Recommendations after first night?

[dstaley]

Hello! I just finished my first night of CPAP therapy and was looking for some advice on what adjustments I should make going into night two. I've uploaded my data to SleepHQ which is available under the public ID cd09e0e1-622f-4516-be9a-cc5f6cf3d104 (so sleephq.com / public / cd09e0e1-622f-4516-be9a-cc5f6cf3d104). I'll update this to an actual link once I hit the minimum number of posts!

Overall, I found my mask pretty comfortable. There were several points in the night where I legitimately couldn't tell that I was even wearing anything. While it took several hours to fall asleep, I think that was mainly because I was trying to pay attention to sensations too much. Thankfully I did get a few hours of sleep, and that resulted in some helpful data.

The first setting I want to adjust is turning off EPR, which I had set to 2. While I can definitely understand how it could help folks be more comfortable, I found the constant up and down of pressure to be a bit distracting. It also felt like I was concentrating too much on my breathing, making sure I was exhaling enough, etc., which made it difficult to fall asleep.

The second setting I want to adjust is bringing up my minimum pressure to 10. Looking at the second half of the night (when I was actually asleep), it seems that 10 would be a good minimum value. I could also probably set the maximum to 13, but I figure there's no harm really in keeping it at 20 for a few more nights of data.

I also might take the machine out of auto humidity and increase it to 6. I woke up with a pretty dry mouth, but that might also be due to the large amount of mask leakage in the second half of the night.

Speaking of mask leakage, I'll be adjusting the mask to be a bit tighter. I use an AirFit F40, and while I thought it was "snug, but not tight" like the app suggested, I guess it could have been a little more snug. I use the medium cushion, and have a large, but based on the size card I'm pretty squarely in the medium size (my nose is about as long as the large square on the size card).

Typically, I fall asleep on my left side, and then switch to sleeping on my back at some point in the night. I wasn't able to fall asleep last night on my side, mostly because I was too focused on whether or not I was pushing my mask on the pillow and causing leaks. I'll probably still try sleeping on my back, just until I get the leakage under control.

If there's anything else jumping out from my data I'd love to hear it! I'm really excited to finally get some decent rest. I know it'll take a while to get comfortable, but given I was able to wear everything for the full 8.5 hours on my first night I'd say I'm off to a great start.

[Old Steve]

Why don't you just download the OSCAR program from this site.  It's free, it works great and you will get more folks to look at your charts.

[dstaley]

Ah sorry, I had read somewhere that SleepHQ was a bit easier than OSCAR when sharing results. Here's the OSCAR charts!

   

[staceyburke]

You had a lot of large leaks at higher pressure.  I would set the max at 10 and raise the EPR to 3.  Post again with these settings.  We may need to decrease the EPR it your centrals go up.  And move up or down the max when we see how your O and H events are.

[dstaley]

Gotcha so 7-10, EPR 3, and a slightly more snug fit?

[Phaleronic]

Hi dstaley,

Raising EPR makes CA events worse, so lower it to 1 or turn it off completely and lower max pressure to 13cm. This narrower band of pressure will help you sleep better. EPR causes apnea control issues as it's dropping epap pressure by 1cm per unit, so with your min pressure at 7cm and EPR @ 2 you are only at 5cm of epap pressure (cas crop up because of airway collapse at this stage)-EPR needs much more pressure than you're used to to function correctly.

You can leave min pressure at 7cm for now but you'll want to raise it after getting used to turning down/off EPR.

Your 99.5 percent pressure is 12.7cm so you do not want your max pressure below this, you want to have a little headroom, so that is why I strongly suggest 13cm max

You're also under leak threshold rate, but the spike can be mitigated by turning off/down EPR for now (low epap pressure causes make leak issues as you'll be gasping for air) and sleeping on a flat pillow on your sides as much as possible.

[dstaley]

Here are the results from my second night! Overall, I'd say it was a success, but it still gives me a lot to tweak going forward.

Reducing the EPR to 1 resulted in significantly more comfort for me. It wasn't as obvious that the pressure was going up and down, which allowed me to relax a bit more and pay attention to everything less. (That being said, it's also possible I was just exhausted after only getting four hours of sleep the night before!)

I also tightened my mask significantly. While that does seem to have eliminated large leaks, it came at the expense of comfort. I could tell that my nose was bent sideways, and there's a bit of soreness this morning. So tonight, I'll try to find a sweet spot between where I was night one and night two. I'll also try a few more mask fit tests to make sure that the seal is maintained even at higher pressures.

For pressure, I went with 7-14, but looking at these charts I probably need to bump that higher as my 95% pressure was 13.96. This is a little strange to me since my 95% pressure last night was 11.7, and I would have expected it to be lower, not higher, given the significantly decreased leakage.

I know it's a bit early to tell, but I'm beginning to think that I might be better suited by something like the F30 instead of the F40, especially since I'm starting to enter the higher-pressure territory. I'll probably give the F40 three more nights of experimentation before just going ahead and buying the F30.

   

[staceyburke]

The reason you pressures went up is your EPR was at 1.  EPR reduces Flow Limits and the ResMed raises pressure when it gets flow limits.  I suggested EPR 3 to reduce the flow limits and a max of 10 which would stop the pressure at 10 reducing your large leaks.  I would still suggest you try this to see how you do.

[dstaley]

Here's 7-10 with EPR 3.

   

I think it's pretty clear that 10 is not enough pressure with the full face mask I have. I've actually ordered a F&P Solo with Pillows that I'm really excited to give a try. I feel like my F40 actually causes more difficulty to breathe through my nose since it squishes it a bit.

[staceyburke]

The pressure is not to low. You had positional apnea that night. Positional apnea can NOT be controlled with pressure. You have to find out the position you are sleeping that is cutting (kinking) your airways. 

It is also known as chin tucking where your chin drops to your sternum cutting off your airways. 

Sleeping on your back or to high of pillow can cause it. You have to stay out of that position and if you can’t you would need a collar. I have a link at the end of my signature.