[Treatment] simplychillin - Request for Advice/Treatment Thread

[simplychillin]

Hey everyone! 

First, I wanted to say thanks to everyone at ApneaBoard - based on my perousal of other threads, y'all seem really helpful, and it's amazing to see this kind of support given without asking for anything in return. So, thank you!

Now, on to my own request: I started APAP therapy on the night of 2024-12-12, and have been having a couple of issues and questions. They're enumerated below, but as for some context, the 3 images attached are best representative of my therapy so far and the other days are, as far as I can tell, unhelpful or repeat the same point as another screenshot. Now, on to the meat of the post.

1. As seen in on the night of December 17th, I removed my nasal pillow mask (and tape, somehow) unconsciously! This has been a pattern in previous nights, with the same occuring (albeit with the full face mask) on the nights of December 15th and 16th. I have no idea why I do this, I have no recollection of doing this, all I know is I wake up and it's off. I've seen advice in the MyAir app that says I should try wearing gloves for a week or so, and while I'm absolutely open to doing this, I wanted to see if anyone had any other recommendations that have been more effective in your experience?
   
2. I've been swapping between the F&P Forma and the ResMed P30i, and while the P30i is undoubtedly better seal-wise, I find it makes the inside of my nose uncomfortable where the pillows contact my nostrils. Is there any way the P30i can be made more comfortable? Am I wearing it wrong? I mean, the head strap and everything feels fine, but just the inner part of my nostril hurts a bit. It normally wouldn't bother me, but when I'm trying to sleep, I find it distracting.
   
3. On the same note as #2, I'm concerned that I won't be able to use my machine when my nose is stuffy. Is the seal issue on the Forma just me? If not, has it been made better in recent years? If it has, should I buy a new full face mask to replace the Forma so that I can use my CPAP while I sleep with a stuffy nose, or is that generally a non-issue?
   
4. On a similar note to #2 and #3, I had a weird issue on the night of the 15th where my Forma was "screaming". It's really hard to describe, but basically, it's like blowing air through tightly shut lips. It hasn't returned, and that was also a night where I had bad rainout, so it's probably nothing, but I was wondering if anyone had any experience with this? Does this indicate a mask issue? (To be clear, this was different than a leak, as far as I can tell, because when I rubbed the diffusion points, it went away for about 2 minutes.)
   
5. On the same note as #4 - is it okay to turn up the ClimateLine tubing to above room temperature? My mother said it wasn't a good idea, but ever since I set it to 80 degrees Fahrenheit, I haven't had rainout issues. Any input on temperature setting for ClimateLine?
   
6. Following advice from my mother, who has been on CPAP for at least a decade, I enabled EPR @ 3 in the clinicial settings. Now that I've read some more about it, I have a sneaking suspicion that that is messing with my therapy and prescribed pressure - should I disable it? Or should I change the pressure range? Both? Neither? I have an appointment coming up on the 26th to review my initial CPAP data with a new doctor (different than the one that prescribed the sleep study), so I don't know how knowledgeable they are, and for that reason, I'm hesistant to change my pressure; however, if it is strongly recommended, then I'd be okay with it.
   

Rest assured that I'll be sticking with this; I just want to get some advice on how to make such sticking with it easier and more effective. Thanks a ton for reading all this!!

[Old Steve]

As to the pressure, I would leave the EPR on, but to start I would run your minimum pressure to perhaps 9cm as your current average is higher than that.  

I think that most of the people on the forum use EPR, it helps to control flow limits and is more comfortable as it lowers your exhale pressure.

Your hose temp is actually a bit less than I use.

As to mask issues I can't help as I haven't used any of your masks...

Welcome to the forum!

[simplychillin]

Thanks for the quick reply!

I'll be setting my minimum pressure to 9 cmH2O tonight and will update tommorow with how it goes. Will be using the P30i nasal pillows as I can get over the uncomfortableness for now.
Will also try wearing gloves/mittens to see if that makes it harder for me to get the mask off.

Good night!

[simplychillin]

Alright, we have the first night's data back!

It's generally looking good, as far as I can tell - lower AHI compared to the other valid days, low leak, and I'm feeling a tiny bit more rested (though that last part could be placebo). I've gone ahead and attached the OSCAR chart, in case anyone wants to compare it to the other days.

On the con side, I forgot to put on gloves/mittens/something to make it harder for me to take off the mask, but thankfully, I wasn't off the therapy for too long when I inevitably took it off last night. Mouth tape stayed on the entire night this time!

To anyone else taking a look at the thread - I'm still looking for input on questions 1 to 4 in my original post. Any musing is welcome!

On a sidenote, I'm super grateful for the advice, Steve, I had a small hunch the minimum pressure was too low, but you suggesting it made me feel a lot more confident that I wasn't misreading the situation, so I appreciate you taking the time to write out your thinking. I'm also glad you said you hadn't tried my masks rather than making stuff up that sounds right; in my opinion, this kind of thing is what makes this forum so amazing: people being willing to say they don't know everything in the world yet helping others with the knowledge they do have. So, thanks, dude!

As to the future, unless I get other advice, I'll probably stay on this pressure for a few more days, and I'll post if anything abnormal happens with my OSCAR data, or if the mittens work to keep my mask on two nights on a row. Again, though, this is just my current plan and I'm open to suggestions.

Thanks again for reading!