[CPAP] New user having difficulties

[jmac862]

       

A bit of possibly relevant background – I am a retired Clinical Engineering Manager and my areas of responsibility included ventilation and anaesthesia so I am/was (5 years ago!) acquainted with the technical aspects of the predecessors of these CPAP units. These last 5 years have seen a decline in the accuracy of the details but I’m still up with the concepts.
I was diagnosed (severe OSA) in February 2020 via one pre-assessment overnight home oximetry recording (ODI = 51.3, Median = 92.6, Epworth = 9). After much delay and virtual consultations, I have a Resmed Airsense 10 Autoset machine with humidifier and a Mirage FX mask
I am having a great deal of trouble adapting to the machine. I can tolerate it for >2 hours in daytime practice sessions, however, at night I frequently seem to lose my tolerance and succumb to long-standing claustrophobic anxiety and need to get the mask off me NOW. I’ve sat on the edge of the bed still wearing it doing my slow breathing anxiety remedy, but, when I lay down it re-emerges and off it goes. I have managed on two occasions to do one 6 hour and one 7 hour stint albeit with what I felt were numerous wakeful periods, so it’s possible but not often.
I suspect the intolerance is caused by the constriction of my head from the mask/headgear. I spent 15 years in the military and often had to spend long stressful periods wearing protective clothing including full-face respirators. These periods were challenging to say the least and truthfully, I often had the respirator on the top of my head more than on my face.
On the basis that it might be something else causing my woes I’ve attached the OSCAR data from the two ‘successful’ attempts to see if there is an alternative explanation…
I’m having another virtual CPAP clinic soon and will probably request a nasal cushion mask (Airfit N30 or similar) though whether it’s available on the NHS I don’t know.
Thanks for reading
John

[staceyburke]

It looks like you have to many flow limitations.  That can disturb sleep.  Your low number should be 9 leave the other things alone and see if the flow limitations will go down.  Everything else looks ok.  I also would turn off the ramp, with a low starting pressure you do not need it and while it is on you will not get any therapy.

[Crimson Nape]

Hi jmac862!  -  

Stacey has some good ideas.  For me, I would recommend the following to try and weed out several variables:

• Turn off the Ramp feature.  - You are just delaying the proper therapy pressure.
  
• Set your EPR to 3.  -  To aid in reducing Flow Limitations.
  
• Set your AS10 to a constant 11 cm.  - To rule out pressure changes as an arousal problem.
  This can be done by either setting it to CPAP mode or set both the Min And Max to 11 cm while still in the Auto mode.
  

Try the above for a couple of nights and see if your tolerance level increases and you start to feel better.

[staceyburke]

as far as masks go, I too have a problem with masks...  I have gone to a very minimal mask - Nasal pillows.  The one I use now is a ResMed P30I, philips also makes one although I'm unsure the exact name.  If you are not a mouth breather I would recommend this type of mask.