Therapy Help!

[greenpj22]

Hello everyone, 

First time posting here but have been on therapy since 2015 or '16. I used a Resmed Airsense 10 Autoset up until April or May of '23. I was originally diagnosed with an at home sleep study with a pressure setting of 5-20. I used it along with a mirage fx nasal mask and I would average 7-8 hours a night. Essentially, whenever I slept, I was using the machine. No dry mouth problems and it stopped my snoring.  

Fast forward to April of 2023. I hit my deductible and decided to do an in lab sleep study. I believe my AHI was 21 and was prescribed a cpap at 7 pressure setting. 

I got an Airsense 11 and N20 mask to start. I averaged 2 or so hours a night and would wake up with a terrible dry mouth and the machine would say I had a leak, so I switched to an F20. Same problems, although dry mouth was a little better. 

Fast forward to last week - I broke down and had the feeling, if it wasn't broke, why fix it? I ordered a Cloud version Airsense 10 and used it for the first time last night and imported data to Oscar. 

I am hoping someone smarter than me can help me get the machine dialed in. I slept pretty good and we went to bed late and I'm an early riser, so only slept 5 or so hours. I didn't have dry mouth but I do see there's a leak. Not sure if I need to go back to the full face F20 or change any of the settings. I can go in to the clinical settings and make any changes as needed. 

Also - not sure if this has any bearing, but I probably weighed 240 or so when I did the sleep study in 2023. Today, I'm hovering right at 200 lbs. I'm 38m, 5/11' so I've done good losing weight and I'd like to stay around this size since I've had to purchase a brand new wardrobe ha

So glad I found this forum and I thank you in advance for the help!

[SarcasticDave94]

Welcome to Apnea Board,

A few things that can help:

1. Call this one urgent, fix the leaks. Your mask is possibly leaking almost constant. Since it's zoomed in, the chart doesn't reveal the pattern yet. You definitely need to address something, mask size, mask type, etc.

2. Change to AutoSet mode, pressure 7-20 for now, add EPR 3, if there's a Ramp, turn that off.

3. Give us a standard OSCAR chart not zoomed to get overall idea.

[greenpj22]

Thank you so much! 

Sorry about the error on the chart. I am going to post an updated one - it doesn't look constant so i could be losing air out of my mouth. 

I still have the F20 full face that I can try out if needed? Also, I'll make those changes to the machine now. 

[SarcasticDave94]

OK, yes, from what I recall on the leak shapes, the somewhat flat rounded elevated areas are likely mouth leaks, while areas that are more sharp and jagged shaped likely are more mask caused, like that area near the end about 6:30 on.

No problem on the zoomed charts, just that an overall is better starting point. Try the edit and let us know if it felt better or not, with a chart as well.

One pointer about feel is this, answer "how do you feel?" preferably before looking at the data so there's no numerical influence on the answer.

[greenpj22]

That sounds great. I’ll try the changes you mentioned and I’ll stick with the N20 nasal mask for now. 

Thank you so much for the help!! Excited to get it dialed in

[Sleeprider]

Your flow limitations are quite high with 95% index of .21. EPR (exhale pressure relief) will eliminate flow limits and make the therapy more comfortable, but there is a small risk it may increase CA events. I'd like to see you try turning on EPR full-time at setting 2 and see what we get. This will be better if you switch to Autoset mode with minimum pressure 7.0 and maximum pressure 9.0. This will ensure you maintain your current pressure and the machine will respond to any obstruction. With the bilevel pressure of EPR this translates to a pressure range of 7.0/5.0 (inhale/exhale) to 9.0/7.0. I normally suggest EPR at 3, but you have a few CA events and it's better to take it cautiously. Keep working on the leaks.

[greenpj22]

Wow, did not even know what “clear airway” was until I googled it. Didn’t know what EPR was either but it makes perfect sense with your explanations. 

I am going to stick with the nasal mask for tonight and do those settings. I really appreciate everyone being so helpful and welcoming. I’m excited to finally get it dialed in to see how I feel through the day. 

For example, I am so tired today but I also didn’t get much sleep due to arriving home so late (or early, however you want to think of it ?)

[greenpj22]

So last night was much better. Went to sleep around 12 and woke up at 7. I believe I woke up once during the night, and I can't remember when it was. Not sure what happened around 330? Also, looks like the leaks weren't as bad and I don't know if I need to focus more on it?

Overall I feel great this morning. Wish I could have slept for another hour or two, but overall I feel good and my quality of sleep was good. 

I attached last night's data. Thanks!

(Sorry, tried to embed the full image here but I need at least 4 posts under my belt to do that)

[Sleeprider]

Well we sure nailed that one! Your 95% flow limits dropped from 0.21 to 0.00, tidal volume increased from 360 to 420 mL, respiration increased and minute vent increased from 5.38 to 7.0 L/min. I bet that feels great!

The trick to embedding a full-size image is to add the image to your post and embed it in the post, then preview the post. In preview, you can enlarge the thumbnail and copy the link and use that with IMG tags using the photo embed icon. It's a good idea to preview again and then submit.

[greenpj22]

Yes, I’m so grateful and I’m actually learning what all these settings actually do which is the awesome. 

Looks like the leaks aren’t as bad now which is good! 

I thought about trying one night with the full face mask to see what happens, but I’m slowly learning as I get older that less is better and don’t fix it if it’s working. 

Hopefully after close to 10 years of therapy I will start getting the max benefits and improve my quality of life. 

I’ve had some liver issues where they originally thought I had early cirrhosis (found out April 2022), but with lifestyle changes and quitting alcohol, my last scan showed only minor fibrosis but the scan wasn’t as clear as the radiologist wanted, so my liver doc recommended a follow up in a year (which will be August 2024) 

I say all of this because in 2022 and early ‘23 I was constantly tired but I had a lot of things going on - but I immediately correlated it to my liver. One side effect is fatigue when it’s not functioning appropriately. Looking back, it could have been from anxiety and trouble sleeping or simply not having my machine set up properly, but most likely a combination of everything. 

Thanks for the help! I am excited to reap the benefits of a good night sleep. Super excited!!!!