[Treatment] New user looking for tuning, tips, and advice

[cjt324]

Hey all, thanks for being here and helping everyone!  This forum looks like an awesome resource. 

I recently (10 days in) started using an airsense 11 with climate hose and F&P Evora FFM after an at home study. I had an AHI of 78 going into this... (Yeah... it was long overdue and I was miserable)...

So far I seem to be getting great results as far as AHI goes, (<2!), but there are a few things in need of some definite improvement to make this viable long term.  I've been looking at what info myAir provides, and just pulled the SD Card data to take a look at OSCAR today.  

The sleep itself - I don't use a smart watch or anything else to monitor my sleep, but my bed does provide nightly reports on how I slept.  Before starting APAP, I was getting 0 deep sleep, ~5-10% REM sleep, and the rest was light sleep with constant breathing disturbances and many awakenings.  Now I'm getting a good bit of deep sleep phases, and some solid REM.  The deep sleep typically seems to be in the first half of the sleep session though - any idea if that's a result of pressures ramping up etc?

   


The data (attached) - 

I saw immediate results and the last several nights have seen an AHI of 1 or less (0.3 last night!).  Obviously the leaks are huge and I need to figure that out.  I've always ground my teeth at night so it's probably jaw movement related but not completely sure.  Flow limitations also seem to be extremely high, from what I understand.  Is that because of the leakage or ?
How's everything else look?
I've made minimal changes from the default settings - I believe I set EPR to 2, and the hose temp to 74F.  I also bumped min pressure up to 6 a couple nights ago.  

The bad the ugly and the questions - 

• When I put on the mask and the machine turns on, I don't really feel like I'm getting enough air, especially at first - tried to bump min pressure up to 6, but noted elsewhere that actually means a min pressure of 4 - should I bump this up to 8? Higher?
  
• I didn't notice it the first few nights, but for the last week or so I've been getting awakened by a whistling noise coming from the machine, especially on inhales and I'm guessing it's happening when the machine is getting up there in pressure.  I haven't yet been arsed to actually sit up and investigate exactly where the whistling is coming from, since I was still half asleep and have so far been able to get back to sleep... But tried moving the hose around and moving the machine itself a bit, didn't seem to affect the noise at all, though when I roll over the noise tends to goes away for a moment before returning... Any idea what's causing this?
  
• I've awoken a few morning with irritated nostrils, especially sensitive to touch, like I've had a nosebleed. I don't think I actually did, but I'm guessing the irritation is related to dry air. I've only found the water reservoir dry once, but that was the night I actually sleep for 8+ hours. At ~6 hours I seem to have very little water left. Would lowering the humidifier's settings help use the water more slowly? Or do I just need to get an external attachment / larger tank?
  
• Should I try a different mask?
  

Overall, I think I'm feeling better most days, but while I'm sleeping better, I'm also sleeping less so I'm hoping I'll see even better daytime results if I can work through some of these issues.  I'll be forever grateful for any advice you might have!  Any additional info or data from other dates that would be helpful to see?

Thanks a ton!

[staceyburke]

I have some different observations.  

First the min is your inhale pressure and anything under 8 is probably to low.

EPR helps with Flow limits and you are at 2.  You still have quite a few FL so I would raise it to EPR 3

Last you have some large leaks.  They are mouth leaks.  Some people use taping the mouth to stop them.  Yours are not terrible but you need to keep looking how much you have and if it get worse, you will need to find a way to stop them.  Large leaks means that the pap machine can NOT give you enough pressure to give therapy and your apnea are not being recorded correctly.

[cjt324]

Thanks! I'll try raising those up tonight and see what kinda of difference they make.

RE: leaks, I'm using an evora full face mask, mainly to avoid taping. I might give a couple nasal masks a try with mouth tape at some point, but I have strong doubts about how well they'll work for me.

[Phaleronic]

Welcome to the forum cjt324

You've been set on inappropriate pressures from your sleep doctor, 6cm is much too low when using EPR fulltime @ 3, and 20cm max pressure is too much and is not needed (as your charts show. Please lower your max pressure to 17cm. Please raise your minimum pressure to 7.4cm and lower EPR to 1. The narrower the band of pressure the less arousals and microarousals you'll experience during the night, and the deeper you will sleep.

EPR is a stop gap for dialing in the proper band of pressure, and it causes issues with natural inspiration.