[Pressure] Please help me snorkel like a pro!

[DenMan]

Hi everyone! 

I could use some help to optimize my therapy. My doc and DME are of little use and insist that the settings are perfect and I just need to get used to it.

A month ago I was diagnosed with an AHI of 31,4 and got a Löwenstein Prisma Smart with a prescribed APAP pressure of 4-7, SoftPAP 1. I am 39 with a BMI of 22.

Since I reached the max every night in no time I bumped it up to 4-12. My mask is the Resmed N30i and while I love the comfort and lightness, I am a heavy mouth breather and had a lot of leaks despite taping. My DME tried a Löwenstein Lena FFM but couldn't get it to seal on my beard so she decided that a Nasal Mask has to work. I was also told not to mess with the min pressure but since it is MY health and there are no rules here that prohibit it, I am seeking for some experts' help (yeah, that's you reading this!).

As for SoftPAP: I don't know if me or my maschine are broken but SoftPAP is really uncomfortable for me. I can physically feel the mask "popping" between inhale and exhale and it feels like I have to overcome a slight resistance for a moment. Really unpleasent. Activating SoftPAP also shows a lot of flow limitations in OSCAR while I have 0 without it. If possible, I'd like to keep it off.

I bought a F&P Evora FFM yesterday after reading the reviews here, to tackle the mouth leaks. It still leaks a bit when I hug my pillow hard enough but overall I am a surprised how well it seals with my fluffy full beard. I'll spend some more time fitting for tonight and getting used to all the straps on my face.

My goal would be to find a fixed CPAP pressure that is both comfortable enough to sleep through and eliminates most of the events, if possible.


Screenshot 1: APAP 4-12, SoftPAP 1, Mask N30i. My free day so I could sleep in. 10h and I still felt horrible and tired all day.
   

Screenshot 2: APAP 7-12, SoftPAP off, Mask F&P Evora FFM. Only 4h and I woke up super refreshed and...hungry?    pls ignore the deactivated session. I was awake, reading.
   

Thank you very much for your help. This board has been a great source of information so far!

[OpalRose]

My goal would be to find a fixed CPAP pressure that is both comfortable enough to sleep through and eliminates most of the events, if possible.

Screenshot #2 looks to be your sweet spot.

There's no reason you can't use a fixed pressure. I would still use the Auto mode and set your pressure to minimum 8 - maximum 8. This way, if there are any Flow Limitations cropping up, it would likely show up in Auto Mode vs. Cpap Mode.

I don't see any Obstructives on your chart, so let's see how that works for you.

Also, if SoftPap is uncomfortable, don't use it.

[DenMan]

I would still use the Auto mode and set your pressure to minimum 8 - maximum 8.  This way, if there are any Flow Limitations cropping up, it would likely show up in Auto Mode vs. Cpap Mode. 

I'll try that and report back! Thank you!
Also, how accurate is the Deep Sleep flag? 57% seems excessive. Looks more like an "you're breathing ok" indicator tbh.

[OpalRose]

IDK... I'm intrigued by that deep sleep flag. Most machines do not measure it.

Do you by any chance own an Apple Watch or Fitbit? These devices usually measure deep sleep. Not saying they are accurate, but it's something to compare.

[DenMan]

Unfortunatly not. A FitBit has been on my To Do list for a while. I might get one and compare soon.

EDIT: Found the Löwenstein White Paper explaining it. 

   

Source: https://lmt-downloadcenter.hul.de/en/fil...e-paper-2/

[BoxcarPete]

I don't agree with "deep sleep" the way they define it. As I understand it, the ideal sleep architecture is to fall asleep, drop through N2 and into N3 within 30 minutes, stay there for an hour, hit REM1 for 20 minutes starting around 90 minutes in, then 1 more hour of N3, then REM2, then you bounce back and forth between N2 and REM for the rest of the night. So true "deep sleep" should only be happening in the first 3.5-4 hours of the night.

Looking at the second chart in your first post, these time checkpoints are borne out in the tidal volume section. Where it is steady is deeper sleep, and where it is chaotic is REM. Looks to me like you fell asleep at 23:25, REM1 at 00:50 - 01:10 (REM delay 85min, duration 20min), had a brief awakening/arousal, then dropped back into deeper sleep until 02:20, where you have 40 minutes of REM and/or leak confounding. Your second REM is obfuscated to some extent by the leaks, but if you're anything like me using a nasal mask, the mouth cracks right open during REM sleep and the air starts flowing out, which can confuse your machine's ability to accurately detect flow rates. These sections do not correspond to your machine's "deep sleep" shaded areas very well, in fact that shaded section at 01:05-01:10 is almost certainly REM.

[paulag1955]

My husband's cardiologist told him to take any of the medical info from wearables with a grain of salt. I'm sure some of that is bias, but still.

[DenMan]

Tried APAP 8-8 tonight.

Woke up around 3:30am cause my cats decided to party. We had a serious conversation about this. Not sure they understood though.

Took me a while to sleep again, cause I felt really well rested and awake. Weird problem 

Second half of the night I set the pressure to APAP 8,5-8,5. The 2 hypopneas around 4:20am were self-inflicted. I was awake and tried an app-based Deep Breathing meditation thing where the Tidal Volume jumped to almost 3300ml (is that inhale + exhale?). Guess that confused the maschine a bit. 

Overall I feel great. A little aerophagia. Have to monitor if it is just temporary.

Thank you very much for the help! Glad I found this board.

As for the Deep Sleep flag: Nice gimmick but there is no way it is even close to accurate. Guess it is nice as "stable breathing period" indicator but not more. The first half of the night it gave me a DS rating of 64.95% which is just absurd.

[OpalRose]

Great! This seems to work for you and you slept well... except for the cats.

Remember though that one night doesn't make a trend. Try to sleep with same setting for at least 3-4 days before deciding to change your pressure.

[DenMan]

Yes thank you

I'll stay at 8-8 for a while and keep working on the mask fit and cat schedule.