Struggling with pressure etc

[ubuntootoo]

Hi Everyone,

I have been using CPAP for a couple of months and have good and bad nights with it. I have changed masks from an F20 (i think) to an F30i. I do like the F30i but whichever mask I use I often wake in the early hours of the morning with the mask blasting high pressure air into my face. I'm not sure if I wake because the pressure or I'm now used to waking at that time. It normally happens between 2 and 4 am.

I phoned my local sleep clinic for advice. The woman wasn't much help, basically saying that she's looking at the resmed air software and saying my pressure is set to a range of 4 to 20 which is 'normal' etc. She said I see you've got the ramp turned off. I said yes but my understanding is that that's only for the start of the sleep period and wouldn't have any effect several hours into my sleep. She just said turn that back on and see how I get on. You know when you have a conversation and the other person isn't really listening to what you say? Well that's how it was. So I tried her suggestion and no difference at all.

I've attached an oscar screenshot. My AHI scores are usually around 1 with the CPAP. Can anyone suggest what's going on? I'm getting so fed up with the situation. I asked the woman at the sleep clinic whether the machine was ramping up the pressure in response to something happening with my breathing or could it be something else. She didn't really answer the question. In the end I was just agreeing with the ramp suggestion to end the conversation as I felt I was wasting my time.

I look forward to any advice anyone can give.

Thanks

[Sleeprider]

Let's fix this. Your pressure is set to 4-20 and no EPR (exhale pressure relief). As a result you have relatively high flow limitations that push you pressure higher and higher. We can treat the flow limitations using EPR and prevent the pressure from being that high and getting rid of the events which might be the result of difficulty exhaling against pressure as it gets above 12 cm without EPR. Here are my recommendations for settings. Give them a try and come back tomorrow to ask "why wasn't this done by my doctor"? Sleep well and give us your feedback so we can optimize this further.
Mode: Autoset
Minimum Pressure: 7.0
Maximum Pressure: 12.0
EPR: On Full-Time
EPR setting 3

Here is a brief tutorial on how to access your clinical settings https://www.apneaboard.com/resmed-airsen...setup-info

[ubuntootoo]

Thanks for the reply. Prior to my phone call with the hospital I was reluctant to fiddle with the machine without their approval, but since the useless call I had I felt I'm on my own with this, until I remembered I'd joined this forum when I first started.

I've now set the machine as you recommend. Thanks for the instructions you included.

Although I have an early start in the morning I hope I sleep through until 5am without being woken. I'll let you know how it goes.

Thanks again :-)

[Sleeprider]

I'm certain this will be much more comfortable. Any problems and we can work on those.

[ubuntootoo]

Hello again,

Last night felt like an improvement but not by much. I’m working all day today but hopefully in the morning i’ll get to look at the oscar data and upload the results. I might switch back to my previous mask. I am finding the f30i is super sensitive to placement on my face. Just a slight movement in any direction and it’s leaking. I’ve finally been told the results of my overnight sleep study. My AHI was 16 which I guess is quite mild. The only benefit i’ve felt so far from CPAP is my regular morning headaches have gone. With such a low score untreated I’m beginning to question whether this is all worth it.

[Sleeprider]

The new Resmed F40 has been getting good reviews. It expands less with pressure support than the F30i and seems to stay in place better according to early users. A simple nasal pillows mask is probably the easiest to fit and least intrusive to wear. 16 is just over the threshold of moderate OSA, and it really depends on how the events occur and what they are. A lot of people experience apnea and hypopnea from a poor cervical alignment, even when using XPAP, and the solution may be as simple as fixing the use of multiple or tall-firm pillows.

[MaskedOne]

Allow me to chime in about the F30i mask - which I use.  I battle leaks with it almost every night; most of the time in the early hours of the morning.  I like the design of the mask and I love the snorkel tube, but the leaks...they cause me significant sleep disruption.

Most all of my leaks are around my nose.  The F30i comes in four nose sizes and apparently my nose is not a standard sized nose.   I know where the gaps are and I plug them with cotton from a cotton ball.  It works until I have rolled side to side a couple of times, the mask has shifted, and then the leaks return.

[ubuntootoo]

So last night I went back to my original mask which is an F20. I slept so much better than with the F30i. The reason I switched away from the F20 was because of the constant leaks. Initially I liked the F30i but I've found it is so sensitive in it's placement in terms of leaks. Just the slightest movment and it would be leaking.

Last night I spent more time adjusting the F20 so it sat right at the top of my nose, and played around with the tightness. I think this in combination with the recent pressure alterations has made a big difference. Of course tonight might be completely different but we'll see.

[ubuntootoo]

Hello Again,

Sleeprider, I implemented the changes you suggested but I've found whatever pressure I set the machine to, when I sleep that pressure limit will be hit. You'll see from the attachment that the machine hit the 14 pressure limit a few times. It does this at 17 too. Does the fact that I'm hitting these limits mean that I do actually need 20? What I find hard to wrap my head around is the inconsistency of it all. One night certain settings seem fine, then the next night I sleep terribly. 

Thanks


   

[Sleeprider]

The clusters of obstructive events or hypopnea are the signature of positional apnea. Read the section in the Optimizing Therapy wiki. https://www.apneaboard.com/wiki/index.ph...onal_Apnea