[Treatment] cdsoffa - Therapy Thread

[cdsoffa]

Hi all,

I am on my 5th night now with the Resmed 11. I was diagnosed with mild sleep apnea (AHI 6.2) via an at home WatchPAT One test. Machine settings:

• APAP, 4-20 cmH20
  
• EPR 3, Fulltime
  
• Ramp = Auto
  

I surprisingly feel somewhat comfortable with the P10 nasal pillows mask on but my symptoms don't see to be improving at all (I know it's early) even with almost 0 obstructive apneas. It feels a little difficult to exhale through my nose against the pressure. I'm still experiencing:

• Headaches in the morning, maybe worse with CPAP
  
• Waking up multiple times per night, peeing 2-3 times, waking up an struggling to fall back asleep
  
• Not feeling very refreshed when I wake up
  

I also notice CSAs popping up but from what I've heard that is normal for a new CPAP user?

Attached is my high-level OSCAR data:
   

I also have been comparing to my WHOOP sleep/HR data. It's interesting that my HR spikes seem to be lining up with flow rate abnormalities (even if they're not classified as an apnea):
   
   

I've been trying to tape my mouth at night but last night I ended up drooling through the tape while sleeping on my side (lol). I might try the chinstrap tonight.

• Are there any tweaks to my settings that you'd suggest?
  
• Is there any reason to increase pressure? Or would this just increase central apnea events?
  
• Are there are other graphs/data points that I should observe to help understand what is going on?
  
• Should I experiment with different mask types? I've only tried the P10 nasal pillows so far
  
• Or am I overthinking it since it's only day 5 and need to continue using to see benefits/improvements in symptoms?
  

Thank you all so much for any help you can give!!

[PeaceLoveAndPizza]

Please read the link in my signature "Formatting OSCAR Charts", then repost your chart. It is difficult to determine what is going on without seeing the entire chart as described in the link.

[cdsoffa]

I'm not sure if I'm following, the entire charts are displayed. Is this better? 
   

[Deborah K.]

Your starting pressure is too low for an adult.  Change it to 7.  Then we can see what you need after that.  You are also using ramp.  I suggest that you set your ramp pressure to 6.  Your headaches may be because you are air-starved.

Try those things then post a chart and let us know how you feel.

Again, welcome, and good luck with your new therapy!  

[PeaceLoveAndPizza]

For the left hand table there is an entire section below what you have on the chart that contains the machine settings as used. We can work with what you have for now, but look at some other charts and you will see what I mean.

What appears to be happening is that with EPR=3 the machine is stopping the flow limitations that normally drive up pressure. With the low pressure you have to start it never gets it into the range for comfort and managing the arousals. I expect as well there are flow limitations going on that lead up to the arousals, even though the FL counter is not incrementing.

Which leads me to you need more pressure. The pressure support (EPR) is doing its job, but without enough starting pressure you will not get the benefits of EPR.

Try this...

Mode APAP
Min pressure 7
Max pressure 12
EPR 3 full-time
No ramp

It will feel a bit different to start, but I expect you will easily get used to it as you relax.

[cdsoffa]

Thank you all for the helpful advice and responses!

I had a tough night last night waking up frequently and having a hard time going back to sleep. Very tired this morning with a nice headache. And cherry on top, I forgot to put my SD card in...

From the machine it looks like my CAs went up to 1.2/hour. Is that concerning?

I didn't necessarily mind the pressure increase, I thought it almost felt more comfortable/easier to breathe?

I will get more data tonight so you can see what it looks like in OSCAR.

Thanks again!

[cdsoffa]

Hi there,

Attached is my Oscar data from last night. I tried using the P30i mask to see if it would be more comfortable (I like to sleep on my stomach at times) but it looks like I was having a few leaks with the mask (probably when I had rolled on my stomach). I ended up taking it off around 11:30 pm because I woke up and was unable to go back to sleep (had a headache and felt very anxious).

   

What do you think is going on when I'm waking up with my heart rate jumping? My HR monitor shows my heart rate spiked at about 11:15pm which lines up with a CSA event:

   

Are these CSA events truly central apneas? If I'm not having many/if any apneas/hypopneas, should I keep using CPAP?

I want to keep trying the CPAP but I seem to be feeling worse and worse when I'm using it.

Thank you all for the help!

[PeaceLoveAndPizza]

Understand that adapting to using CPAP may take two to three months. It is not a miracle cure for sleep issues, it can only help with sleep-disorderd breathing issues. Most of us have slept poorly for years and somehow ended up with a CPAP to help with it. We should not expect it to fix things overnight or in a few weeks.

For that 1:49 you used it, things look really good. What likely happened is you turned into the pillow around 23:05 which dislodged the mask causing the leaks. That is typical for the P30i or any of those “connect above the head” masks with silicon tubing. You may find the P10 better if you want to continue with nasal pillows or F30/F40 better as it is held more securely in place. 

Those are not true centrals, it is sleep-wake junk that happens whilst falling asleep or awakening. Same for the zoomed breathing. Nothing there to be concerned with in either case.

The best thing you can do now is keep at it. If you have the means try an F30 or F40, some online stores on our Supplier List have 30-day return policies. Supplier #1 has a good reputation and I use them myself. They have Black Friday sales going on and they have some good deals. 

Whether you continue with CPAP or not is your choice. Something drove you to getting tested and using a CPAP, that has not gone away. I suggest giving yourself 90-days to see some improvement, then reevaluate.

[cdsoffa]

Thanks much and agreed that it probably won't be an overnight fix.

I agree that going back to the P10 seems better. I was pretty disappointed with the P30i mask after using it last night.

I know it appears that last night leaks caused me to wake up but the previous night before (when I forgot to insert my SD card) I still was very restless while wearing the p10 mask and subjectively don't believe I was experiencing many leaks. So something seems to be waking me up at night/causing my HR to spike/inducing headaches.

What about turning off EPR or lowering it? I've read in other forums that EPR can cause CAs to pop up because we're dispelling CO2 better which causes our brain to think it doesn't need to breathe (correct me if I'm wrong). And this could cause oxygen desaturations (which I'm assuming would lead to headaches/waking up). Is there any merit to EPR potentially making my sleep worse?

Thank you again much. Grateful to have folks out there willing to chime in and help!

[PeaceLoveAndPizza]

I have not seen enough data to recommend more than I already have. If anything you can change EPR from 3 to 2, but I would not get rid of it completely until you have more nights under your belt with the recommended settings.

There are many rabbit holes you can go down. It is your decision which ones you want to follow. One good rule of thumb when deciding between two possible paths is go with the one that does not involve a magic spell.