[Treatment] PrimaApneaDude's Therapy Thread

[PrimaApneaDude]

I'm starting up treatment again for many reasons and would like some advice. I was using a PR Dreamstation APAP and was having many problems. The last straw in Dec 2022 was waking up and rinsing my mouth with water and spitting out tons of black specs. I stopped using it and am still waiting for the recall fix.

I've learned that the algorithm hasn't worked well keeping up with my apnea events resulting in my AHI hitting 38 with treatment without mask leaks.

I'm starting again because I've developed V-Tach, nausea, vomiting, headaches, WBC labs abnormal and am crazy tired all the time. I was so fed up with PR and my situation that I threw everything away which I now know I shouldn't have done but no going back now. My doc wants me back on treatment after having a hypertensive crisis event.  I woke up and had to call EMS and my BP was 185/128, pulse was 232bps and Sp02 was 81%.  This can't continue.

My neurologist is giving me an Rx for any APAP, mask and supplies so I can get whatever I want.  He suggested I check out this forum for help and encouragement and said he tells all his patients to read the resources even if they don't want to join. He gives open-ended Rx mainly due to supply issues but he can write an Rx for a specific machine to ensure a DME via insurance provides the machine his patient wants which works more often than you would think.

I'm paying for the machine out of pocket so I can pick anything and want to make a wise choice. I'm a mouth breather so full face masks are what I've used in the past. I've had problems with breathing out feeling like I can't catch my breath. I've woken up many mornings with my mask off still running with no memory of taking it off. I also toss and turn at night and in the past have rolled on the hose. I've never used a hybrid mask that goes under the nose as opposed to over the nose. I didn't know these existed and feel this would help me greatly in doing this successfully.

I'm looking at getting the Resmed Airsense 11 Autoset and trying the AirFit F30i mask. This mask seems a better option for comfort and my tossing and turning compared to my old mask.

I would like your feedback and suggestions and I plan to purchase in about 2 weeks.  Thank you all for your time and any feedback you can provide!

[Melman]

Welcome to the forum. Resmed Airsense 11 Autoset is an excellent choice. You should start with a minimum pressure of at least 6 or 7. Most feel starved for air at a lower pressure. Do you know if many central apneas were observed in your sleep study? If not, I recommend trying min  pressure 7, max pressure 15, and EPR full time at 3. Be sure to post OSCAR data so we can advise adjustments if indicated. You will need an SD card in the machine to record data. Go here for instructions to adjust settings. https://www.apneaboard.com/resmed-airsen...setup-info
See the links below for how to organize and post OSCAR charts,

[PrimaApneaDude]

I've had 3 total sleep studies (1 lab titration and 2 home) over the last 10 years. I've never reached REM sleep in any of them and they all had some central apnea events but mostly obstructive apneas and hypopneas.  My AHI on these studies was between 5-10 but my doc thinks my apnea is far worse during REM sleep based on other information. Simply put I had a major seizure that put me in a coma for days on a ventilator hooked up to a 24/7 EEG and after weaning me off the vent they had to put me on bipap due to severe apnea events during REM sleep. I also have PLMS and RLS and take meds for this and I have asthma with COPD.

I have icloud backups of my past OSCAR data that I've loaded to my mac but it must not be complete but I'll post what I do have as soon as I can. I've got to read and figure out everything using the directions provided. Thanks for the information.

[PrimaApneaDude]

           

This is all I can get from my backups. All but my last 2 daily reports look like they were lost.

[PrimaApneaDude]

I got my new Rx without issue and he started me on 5-15 apap and is scheduling me to have an in home sleep study with eeg instead of in the lab as I never reach REM sleep in the lab.

I've ordered the following below from Supplier #1.

1. ResMed AirSense 11 AutoSet.
2. ClimateLineAir 11 Heated Tube.
3. ResMed AirFit F30i mask standard size frame and medium size cushion.

I measured my head and used the sizing templates so hopefully the sizing will be fine.

My doc said he doesn't have a problem if I changed settings as long as I believe they will help improve therapy success. I'm going to start with Melmans suggestions and adjust from there if needed based on OSCAR data.

