[Pressure] New User: Help w/ Optimal Settings for ResMed AirSense 11 with Airfit N20 Nasal Mask

[textureofthings]

Hi and thanks to everyone in advance for your assistance with this. I recently got a ResMes AirSense 11 (been using for 1.5 weeks), which was set to standard settings of 4-20 with nasal pillows. I couldn't get the nasal pillows to work for me, I kept feeling a resistance when trying to take slow deep inhales and exhales (on the tail end of the breath) and it was driving me crazy. I also felt this sensation of the air undulating at the tail end of the breath, that my doctor couldn't understand and I haven't been able to find anyone else with this issue on the forums. I tried increasing the EPR, but the higher that was, the issue was more intense. I'm finding that the lowest setting of EPR works for me.

I switched to the nasal mask Airfit N20 and that was overall better, but not without its minor issues. I often feel mild chest discomfort in the morning, like there's been too much air. My setting is 5-20, which I upped to 6-20. Ramp is off. EPR is 1. Last night, my mouth kept falling open and breaking the pressure which woke me up. I will try mouth tape before I can get either a chin strap or a new mask that also covers my mouth. 

Would anyone be able to review my last 3 charts and opine on optimal pressure settings for me? Any other insights would be greatly appreciated. For instance, I thought I had OA, but mostly am seeing CA and some Hypopnea. What does this mean?

Thank you so much in advance 

[simplychillin]

Hello!

I'm very new to ApneaBoard and the treatment of sleep apnea in general, so take anything I say with a grain of salt, but I personally would be curious to see your original sleep study data in order to determine if the centrals are treatment-emergent. As to how to get your sleep study: great question, and as I don't want to give you bad advice on how to interact with your doctor, I'll let someone else handle that (sorry). As to what you can do if they are, I don't really know: normally the recommendation AFAIK would be to reduce the pressure, but your machine already seems to be pushing it higher than your minimum and maintaining it there.

Also I noticed that the charts you attached were for December 10 to December 12 - in my experience I had a couple centrals the first day or two, then they went away, so I'd be curious to see a more recent chart as well. Of course, if the charts you posted are most representative of your therapy overall and the more recent ones are outliers, then ignore this.

With regard to the "undulating", I experienced that the first few nights and then it went away with EPR. It's interesting that EPR makes it worse - I'm totally out of my depth on this and will yield to more experienced people on this forum.

With regard to the mouth tape: While I like mouth tape, I don't have enough experience to be able to recommend it, but my mother, who has been on CPAP for at least a decade, recommended it to me as a permanent solution. And, at least for the ~5 days I've used it, it works great. So maybe try it for a bit before you commit to a full face or chin strap? That's just my opinion though.

Finally, just one more thing: Welcome to the forum! Here's hoping your issues improve.

(PS: anyone who is more experienced than me, I'd love it if you could critique my thought processes on this; I'm trying to get better and if you let me know where I've messed up, that makes it much easier to improve.)

[jdougc]

Can you post your sleep study with personal info concealed? I am asking to see if you had CAs, Central sleep apneas during the sleep study.
You only show 1 obstruction, a hyponea in your graphs.
Other people with knowledge can help you here.

[Deborah K.]

Your pressure is a little too low.  I suggest you change it to 7 to 12.  

Did your sleep study show a lot of CAs?  If you don't know, post a copy of the study.  If you don't have a copy, ask your doctor's office to provide one.  By US law they have to give it to you if you request it.

Lots here like Cover Roll Stretch tape or Hypafix tape, both of which work quite well.  I prefer kinesiology tape as I find it more comfortable and better able to fit facial contours.

Again, welcome, and good luck with improving your therapy and comfort!  

[textureofthings]

Hey, thank you so much for your response. These are actually from the last 3 days - realizing my machine is not set to the correct date. Yep, will try the mouth tape for now. 

I'm actually waiting to do another sleep study in January. I had one done 3 years ago and I got right up to 5 AHI, but didn't quite meet the mark for apnea. However, I've read some research that women present different symptoms than men and typically have a lower AHI with apnea. My sleep issues became acute a couple of months ago, which is why my sleep medicine doc fulfilled my prescription before we could schedule the sleep study. Since I've started using it, my sleep has improved, but I feel I haven't fully dialed in my experience.

One question re-changing my pressure to 7-12, does it actually matter in bringing down the maximum? Doesn't my machine auto-regulate pressure up and down?

[SeePak]

Welcome Tex

Pressure changes by your machine take longer when you use the whole range of 4-20 cm.
By shortening the range you have faster response, plus you dont use pressure that could be too high for you causing other issues, possibly including the sore chest you feel in the morning.
Finding the sweet spot is what is being done here.
I cannot look at your charts cause the server is busy right now, will check back later, to see about your OA vs CA vs H events,. however,...

When choosing mouth tape, it is important to allow 'mouth puffing', when you have an obstruction in the nasal airway, which allows you to relieve pressure thru your mouth.
Put a small slit in your tape if you fully cover your lips, or try Myotape found on the internet.


UPDATE:
Had a chance to see your charts.

For the CA events, being a new CPAP user, you may see these lower as your body gets accustomed to therapy.
If not, try reducing EPR to 0.
The narrower pressure range could work, however the pressure is staying low as per your data for median and 95% so this may or may not have an effect.

You are a very new user, so need some time for any change to stabilize and take effect.
Your charts right now look very stable, so i would think a tinker here and there will get you feeling great!

[LaurenceShaw]

Why is your leak rate so much lower on the 11th than the 10th and the 12th?

[textureofthings]

Thanks so much for this feedback. I really appreciate it!  

Curious why lowering EPR to zero could help with the CA events. 

As for my leak rate, perhaps I was sleeping on my side, which I’ve noticed the nasal mask leaks much more when I’m putting pressure on it from one side.

[LaurenceShaw]

Thanks so much for this feedback. I really appreciate it!  

Curious why lowering EPR to zero could help with the CA events. 

As for my leak rate, perhaps I was sleeping on my side, which I’ve noticed the nasal mask leaks much more when I’m putting pressure on it from one side.

 Re leakage rate and sleeping on your side ... that makes sense.

[SarcasticDave94]

Lowering Max pressure can help intentionally limit the CPAP pressures while newer users make adjustments working from the bottom up. Min pressure needs to be the lowest you can use but have the air stent keeping the airway open still.

This is kind of like driving a car with an automatic. You still need to select a gear first. Those other selections besides D allow you to downshift on a downhill. You may also need this to tow. And much like the car, your accelerator pedal isn't off to on only. You press it to suit the condition and driving situation.

Your CPAP needs guidance to meet your therapy conditions by setting guidelines of minimum and maximum therapy pressures.

Done right, your therapy from the CPAP isn't basic cookie cutter. You shape it to fit your needs by telling the CPAP start at X cmH20 because I want to avoid air starvation feelings, or avoiding Apnea because it's too low. Dropping Max pressure keeps the machine from running away and crashing therapy. Eventually you can open up the max as you see fit.

EPR (exhale pressure relief) turns your lesser expensive Auto CPAP into a 3 PS bilevel with EPR 3 and fill time is active.

Your min pressure does need to mathematically work though. The physical minimum you CPAP goes is 4 cmH20. EPR makes the pressure drop but no lower than that hard cap of 4.

EPR 1 full time works fully at min 5
EPR 2 full time works fully at min 6
EPR 3 full time works fully at min 7

5 - EPR 1 = 4
6 - EPR 2 = 4
7 - EPR 3 = 4

Above 7, any EPR works unhindered.