[Pressure] Self-Treating | First Night | Oscar Data | Pressure Settings

[rzciii]

Hi all,

I'm self-treating my sleep apnea for now as I live in a country where getting a sleep study has proven difficult. Plan to get a formal study done in a lab this summer, but I couldn't wait any longer and went ahead and bought a machine (Airsense S10 AutoSet). Last night was my first night using the machine. It was my first night in 6 months sleeping more than 2 hours in a row without waking up to pee. It's lunch time now and its the first day in maybe 4 months I haven't felt like I was going to fall asleep at my desk.

Anyhow, I would like to improve my pressure settings, so if you're more experienced with the data that OSCAR outputs, I would very much appreciate your feedback.

Last night's settings had a min of 10 and max of 15. My thoughts were:

• I never seemed to go below 11.5 - set the minimum to 11 or 11.2?
  
• The maximum of 15 was sufficient until the 2:30-3:00 area, where the graph seems to hit a ceiling. Should I go for 16? 17? 20? 
  
• I didn't have much discomfort breathing against the pressure, I am considering reducing the EPR from 2 to 1 and see if that is still comfortable.
  

I believe I woke up just before 3:00 due to the high pressure and the jump in the graph back down to 10, but I must have gone back to sleep quickly, because I don't remember it at all.

Thanks in advance for any help/advice.

-Trey

[OpalRose]

You're on the right track except for the EPR. In most cases, EPR should help with Flow Limitations. FL don't count in your total AHI, but play havoc with your sleep quality.

Look at your graphs. Line up the FL with the pressure spikes. You can see where the FL causes the pressure to rise. End result: sleep disruptions.

Try this adjustment: Set your minimum pressure at 11cm with a maximum at 15cm.
Set EPR to 3.

Repost after a couple nights. You may need some slight adjustments, but maybe not.

Your charts looks good overall, except for FL. Also, take note how you feel with any changes. That's what's most important.

[rzciii]

OpalRose - thank you for the feedback. I made a few changes last night:

• Switched to nasal pillows mask (just arrived in mail, much more comfortable, though I notice I had a bit more leaking)
  
• Set minimum to 11
  
• Set maximum to 16
  
• Set EPR to 3
  
• Used the humidifier (did not use it the first night), set on Auto. Here in Tianjin it is a very dry climate, so that seemed to make things a bit more comfortable.
  

There are two gaps in the data. I believe at 11:20 I took the mask off to talk to my wife. I woke up around 1:35 to deal with my ileostomy bag, which usually requires a trip each night, but is otherwise unrelated.

Anyhow, I have the data attached from OSCAR. I felt great when I woke up this morning. First time in years that I didn't press snooze when I woke up. I did, but I closed my eyes for two minutes and realized that I was wide awake and didn't want to sleep anymore. A very strange sensation for me.

The nasal pillow mask was much more comfortable - Resmed P10. I'm not sure if Medium was the right size, I do notice I had more leaking last night. Advice on what to do there would be appreciated as well.

[clownbell]

@rcziii - I am NOT an expert, but read somewhere that ResMed says that Large Leaks for less than 20% of the night are unlikely to have a significant negative effect on therapy. Of course 0% would be wonderful but the real world may be different than the ideal. And your large leaks were not THAT far over the threshold. That being said -- if the leaks are waking you up or blowing into your eyes, then they become important regardless of the percentage number. Hopefully an expert will come along soon and shed additional light on the situation.

[OpalRose]

It's good to hear you had a much better night. I would hold with these settings for a while and take note of how you feel.

The Flow Limitations came down and you seemed to be more comfortable.

As far as the P10 mask goes, keep trying. It may be that you'll have to try a different size nasal pillow. Try the large and see if that fits better. A couple hints: the pillow should not be inserted too far into the nostril, but sort of sit just under the nose.
Also, it will seal much better if you use a lanolin cream or a nasal gel. These products not only protect the inside of the nostrils, but helps the pillows to seal better.

As clownbell stated, your leaks aren't bad enough to affect therapy, but can keep you from getting a good sleep, especially if you're adjusting it all night.

You're doing great, so hold steady with these settings and take note not just the numbers, but how you feel.

[staceyburke]

You are doing well. I would not change pressure but would try EPR 3. You still have high flow limits that are treated with EPR.

[OpalRose]

I think rzciii is using EPR 3.

[rzciii]

Thanks for all the replies.

Things mostly seem to have settled out nicely. Its 8:30 AM here now, and last night's sleep was the fourth night in a row of pure awesomeness. I didn't bring my memory card into work this morning, so I haven't seen last night's data. Felt like the two nights before though, so I expect more of the same.

I decided to leave my settings alone for a week so I could see how things settled out over time. I will make adjustments next week. Currently, my settings are:

• Min 11
  
• Max 16
  
• EPR 3
  
• P10 Nasal Pillows mask
  

I do seem to have the issue of relaxing and opening my mouth, letting some air escape, but I'm hoping my body will adjust if I give it time. If it doesn't after a few weeks, then I'll consider some solutions to help with it. It doesn't seem to affect the machine, but it does wake me up a bit, and the dry mouth isn't super pleasant.

I am noticing that for the last two nights my 99.5% pressure has settled lower. In order, for the first 3 nights, the 99.5% pressure was 15, 15.06, 13.
Similarly, the 95% pressure for the three nights was 14.68, 13.84, 12.62.

I will post an update tomorrow with a full five days of data so I can see if there are any trends. I may use photoshop to make an image that allows an "over time" comparison with the graphs.

Thanks again, everybody.

[OpalRose]

"pure awesomeness" is something we don't hear too many times.