[Treatment] tortellini - Therapy Help

[tortellini]

Hi! I hope I did this correctly. I attached my 6 standard charts from last night.

The pillows mask setting is per the manual for the F40 mask, which I don't quite understand since it seems like a full face mask but I'm just going by the manual.

I'd love any insights. I usually seem to take my mask off in the middle of the night. If I do wake up with it on, what was a good fit when I went to sleep has turned uncomfortable and audibly leaky, and I'm groggy in the mornings, which is the opposite of what I thought was supposed to happen.

   

[PeaceLoveAndPizza]

Nicely done on the formatting! Thanks for that. Only suggest there is to replace tidal volume with respiration rate. If someone wants specific graphs they will ask.

You are using the typical default settings, I think we can do much netter than that.

For now, use the following settings:

Min pressure 7
Max pressure 15
EPR 2 full-time
No ramp
Response standard

Few adults are comfortable with IPAP (inhale pressure) less than 7. You have enough flow limitations to warrant some EPR as well. I suggest going back to a standard response and seeing how that works before changing it.

Give that a go and let us know how it works. I think you will be much more comfortable with more pressure and some pressure relief on EPAP (exhale pressure).

[tortellini]

My SD card must not have been inserted correctly the night before last, but I did get data for last night using the settings you suggested. I switched out tidal volume for respiration rate and also reposted my first graph with respiration rate, excluding a couple of 1-min "sessions" that were just me adjusting the mask under pressure. Thanks for the help!

I was able to keep my mask on for more of the night, but there's still something that compels me to take it off while asleep. Maybe I just need to use medical tape to secure it to my face or something, haha.

I was super groggy this morning - I wonder if I'm getting deeper sleep with the APAP than I'm used to getting.

       

[PeaceLoveAndPizza]

You can see how the AHI dropped from 7.15 to 1.81. We are getting closer.

I suggest bumping up the min pressure from 7 to 8. Your smoothest flow rates are when your IPAP (inhale) are around 8. I would also say keep EPR=2 for now to see how you react to just a slight pressure increase.

Min pressure 8
Max pressure 10
EPR 2 full-time 
No ramp

Give that a go for a few days and let us know how it is working. If it feels too much pressure you can increase by 0.2 or 0.4 over a few nights to get used to it, until you get to 8.

[tortellini]

I haven't gotten as good results as that 1.81 since then 

I'm especially concerned about last night - to my untrained eye I seem to be needing more than 10 max based on how much time it spent at 10? Maybe last night was a red herring. I felt awful when I woke up this morning, that's for sure.

I can also post the night before last if needed.

   

[PeaceLoveAndPizza]

Seeing another night would not hurt, but I don't think it is necessary at the moment.

The first thing I notice on the latest chart is that most of the events reported look to me as what we call SWJ (sleep-wake junk), meaning you are basically awake when they happen. Look at the first part of the chart from 23:30 to 23:45 and again around 00:00. In the first instance you were still awake and you had two hypopnoeas and two RERAs, then again for the second. Look again at the last section from 06:45 to 07:00 where you had around 12 events whilst waking up. If you get rid of all those events you AHI was significantly lower, somewhere around 1 or 2. 

The middle section from 01:00 to 02:30 is primarily sleep and only had one event. That is the pattern we want to try and replicate.

If you want to try an experiment, use the following settings for a night or two.

Mode CPAP
Pressure 9
EPR 3 full-time
No ramp
Response Standard

What I want to find out is how you respond to things without the pressure swings. It may go totally off the rails, but I do not think it will be much worse than you currently are experiencing.

One thing you have to work on is keeping the mask on and the therapy going. I know it feels strange, but there is sufficient pressure to not feel air-starved, so I do not think it is that. It is difficult for almost all of us as we start out with CPAP, so you are not alone in the struggle. Try wearing it whilst watching the telly or reading prior to bed. The more you get acclimated to wearing it, the better.

Depending on how this goes, we can try other things with a fixed or variable pressure, whichever you are more comfortable using.

Start looking at your sleep hygiene as well. Flatter pillow, relaxing before bed, no electronics, no eating at least 2-3 hours before bed, listen to nice soothing music, whatever it takes. Give the following a read as well for other ideas.

Mastering Sleep Hygiene: Your Path to Quality Sleep (sleepfoundation.org)

[tortellini]

I've been using my APAP for about a month. The two masks I like the best so far are the F30i and F40. I do have some questions about this general type of mask.

• Will cutting out the nostril divider have any sort of negative impact? My nostrils are asymmetrical so the divider doesn't line up with my actual nostrils if the mask is otherwise properly seated.
  
• Have people found that the extra tubing between the mask itself and the CPAP hose necessitates adjustments in the temp/humidity settings? I currently use auto on both but I'm wondering if I should up one/both.
  
• Is there one that people recommend over the other? I seem to be able to keep the F30i on for longer but have higher leak rates vs. the F40. (Can post OSCAR screenshots if needed but I'm still not able to keep any mask on for more than about 4.5 hours max so idk how helpful they'd be)
  

[PeaceLoveAndPizza]

1. I have cut out the divider whilst using an F30 with no issues. I basically cut it into an almost hourglass shape to not affect the support structure.

2. The extra length should not matter as the machine will adjust pressure as needed. The heated hose has a sensor at the end so it will adjust it to there as well. You can always add a hose cosy to keep the extra length warm, even a cut sock will do the trick in a pinch.

3. I tried an F30i and did not like it due to leaks. The F30 with a cut-out divider worked well for a long time, until I finally settled on the F&P Evora as it had far less leak and comfort challenges for me.

Note I have never tried an F40. Maybe someday…

[yankees123]

I have been using the F40 for a while now and I love it.  It’s so comfortable compared to other ffm.  Of course everyone is different.  I am a side sleeper and find no issues with leaks at all.

[tortellini]

Hi,

I tried a few of the things you mentioned (settings, flatter pillow), changed the cushion size, and taped the mask to my face with medical tape, and was finally able to keep the mask on for over 7 hours total.