[Pressure] Advice on pressure adjustments

[akarifur]

Hey there everyone, just joined the forum after reading alot of good advice here (thank you so much for this resource of this forum). I just finished my first week on cpap and boy was it a journey. I like many others initially thought "oh i'm a mouth breather" and got full face mask(s) to try, I tried a few but kept having alot of leaking issues and frustration along with it. But finally i took the plunge this weekend on a Nasal PIllow mask the P10 and boy my leaks went way down.

However, I've been kind of a "bad boy" and been trying to probably a bit too aggressively find my right pressure. APAP was waking me up alot and causing me some havoc, at least to my inner impression. So i tried to nail in a cpap pressure based off information in OSCAR of the apap nights. I"m here cause i'd really like some advice on my pressure settings and what people think is the right move for me to try on a longer cycle. I've attached 3 nights of OSCAR data for help

Attachment Guide:

Attachment 1: F30 mask, last night on full range 4 - 20 APAP
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Attachment 2: P10 nasal pillow, APAP 10 - 15cm
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Attachment 3: P10 nasal pillow, CPAP 15cm
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[Expat31]

Hello, 

Thanks for your graphs. 

Glad that you have made progress on your mask leaking. Leaks really can seriously sabotage therapy and the graph produced generally become highly unreliable. 

With FFM, as they have a large surface area, they can be leak prone, it all depends on one's facial characteristics. Pillows can be excellent and more comfortable. 

However there are two types of leaking, mouth leaking and mask leaking. The former is caused by the chin dropping during deep sleep, the latter leaking is usually indicated by sharp spikes on the leak graph, whereas mouth leaking indicated by flattening instead of spikes. In your last graph there seems to be a mask leak again, perhaps the mask moved. 

I can't emphasise this too much, large leaks must be controlled as much as possible. The algorithm cannot work properly to give you proper therapy. You will have a lot of discomfort with sleep disruption,

On a quick review of your graphs, it looks like you have periods of positional apnea, indicated by the tight groupings of events. 

There ard two main causes of positional apnea:-

1. Supine sleeping, when during REM phase of sleep, the body is partially paralysed and the tongue can fall back and block the airways. Perhaps your sleep study gave some indication of this. 

2.The trachea may become kinked, blocking tbe flow of air. This can happen in any position, supine when it falls back towards the chest, or side-sleeping in the "foetal" position. You will see many references on this forum co concerning cervical collars, as well as type of pillow used, especially thick ones. 

The solutions are usually avoiding sleeping on your back, or as above, a soft cervical collar. 

Please see these links for further information and detail:-

Soft cervical collars.
Positional sleep apnea-the case for straightening out upper airways.
Sleeping positions & pillow adjustments (video Mayo)

As for pressure adjustments you can try these:-

Min 7cms, max 12.  
In addition, set EPR to 3. See here  EPR. for further detail and explanation. 
   
Try these to see how it goes and repost.

[akarifur]

Thank you so much! I've gone ahead and ordered a cervical collar based off reviews on this channel to try out and i'll adjust my pressure settings for tonight as you suggested. I'll report back here as i get new oscar data. Thank you again and happy sleeping to you as well

[Sleeprider]

Akarifur, I agree you will need the soft cervical collar. Apnea Board was the first to identify positional apnea and the use of a soft cervical collar as effective in these cases.
Wiki Positional Apnea: https://www.apneaboard.com/wiki/index.ph...onal_Apnea
Wiki Soft Cervical Collar: https://www.apneaboard.com/wiki/index.ph...cal_Collar

Your settings need some adjustment to counter the flow limitations. Let's back of pressure a bit and use Autoset mode with Minimum pressure 8.0, Maximum pressure 15.0 and in settings turn on EPR Full-Time at setting 3. This will give you 3-cm of bilevel pressure support which will improve flow limits, RERA and hypopnea. Of course no amount of pressure can overcome a positionally obstructed airway, but I think you will find this more comfortable and effective as you work your way through the soft cervical collar.

[akarifur]

Update on one night, I haven't received the cervical collar from amazon yet for last night. It might arrive today but I did the adjustments that you (sleeprider) recommended and holy cow, my best AHI (1.17) yet and minimal leaks too boot. I've attached an image of it for log here, i'll update once i try the collar, for my information if i ca't get used to a collar (probably not a concern but i like to have options) would a chinstrap be effective or is the collar for more than just chin issues?

[attachment=59079]

[Sleeprider]

I sometimes get lucky, or have gotten to where I see this so much, it just seems natural By giving you EPR and a better minimum pressure you had lots of benefits. Your therapy was not broken into multiple sessions, your pressure somewhat stabilized, AHI reduced about 75%, flow limits dropped from 0.25 to 0.04, respiration dropped from over 17 to 14, and leaks were incredibly better. I think you could use a minimum pressure increase to 9.0, and we'll see how the collar works out. Chinstraps are more for mouth-leaks while collars tend to improve positional obstruction. This latest result looks like it may be possible to address the remaining issues with a bit higher pressure. You may be closing in on some better sleep!

[akarifur]

Just a small update, i adjusted minimum to 9 unfortunately the collars didn't arrive yesterday but are now out for delivery today along with my new pillow that has better support (thank goodness, been a problem too). Posted last night's graph for information and let me say again I am eternally grateful for the help, going it alone was driving me nuts and really getting me nowhere.

[attachment=59114]

[Sleeprider]

Be sure to minimize the monthly calendar at the top by clicking the triangle in the date line or F9. It will allow more statistics and settings settings to show.

[akarifur]

Sorry I haven't updated in a few days, I unfortunately was advised against the use of the SCC by my primary care physician due to other factors so that became a no-go to try however, my nights have felt pretty great even though my AHI is still above 0 in the 1-2 range. I've posted the last three  nights information if you have any more advice, but the progress so far has been amazing and i've really appreciated the advice so far. I will be starting a weight loss program soon so I am hoping that will also help get me closer to 0 AHI over time.

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[Crimson Nape]

I hope you are aware that while an AHI of zero can happen occasionally, it is not the standard to expect.
- Red