, or find it more disruptive to sleep. It is really intended for those using higher pressure.

A common mistake is to assume since your machine is an auto-cpap it does not need to be optimized for your therapy pressure. In the case of the Resmed Autoset, the machine actually increases pressure fast enough to head off most events, but most other machines don't. It is always better and less disruptive to sleep to minimize the pressure variation during sleep. After you have used your machine the first time, it is a good idea to move the minimum pressure to equal your median pressure for that first night. That increase in minimum pressure may be the only change you ever need to make but continued optimization may improve results.

[Jane9999]

.....People using very low pressure like this don't often benefit from the use of EPR at all, or find it [the pressure variation] more disruptive to sleep. ..... 

...It is always better and less disruptive to sleep to minimize the pressure variation during sleep. ...

Sleeprider - is there research that has shown the above statements or is that your personal experience.

I would especially like to see any research showing the effect of algorithm differences between the 
two brands (Resmed ..heads off events),  I am a research kinda gal,

I am still waiting for the SD chip so I can make intelligent changes - I am flying blind without that.

[Jane9999]

I got my SD card, installed Somnopose, and pulled out our oximeter.

I still get much worse sleep every night I use the APAP (than when I am not using the APAP).
So I can survive, I am using the Apap only every other night so every day is not trashed.

I think a big chunk of the problem is that I am getting only light sleep and not dropping into deeper sleep.  Caused by Mask issues, too high of pressure issues, and more.

Mask problems:
--I get a regular air stream blowing over my nose - like having a mini fan blowing across my nose "tickling" me.  
--The mask without the Apap running is comfortable.  But the pressure, even at 4-6, creates pain on the upper sides of my nose and upper cheeks. 
--Often I really feel the sensation of the air across my upper masked area with every in breath (fan breeze sensation) and outbreath (stale and heavy like someone is breathing in my face)

Next steps:

I am going to call Resmed again, they were very helpful last time and my DME and Sleep Dr seem to only be looking at the very summarized information from the Resmed and taking what I consider blind guesses.

I am going to try a different mask.  With Corona stuff going on, the DME does not fully fit masks, they measure and ask what mask you think might work and discuss features, and

Pressure too high:
-- I wake up feeling like Leaf blower blowing in mouth
and I can't even shut my lips. Sometimes doing a couple strong steady inbreaths/outbreaths can help lower the pressure, but sometimes the air pressure is so strong I can't do that and have to turn the Apap off and back on again.

It has only been 2 nights and they are not similar, but I am going to try lowering the max pressure to 9 as one night before I had the SD card I did this and I slept much better.


Note:  The two nights so far are very different - second night is attached in the next post.

Charts from first night with SD card are here:
       

[Jane9999]

This night I had the somnopose running, my oximeter running, and the SDCard.
I also had the mask tightened down even more, to stop any mask leaks since I do a lot of side sleeping.
However, 1.5 hours into sleep (starting just before 1 am), I work up because it felt like an elephant was sitting on my face and I could not breath.  This sensation was worse than anything I have previously felt (with or without the apap). 
I took the mask off and did my typical put it back on a few seconds later but got the same sensation, so I took it off for the night. I left the somnopose and oximeter running the rest of the night. 
I thought my low O2 might be positional (back sleeping) but it happens on my right side also.
I do have a contour pillow coming (in the mail) that hopefully will help some.

The last chart here shows the info from the oximeter and somnopose.
   
   
   

[Sleeprider]

Your pressure settngs of 6-11 results in extremely high flow limitations and maximum pressure being applied through every session. All events are obstructive. You need two new tools. First, you need to change your pressure settings to a minimum of 7.0 to a maximum of 16.0 and turn on EPR full-time at a setting of 3. This will help to relieve the airway restriction that is causing flow limits. To top it off, you have a severe case of Positional Apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea, and probably need to add a soft cervical collar to your therapy http://www.apneaboard.com/wiki/index.php...cal_Collar

So far, I have suggested at least 3 changes to your therapy that you have not implemented. If you choose to continue to suffer, this is on you. Please consider my recommendation as my final offer.