Struggling with VPAP - Meeting Sleep Tech tomorrow!

[JRC81]

Hi Apnea Board Community,

I am meeting my Respiratory Nurse tomorrow and I would like to ask for your thoughts & ideas about my situation.

My goal is to reduce my daytime tiredness so I can enjoy life more, be more present for my children, and concentrate better at work.

I was diagnosed with Obstructive Sleep Apnoea in July 2023 following a home sleep study showing AHI ~ 33, which was considerably worse when lying on my back.  I started CPAP in December 2023 however my daytime tiredness remained high and my diagnosis was changed to Central & Obstructive Sleep Apnoea.

I started VPAP in May 2024 but am still struggling to use the mask for more than a few hours and remain very tired despite my AHI often being < 5.  At weekends I struggle to get out of bed at all.

I recently loaded my data to OSCAR in the hope of finding some insights I can apply.

In the last 30 days my Days Used > 4hrs was 15 (50%) and < 4hrs was 7.  I am averaging 4.39hrs per night, with a median of 4.31.  My time above Leak Rate threshold is close to 20%.

My "all time" stats are similar with my Days Used > 4hrs at just over 60% and Leak at 18%.

I am finding I often wake in the night feeling unable to breathe and take the mask off then fall back asleep.  I find the mask uncomfortable.  I broke my collarbone in July so this has impacted on my sleep as lying on the broken shoulder causes discomfort & eventually wakes me up.  I've also had an upper chest infection in the last week which deterred me from using the mask.

Before falling asleep, I find that the VPAP wants to increase the pressure in whilst I am holding my breath in my lungs or breathing out.  This feels uncomfortable and I find I increase my breathing rate to try to align with the VPAP.

Thank you for taking the time to read my post.  I am happy to post screenshots from OSCAR if that is helpful to anyone reading this and wanting to comment.

Kind Regards,

James

[Jay51]

If you would please post some OSCAR charts we might be able to give some suggestions. 

Organize your OSCAR Charts

Attaching Files

[paulag1955]

Have you tried any other styles of mask?

[JRC81]

Hi Jay,

Thank you for your reply and the links.

Please see screenshots from two nights' OSCAR data below:

This one (23-Nov) is a fairly typical night:

   

This one (19-Nov) is less typical as I managed to keep the mask on for 8+hrs and seemingly sleep uninterrupted.

   

I would be curious to understand more about what OSCAR can reveal.

Kind Regards,

James

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Hi Paula,

Thank you for your reply.

I have also tried the ResMed F20, however I was told my leaks were too high.

Kind Regards,

James

[SarcasticDave94]

First off, you're on a specialized machine, an ST it seems. This has timed breath functions, but then only has an exhale and inhale.

So do you have some special pulmonary needs other than Apnea? The ST is the basic model to support COPD patients. Your 9 series is older as well. Depending on what exactly you're dealing with, the ResMed AirCurve 10 VAuto might be fine if you do not have lung conditions, or Lumis with ST-A if you do have other lung conditions to deal with.

Depending on what you are really needing, there's newer ResMed machines that'll help give you better therapy.

Also, yes, your leaks are in need to be addressed. How old is your mask cushion?

[JRC81]

Hello Dave,

Thanks for taking the time to reply.

My machine is a ResMed Lumis 100 VPAP ST-A. I believe it is a Series 10 but for some reason OSCAR records it as a series 9.

Apart from the sleep apnoea, I am otherwise in reasonable health with no other respiratory or pulmonary issues.

I was told I needed this machine to treat the Central Apnoeas which were not being addressed by my original CPAP, an AirSense 10 Elite.

My mask cushion is six months old.

Thanks again,

James

[SarcasticDave94]

If it is for Central Apnea treatment, then look for the ResMed with ASV in the name. This ASV is specifically used for Central Apnea treatment. It will however treat all Apnea and Hypopnea, but it cannot diminish flow limits.

[JRC81]

Ok, thank you I will do some research and ask about ASV at my next review.

Kind Regards,

James

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Hi Paula,

The nurse today gave me an F40 mask to try. It seemed to fit better and leak less when I tried it on during the consultation.

Kind Regards,

James

[Jay51]

I agree with Dave's assessment.  Also, you have some clusters of H's which might be helped by reading and applying this:  

• 5.3Positional Apnea
  

                                                                                                                                                                                                                                                                                                                                                                                                         Here are some additional tips from our wiki for mask leaks:   Mask Primer

[JRC81]

Thanks Jay,

I'll look at adding a cervical collar to my routine.

I've searched ResMed ASV and it looks very interesting. I'll keep this in my back pocket for next time I speak to the nurse.

As of earlier today, I have a new mask and different settings to mitigate "cycling asynchrony". I've also been encouraged to start using my humidifier again and get the hours up.

Kind Regards,

James