I'm more optimistic this time around as I didn't know this site was a resource last time I tried therapy. This was partly my fault as I could have searched the internet for help and found this site. My first try was as a complete novice and you trust your doctor and DME company and you don't know what you don't know type of thing. I didn't know they had different types of full face masks and my DME and insurance didn't lead me to believe I had choices and could change masks on the next resupply date.

Again I could have done more to help myself but everything else was overwhelming and these thoughts never crossed my mind.

I hope my experience can show that maybe you're not alone and we can succeed when we failed before by taking charge of our health instead of sitting back and assuming we'll be told what we need to know.

I'm actually looking forward to this second attempt and I feel prepared for it and hopeful for success with help from the amazing people on this site!

[Sleeprider]

Once we see some data from using the machine I’m sure we can help you expedite optimization.

[PrimaApneaDude]

I got my machine and mask today. I went and bought an SD Card and it seemed to detect it with a generic popup after I plugged the SD card in.

I'm starting with the following suggested settings...
1. Min pressure of 7 and max pressure of 15.
2. EPR set to full time and a level of 3.
3. Heated tubing settings on Auto.

My ramp is currently disabled but I was wondering if I should turn the ramp on Auto with a lower pressure of 4 or 5 during ramp. I'm assuming no ramp based on the statement that most people feel starved for air at lower settings which was why it was suggested to set the minimum pressure to 6 or 7.

I'm going to start therapy early and watch TV for a few hours to get used to the feeling again of wearing a mask and having air pressure and take advantage that I don't have to wake up early as it's Saturday. This removes the mental pressure of feeling like I have to get used to it quickly to fall asleep early enough to wake up.

I will upload my OSCAR data tomorrow for feedback. To be clear I'll have ramp mode turned off unless told otherwise before I fall asleep tonight.

Thanks for everyones help so far!

[PrimaApneaDude]

   

I did better than I expected but I need to fit my mask better or consider another mask.  My nose is pretty sore which surprised me. Maybe the cushion is too small.  I might check out a local medical supplies store that sells masks and get measured and try different masks. I remember my last mask was the dreamwear full face mask which I remember being way more comfortable than my current new mask which is the F30i. I also took care to avoid tightening the straps too much as well.

I will see what you all think about everything and go from there.

[Sleeprider]

Leaks are not a problem based on this chart. All leaks are short "blips" suggesting an occasional seal failure, but nothing like mouth breathing. What mask are you using? You may want to update your user profile. https://www.apneaboard.com/forums/usercp.php

Looks like 7/4 starting pressure is a bit low. Raise minimum pressure by 1-cm. CA events are pretty normal for starting out, and should diminish as you adapt to the bilevel pressure provided by EPR.

[PrimaApneaDude]

I went to a local medical store this morning and bought the dreamwear mask.  They measured and did a fitting of my existing mask (ResMed F30i) and even tried the large size cushion and the plastic pieces on the side of the nose parts were digging into my nose. The digging into the sides of my nose gets much worse when sleeping on my side. I do have a larger than average nose.  This similar type plastic piece sits lower on the dreamwear mask so it doesn't press against my nose at all even when I sleep on my side. They tried to fit the F30i wide cushion which still dug into my nose. The large cushion was too big and didn't stay sealed. The large frame didn't stay on the top of my head correctly either.

The best fitting for me with the dreamwear full face mask was the medium frame with the medium wide cushion which didn't hurt my nose at all during the fitting. They did the fitting using pressures of 5, 10 and 15 each while laying flat on my back and laying on both sides. They also did the same testing slightly elevated once I told them I had an adjustable bed since I sleep slightly elevated with one pillow. They didn't check stomach sleeping since I've never slept on my stomach.

They didn't have the medium wide cushion in stock with the medium frame so they gave me the full kit with the medium frame and all cushion sizes for 99.99 which seemed pretty good to me.

I hope this helps others who might be having the same types of issues.  These are very different masks even if they look the same and have the same features.