[Treatment] hnk552 New Treatment OSCAR Data

[hnk552]

Hi! First of all, thanks so much for creating this forum and providing so much information. It helped me avoid my DME giving me a machine with 1100 hours on it, and I got a new in box Resmed 10 Autoset instead.

I have mild apnea with an AHI of 12 with an at-home sleep test. I can get a screenshot if it's helpful.

Equipment: Resmed 10 Autoset
Mask: Resmed P30i nasal pillow
Sleep style: side sleeper with frequent side changes

I didn't have an SD card on the first night so no Oscar data, but didn't take decongestants and had difficulty breathing. After I took Claritin I fell right asleep.

Although I thought I was a mouth breather, it appears that's not the case if I use Claritin + Flonase. 

For this chart the mask was fairly tight and left some painful marks on my nose.

   

Chart 2: Used 5mg quick release / 5mg slow release melatonin + claritin + flonase

   

Chart 3: Claritin + flonase. Poor sleep, very active, kept waking up. There's some influence from my sleep partner who had congestion/coughing issues which might have woke me.

   


Questions:

• This is early in my treatment, and I'm fortunate in that I've been tolerating everything well and keeping the mask on for ~8hrs. However, is there anything that stands out at this point?
  
• Am I keeping the mask too loose?
  
• When I first put the mask on, and at times during the night I feel that it's hard to breathe, almost like I'm "out of cycle" and I have to exhale through my mouth a few times. Is this just acclimation or should I adjust my EPAP up to 3. I think it was set that way originally but now it's at a 2.
  

I feel like the DME guided me into picking a mask without letting my try on various options. I picked the "top of head" style because I change position. I'm wondering if the N30i (which uses all of the same hardware as the P30i) would reduce the nose irritation. Since I do go through a few colds a year with severe congestion, I'm wondering if I either should have picked a partial full face mask like the F30i or the Amara View.

However, I might be overthinking the mask issue a bit. Aside from an initial mask fitting, do DMEs typically allow you to come back in and try different styles?

Thanks for any advice!

[staceyburke]

Welcome to the board. Your min is to low to use EPR (exhale pressure relief).

The absolute lowest pressure any pap machine is 4. The EPR subtracts from the min to make the e hale easier and to help with flow limits.

So I would suggest you raise the min to 7. That would make - inhale 7, exhale 4.

Where you have it now min4 EPR 2 can’t happen your exhale will still be 4.

[hnk552]

I made the recommended changes (pressure 7/20 with EPR of 3).

Last night's sleep was worse, AHI jumped to 3.31. I felt like I had more small leaks with the P30i and had to fiddle with it a few times during the night.

I also woke a few times with, I guess the technical term is "mouth fluttering". 

   

The nice thing about the P30i seems to be if you keep it loose, usually just a quick reseat of the pillows while under pressure gets the seal back. Tightening it up is not a winning approach.

I still want to see if the N30i behaves any better, and will try to talk my DME into letting me try on some other masks and exchange. Now that I have the P30i sized I can get it online.

[SarcasticDave94]

If you want to swap P30i for the N30i, just swap cushions. The headgear is the same.

Mask choice and adjusting is the hardest part of PAP therapy.

I think your Ramp is going to hinder therapy as well. It's blocking therapy for the duration, and if you restart therapy then the ramp will start over, wasting more therapy time.

[staceyburke]

Your night looked better with the increase EPR. You had a group of centrals right at the end of the night that was probably wake sleep junk and without thouse your AHI would be lower. 

Keep working on leaks and I thing you will continue to feel better.

[hnk552]

Thanks for the advice. I turned the ramp off, and tried to use the large P30i pillows. What a difference, I didn't have to fight against the air and didn't get that "catching up with my breathing" feeling. The larger pillow sealed a bit better and felt fairly comfortable.

I've been obsessing about mask choices every since I started last week, but I think I'm going to just cut it out and let it ride with the P30i for a little while. 


Here's my nightly data. 

   

Unless there's something that stands out that needs correction, I'll stop posting for a few days and see how the trends go.

[SarcasticDave94]

The data is showing acceptable therapy. How do you feel for it? That's the real key item now.