[Diagnosis] Concurrent Conditions and Diagnosis Doubt (Mild OSA)

[slortien]

Thanks for looking! I checked about CSA a little. Maybe my problem is the higher pressure, given CSA can be a reaction to PAP therapy. Based on the name in Oscar, I had assumed "CA" was just when my mouth came open. I do live at high elevation (about 6000ft/1800m), but I've been here for about 8 years. This was my highest index so far on the CPAP, but like I said, it didn't feel different from other nights.

Maybe permitting lower pressure and allowing the device to adapt is the better approach for my situation at this time (like I had it for a couple days early on). I do tuck my chin too much, and the cervical pillow does seem to help a bit, so it could be positional as well. 

One odd data point from my study is that, while my index is higher in my sides than my back, my left side is MUCH higher while my right side is lower (I think it was something like 6 on my right and 16 on my left). I dropped that information to make the chart prettier in my first post ? Part of this could be because I push my head forward to get more fresh air off the side of the bed when I'm on my left side, but this isn't an option on my other side since it's a two person setup.

I also learned early on to breathe as quietly as possible, which probably isn't helping!

I've attached last night's oxygen saturation according to my smart watch. It appears that my desaturations line up pretty well with those clusters of CA events.

[SarcasticDave94]

Hmm ok well high elevation itself can enhance CA. You're the leader here, so if you want lower pressure, go ahead and give it a try. Maybe a range of 7-12 and consider trial on EPR 1. EPR will assist the Obstructive events but may worsen CA.

Still a bit premature but ASV may well be a necessity not a luxury. Try another little bit to collect ammo for the fight.

[slortien]

I tried a night with EPR off and a range of 4-16, since resources said exhilatory pressure is important for CA. Got an index of 1.7 with 0.8 CA (by far my lowest), but the SD data was corrupted. Maybe taking the card out about 5 minutes after waking up wasn't a good idea. Still woke up a decent number of times throughout the night, but I'll keep it at these settings for a while and see if it continues to report good numbers.

[HalfAsleep]

Just to add here, since others seem to be taking your pressure needs in hand... In my experience, it takes quite a while to adjust to the xPAP experience. For me, it was over a month before I felt any kind of rested, and it's still not every night (I'm going into month 4).

I've also found, once you get close to figures that look like they may technically work, stick with them for a bit before you make new adjustments. Things might settle down as far as your sleep experience, but this will also give you a chance to learn for yourself what happens for you during a night's sleep, what Oscar conditions make you feel more rested, etc.

For example, I used to be very quick to analyze my Oscar data and make corresponding changes. However, I've lived with the current settings and mask for over 2 months. Although my AHI is different every night (I guess that needs addressing), I do notice the basic profile on my flow rate is consistent. I've also gone from 2-hour chunks of sleep to 6+ hours in those months. Now, I feel I'm in a position to evaluate: I have more insight on my sleep experience as it relates to the technical output.

[Deborah K.]

I have seen on Amazon that you can get 4-inch and even 2-inch bed risers. Maybe lifting the head of the bed less would accomplish what you need without being uncomfortable or causing you to slide down the bed. I would not think the 2-inch version would help much, but that the 4-inch ones would be good.

[slortien]

I'm back with another night's sleep! I tried the Nasal Violator pillows (the size small) that came with my P10 mask kit for the first two sections last night, but woke up repeatedly due to the higher resistance. I got up in the big gap, but the second gap was just switching back to the mediums. I think they would be more comfortable than the medium size if they weren't so firm and restricted, despite going much further into my nose. I've tried them out on every pressure setting so far, but fallen back to medium during the night every time due to discomfort.

You would think that these would be made to mimic each other as closely as possible resistance-wise, given lots of people have a smaller range of prescribed pressures. I'm also somewhat surprised that the machine doesn't adapt to deliver more air with the more restrictive flow pillows. I guess it's also possible the restriction is from being inside the nose more, or by spreading my nares it might cause the skin that's being pressed up (by the pressure of the mask and band) to mushroom and block more airflow where the bone/cartilage start.

I'm planning to ask for a new mask, as the medium loses seal or slips out a couple times a night but I have a hard time sleeping with the small. The DreamWear pillows seem like a close match and would get the top attachment so I don't get tangled in tubing as much. I'm assuming any ResMed pillows, like the P30i, would have the same issues I don't like on the P10.

The last two nights are my first nights on CPAP that my watch says I got sleep quality close to my normal before treatment. My awake times are still on the worse end of my normal, but hopefully that will improve as I get more used to the device. I can't keep the thing on more than about 7.5 hours before my body just nopes out. Still not feeling any improvement in daytime sleepiness, stress, blood oxygen levels, or anything like that either. Wish I were one of those people who just puts on the mask and it's like I wake up from a nightmare!


@Deborah That's an interesting idea. Looks like a 2 inch rise across an 80 inch mattress would be about 1.5°. I think I would have to sleep in my own bed if I did it, but I do have another available... Having my head against the headboard might not be a problem either if that did happen, given that's how I sleep normally. I also used to sleep wedged between the mattress and the wall when I wasn't sharing a bed

@HalfAsleep Thanks for the encouraging information! I had heard that getting used to treatment and seeing positive results were often out there in time, but it's hard to have patience, especially since they only give you 30 days to change or return anything and out of pocket for these things is not cheap. I'll try to chill a little. I do have a tendency to blow things out of proportion 

[SarcasticDave94]

Unless I'm missing the narrative completely, you're using nasal pillows. They should not be inserted into the nostrils, resting on the nares, yes. These aren't nasal prongs.

Maybe go BIG on the size.

[slortien]

Ah, sorry, I don't mean the whole thing is inserting into my nostrils, just that the opening is. With the small, the widest part still doesn't go inside my nostril, but the rubber/silicone gets progressively stiffer the closer to the wide part you get. The large is big enough that I have to manually tuck extra material (between the nostrils and close to my lip) into my nostril to get anything resembling a seal. On both, I need to increase strap pressure to maintain the seal when compared to the medium.

[Deborah K.]

When I was using the P30i I started with the small pillows as I have pretty small and narrow nostrils. Eventually, I tried the mediums but found I was most comfortable with the large pillows. Give them a try!