KwbIsMe has a therapy thread

[kwbIsme]

OK. Thanks for people commenting room tips! 

I tried for a CPAP back in '08 and didn't quite qualify, add some weight and an international move and the issue came back with a vengeance, so a split study showed 43.5 events/hr. I'm pretty excited to hopefully get this stuff under control... which I'm hoping leads to energy and motivation for improving mental//physical health. 

I got my machine 2 nights ago - Airsense 11 autoset with Airfit N20 mask. Pressure is set at 4-20, but my prescription is 6. I adjusted the ramp from auto to 45 minutes, everything else is auto. 

1) Mask... don't love it. I sized it, my study used a comfort gel blue which my DME Said these N20 were equivalent to. These seem smaller on my face, it feels like it's putting pressure on my nostrils restricting airflow... but, I don't know how much of that is in my head. So I'm thinking of requesting nasal pillows, but I'm at an overseas military base so it takes 2-3 weeks to get things. Basically, is switching worth the hassle, aside from the nose pressure the mask doesn't bother me, doesn't leak, I tend to move about in my sleep too if that matters.  
  
2) Exhaling... I understand this is just something I have to get used to? I made it 3 hours my first night and 6 hours last night. My lungs are a little sore.

3) MyAir app, it's not pulling the data from the machine. It shows the bluetooth on the machine, iphone says it's connected, it acts like it's syncing then doesn't load any data. I used the app the first night to go through the training/intro thing, so I know it's setup. Machine doesn't have cell signal since it's a US machine overseas. I've tried running my app over a VPN, but nothing. I get to see the day summary and I do have a sim card I haven't played with.

[Sleeprider]

We don't generally see a lot of comfort or success with default pressure values of 4-20 pressure. We really need to see an Oscar chart to help you get the most effective settings. For starters, we often recommend using the exhale pressure relief (EPR) setting. It allows for 1 to 3 cm of pressure relief during exhale, and makes breathing much easier. To make room for EPR we recommend increasing the minimum pressure of 4-cm plus the EPR setting, so if you use EPR 3, the minimum pressure should be set at 4+3=7-cm. It is also a good idea to minimize ramp time if it is used at all.

Welcome to the forum. Read the wikis linked in my signature on how to Organize Your Oscar Charts and Embedding Files and Images in your post.

[kwbIsme]

OK, here are the last 3 days of data. I generally have been sleeping in until 8, but when I wakeup in the early morning hours (either toddler, liquids, or fighting the machine) I end up just taking the mask off instead trying to re-ramp back to sleep. 
  
I think what's happening is at some point, I start breathing through the mouth, which closes off my nose, so the machine tries to clear the airway and ramps up pressure, then I get mad that I can't exhale through my nose against a cat5 hurricane.  
  
           

[Sleeprider]

I still think you should set minimum pressure at 7.0, maximum pressure 12.0 and EPR 3. Your EPR is set to Ramp Only and should be changed to Full-Time. These settings are going to be more comfortable and less disruptive as flow limits and pressure spikes will resolve. Your leaks are getting steadily worse and are certainly disruptive to sleep. Perhaps not so much as toddler fluids, but I haven't dealt with that in several decades. The Mask Primer wiki may help you deal with leaks http://www.apneaboard.com/wiki/index.php/Mask_Primer

[jlfinkels]

Consider a soft cervical collar (link is in Sleeprider’s signature for more info). It will help with opening your mouth when fitted properly. Personally I use a Caldera Releaf, but there are many good ones to consider choosing.

Trying a nasal pillow with properly sized pillows should help with comfort, the new N20’s have been reported to cause soreness on the bottom of your nose, so it is worth a try. For me the secret to comfort with pillows is to not have them too tight and to let the air expand them in your nostril so it is not crushed against your nose or face.

Sleeprider is very knowledgeable about pressure settings, so be sure to give it a try.

[SarcasticDave94]

The mask cushion size or some other aspect like strap adjustment are suspect in lack of leak control.

I think a bigger issue is the settings that are in conflict with one another. Ramp locking you onto 4 with EPR 3 in Ramp only. This nets nothing but min pressure 4 and zero benefits from EPR. ResMed resets the Ramp time every time you restart therapy, compounding the lost therapy time.

I would cancel Ramp completely. That's one less variable that's making therapy less effective. EPR 3 is the right answer, but since EPR/exhale pressure relief reduces your Min pressure by itself it needs more pressure to reduce from. 4 is the lowest you can get, EPR will not reduce you lower than 4.

As Sleeprider said pressure plus EPR equals your set Min pressure. You want EPR 3 full time and to make the math work, min pressure must be 7. It will actually feel better than what you're running now because it has room to reduce.

It will also reduce flow limits which are the key to keeping pressures from spiking higher.

My recap is this:
Cancel Ramp completely
Min pressure 7
EPR 3 full time

[kwbIsme]

Well that did the trick, I made the recommended changes and slept through the night! Awesome.
I'll give it a couple nights and post some more data if needed. I only slept one night on the changes, we then went out of town for a night and I didn't bring my machine (we recently moved to Japan so navigating trains, streets, etc is a bit new and hectic to cart around expensive equipment).