[Symptoms] New CPAP User, Started Snoring Again

[heyou]

I am considering dropping min to 10 and bumping max 15, based on re-reading the optimizing therapy wiki article. Thoughts?

[OpalRose]

Use the 95% leak reading as your guide. The ResMed machine will handle leaks rates up to 24 without compromising therapy. But of course we all like to see that leak number lower as it is disruptive to sleep.

Your flow limitation is still too high, and the EPR of 3 is not helping as it should, probably due to the leaks.

Have you considered talking to your doctor about upgrading to a BiLevel? This would allow you to use the higher pressure that you need by using Pressure Support to add to EPAP and that allows you to use a much lower pressure. (PS is added to EPAP to equal inspiration).

Right now, it seems that the higher pressure you need to help with Flow Limitation is just going to cause you more leaks.

For now, keep working on your leaks, and the lower pressure may help, but could also allow other apnea to creep in. It's a trade off, but don't give up.

That talk to your doctor about a BiLevel is still a good idea.

[heyou]

I started searching other threads about switching to a bi-level, seems like an arduous process. Since I only started with the cpap in September, I doubt insurance would be willing to play ball, so I might have to go the secondhand machine route. In the meantime, I definitely am not giving up on adjustment!

Last night is attached, new lowest AHI and leaks are much better. I still see flow limits, and bumping up against my maximum pressure. Should I try increasing the max right to 20? I feel like I'm getting close on mask adjustment. Any other changes I need to make? 

I also suspect I might be allergic to my buckwheat pillow, I started using it right before my first post. I have been waking up slightly stuffy, and other cold symptoms. Can't tell if it's an actual cold, allergies from the pillow, or weather being unseasonably warm for the past two weeks. I'm putting on an allergen pillow cover tonight. I took an otc allergy medication Friday night, didn't seem to make any difference.

[BoxcarPete]

You are getting there. Flow Limits and RERA seem to be the majority of your remaining trouble, and these are associated with partial blockages. There are many things that can cause this, including allergies and nasal obstructions. Have you tried a nasal only mask yet? Not only do they tend to leak much less than FFM, the pressure is delivered directly into the upper airway, keeping a pressure differential to the oral cavity, which can make a difference to some people depending on their particular physiology.

Other than that, you said your original sleep study was through an ENT office. Was your airway evaluated for obvious obstructions at the time?

[heyou]

I have not tried a nasal mask, I know I tend to mouth breathe sometimes and requested a full face when I started with the cpap. My wife uses one as well, with a nasal mask, I will try using her old one when she gets a replacement mask. The ENT did tell me I have a deviated septum, but not severely. His note said: "Nasal Septum, deviates to the right (spur) and deviates to the left".

Attached is last night, lowest leaks so far! I did bump the max to 16, still bumping against max during the night a few times. I also did not feel any allergy symptoms when I woke up. Should I keep bumping the pressure? Anything else to adjust, or am I getting into the range of needing to try a bipap or different style mask?

[heyou]

Here's last night, made no changes. I think leaks are as good as they're gonna get with this style mask. The only changes I've made is putting a thick mattress pad on the bed. My wife prefers having it on to not, we'd taken it off right before I started posting. I see my highest pressure is still hitting max setting of 16, but it's not flat when it does, just a short spike. I think I'll see what bumping it to 17 does. Thoughts?

EDIT:Looking back to my first post, before making any changes to the default min 4 max 20 pressures, my highest recorded was 15.4, and 16.5 the next night. I feel like that is proof bumping the max is a step in the right direction?

[heyou]

Last night attached. I felt quite a bit more awake when my alarm went off yesterday and today, so I was excited to check the data after work. Everything seems pretty similar last two days,still bumped max pressure even after upping it to 17. Med pressure is now 13, per the optimizing therapy wiki article, I think I should up min to 13, and since I;m still bumping max, setting max to 20.  My wife reports minor snoring before she falls asleep, but not enough to disturb her. That has been my whole goal, should I keep adjusting? I'd love to see what the group can advise at this point!

[BoxcarPete]

I wouldn't go right to 13 min, it looks like 11.6 ~ 12 will be plenty because the machine will lower pressure really slowly once you get closer to minimum. If you keep setting your minimum to your mean pressure, after some time you will find yourself at a range of 20-20. I first recommended that you limit the max pressure because you seemed to have leak problems coinciding with the times at higher pressures. That doesn't seem to be the case any longer if it ever actually was, so if there's nothing like aerophagia or disturbances from pressure increases that bother you, there's not really a good reason to limit the max.

[staceyburke]

You are having some positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

[heyou]

Thanks for the input! Read the article on collars, I ran out today and got a collar from CVS. I tested it out, pretty sure I will be able to sleep with it. Pillow is already very flat (buckwheat), so we'll try the collar tonight. Alot of the collars mentioned in that article, as well as in the reviews sub-forum seem to be no longer available!

Based on BoxcarPete's input on pressure, I'm at 11.6/20 right now. Last two nights are attached, didn't get a chance to post yesterday afternoon.