[Equipment] New here! Need help with flow limits and dialing in settings!

[JustG]

Hi All!

I was recently diagnosed with severe sleep apnea (59.8 events per hour... oof lol). Actually, I was diagnosed with mild-moderate sleep apnea many years ago, but am just now taking action. Better late than never?

I got set up with my ResMed AirSense 11 APAP machine and the AirFit P10 mask (medium) mask last Monday, on the 8th, and have had some success with it in that my number of apneas have thankfully decreased, according to OSCAR and the MyAir app, but I'm definitely struggling to get a good nights sleep with it. Averaging around 5-6 hours of fragmented sleep a night while wearing it at the moment. 

My original prescription was the stock 5-20 pressure range, 1 EPR full time. After struggling to breathe while trying to fall asleep I did some reading on this forum here, and have changed my settings to 6-20 and now 7-20 with EPR set to 1 only during ramp. I feel like I slept better one out of two nights after changing those settings, but still not well. 

I downloaded OSCAR to see a bit more of what is going on but am struggling to get my head around all the data. From what I can see, there are definitely a few things that look... rough around the edges? Particularly in regards to flow limit and flow rate. 

I don't want to give up on this. I know it's still early, but it's also hard to have fragmented and disrupted sleep so many nights in a row. 

So, here I am, hoping all of you wonderful people here can help me get things dialed in! Open to any and all observations and suggestions!

I have attached screenshots of my data from Tuesday night. If any more are needed, please just let me know. 

Thanks in advance!

[Narcil]

your charts look pretty good but i think we can do better. i would try to set EPR on 2 and to full time instead of ramp only to try to help the flow limits.

your 95% pressure is almost 13cm like me so i think you can keep raising the min pressure slowly whatever feel comfortable for you. just to try and narrow down the apap range a bit to avoid those mountain peaks on the pressure graph and hopefully improve comfort. you can raise it to 9-10cm at least but slowly and i would also limit the max pressure to 15.

you seem to have a bit of mouth leaking also, but nothing too bad. the mask primer may help.

[JustG]

Thank you so much!! I will make these changes tonight and report back.

If you're able I would also love some input on whether or not the changes I made seemed to help in the first place or not. 

I attached screenshots of two of the nights I had before I made the changes. So the settings were 5-20, 1 EPR at full time. Also of note; I was using a small size nasal pillow for the P10 mask during the night of July 10th. But my nose hurt in the mornings the first few days I was using that, so I switched to the medium size on the night of July 11th and haven't had that pain since. But if it looks like I was getting better results with the small size I can change back. 

Appreciate the feedback!

[Narcil]

you had more leaks on the 10th than the 11th so i think the medium is working fine. either way if the small one is painful, you shouldn't use it. a mask should be slightly uncomfortable from having stuff on your face but it should not be painful.

you were right to increase the min pressure and like i said i think you should keep raising it slowly. and epr for the full night should help also.

you could also experiment with turning off ramp completely see if you really need it, most people don't. but on auto it's fine as well.

[JustG]

Alright, here are my results from last night posted below. 

Settings were set to 10-14 (meant to do 15 but must have clicked wrong. I can change it to 15 tonight if necessary)

EPR 2, full time

Ramp off


Took me a while to get to sleep. It usually does. But that’s mostly due to my PLMD acting up. Still working on getting that treated correctly, but that’s another post for another forum lol. 

AHI looks good, but I know it’s not taking into account any events that are under 10 seconds of which there are still a few. Leak rates could still be better? Still a decent amount of flow limits happening later in the night. Not sure how much of this can be dialed in further.

Please let me know what you’re noticing here, and if I should change anything further or not.

Thanks so much for your help!

[Deborah K.]

I suggest that you raise your EPR setting to 3. You will get better therapy and more comfort.

[JustG]

Happy to try that as well!

Any input on the pressure settings range? In my last comment I posted my results while having it set to 10-14. The original screen shots I added were at lower pressures. Not sure how to proceed or what was more effective. 

Thanks!