morgana's - Therapy Thread

[morgana]

               

Hi folks
i'm new to this forum and looking for some help. I've been using CPAP for a year and am still struggling with a few things. i use the Resmed air sense 11. I initially used a nasal mask which I found comfortable and not intrusive, however, I had bad dry mouth, aerophagia and huge leaks. i changed to the resmed F30i which controlled the leak really well, although I find it uncomfortable and get frequent headaches. My AHI average started off at around 3 but has steadily increased to nearly 6. OSAs are well controlled but I developed CAs Which on individual nights can seem alarmingly high (10) but on average are probably about 2. I'm giving these averages as I haven't had a Resmed report done for quite a few months and the info I retrieve from my machine is minimal. I have spoken to my sleep Dr who is unconcerned about the CAs and tells me I just need to focus on the AHI score which at that stage was under 5. However, that wasn't very reassuring. I am sleeping better since commencing therapy but I'm still waking frequently and don't feel rested in the mornings. My most immediate concern is that since I have been using Oscar since October this year I have noticed 5 episodes of CSR. I have posted 3 images of an event from two nights ago. i am a 71yr old female and healthy with no heart disease. If anyone can shed any light on what is happening I'd really appreciate some help as I'm exhasuted trying to figure all this out and starting to feel a bit anxious.

[SeePak]

Hi Morgana

A few things....

Remove the monthly calendar from your charts before taking screen shot.
There is more info that can help people figure out what is going on.
Also, have you been told you are a mouth breather? When you said you had lots o leaks with nasal mask, that was probably mouth breathing. When the leak rate goes up and flattens AND flowrate goes down (using nasal mask) that is a sign of mouth breathing.
Do you have dry mouth in morning or bad breath?
Also, CSR is something that is apparently very rarely seen here by the moderators. I too have LOTS of CSR and i too am in good health and that was suggested for me. We have a breathing pattern that somehow suggests this in the Resmed algorithms that figure out the events.
And what i notice same as me is you have a Nice lower minute volume rate ( ~ 4 l/m ) and lower respiratory rate, breaths per minute of 12
I think that produces data that is skewed somehow, but that is my slant on it.

As far as your settings for your machine, that will draw a lot of different opinions.

I suggest tightening up your pressure range, maybe 8 cm min. and 11 cm max.
I know your machine is going up to 11 cm on your chart, but suspect that will stop happening once you have a high enough minimum, and dont want to give you something more to have to deal with leaks , aerophagia etc, with higher pressures.
If you need more pressure, we will know after a couple days.
Also, what was the result of your sleep study if you had one? what was the settings they recommended, when did your Obstructive events STOP, what pressure?

Stopping waking moments is tough and you will need trial and error to figure that out.
You may have some positional in there, which means you could be chin tucking, but dont seem to be getting OA events, so i doubt it, but not sure.
Do you sleep on your back or side?

I think you can relax about your current results and..

Sleep Well.
So for now until someone else responds, relax !

[morgana]

Hi SeePak
Thanks for your response.
The following is an early 30 day report from November 2023 (a month into my therapy).
Mask: Resmed N30i (nasal). Pressure setting 6-16cm, which was set from my sleep study.
-Pressure: median:8.0, 95th%:9.5, max:10.2
-Leaks: median:27.0, 95th:48.2, max:57.9
-Events/hr: AI:3, HI:1.0, AHI:4.0, CA:1.8, OA:00, Unknown:1.5, RERA:1.5, CSR: 0.0

So it looks like the OAs were managed effectively from the outset and the CAs developed at the same time, although they were not present in my sleep study.
The Resmed coach told me I had mask leak and mouth leak. I couldn't notice the mask leak so it was difficult to address but I noticed the mouth leak with the aerophagia and very dry mouth. I also tried using a V-com and mouth tape with varying success. The leaks reduced when using mouth tape but I would not have been able to remove it quickly enough if I needed to. Using ramp time was fine but when the pressure increased it just forced my mouth open. I also struggled to breath when the pressure got to around 12.
In an effort to address the effects of the leaks I tried the F30i which managed them incredibly well (despite it being uncomfortable and giving me headaches) but didn't seem to make any difference to my AHI. I guess I assumed if the leaks were reduced therapy would be more effective and my AHI would decrease. Is that not the case?

June Resmed report showed:
Mask: F30i (hybrid FF). Pressure settings 8-14cm
Pressure: median:11.1, 95th%:12.8, max:1.3
Leaks: median:1.2, 95th%:10.9, max:18.2
Events/hr: AI:0.5, HI:3.5, AHI:4.0, CA:0.5, OA: 0.0, Unknown:0.0, RERA:0.7, CSR:0.0

After this I went back to using a N30i nasal mask in July due to issues with rainout and discomfort with the F30i.

Today's last 30 days report showed:
Mask F30i pressure setting started at 8-12cm then dropped it to 6-11cm for last week.
Pressure: median:11, 95%:11.7, max:11.7
Leaks: median:1.0, 95th%: 13.0, max:28.8
Events/hr: AI: 2.5, HI:3.5, AHI:6.0, CA:1.6, OSA:0.7, unknown:0.2, RERA:1.1, CSA:average/night.
3 mins or 1%

When seen like this the CSRs don't look so bad but on individual nights they can seem quite scary.
As you can probably tell, I'm still unfamiliar with OSCAR and trying to upskill myself as I go, but there is still much I do not yet understand about the graphs and figures. So it's hard for me to know what are OK numbers and what I should be concerned about.

As soon as I learn how to configure things (eg remove calendar) I will post more images.
Thanks again for your advice.

[morgana]

[attachment=72537]

Hi folks
I was getting too many CA, RERA, U/K and CSRs. I had some useful help from this forum (thanks SeePak) and increased my pressure from 6-11 up to 8-11. 

I also disabled ramp and turned off auto start. It's been three nights and CAs are 0.3 but AHIs remain similar, all comprising H, RERA, and two occasional CA.  

Should I increase my minimum (or max) pressure, or use EPR. Might the CAs increase If I use EPR?

Some advice would be greatly appreciated.

(Apologies for the screenshot - I followed all the instructions but could not attach file so this was the absolute best I could manage)

[staceyburke]

You have 2 main problems.  First is You are having positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

2nd you have very high flow limits.  To try to help with FL we use EPR.  I would suggest you try EPR on full time set to 3.  Flow limits are apnea also just like O and H events but they do not last long enough to be classified as apnea (10 seconds or more).  But they can stop you from getting into deep sleep and can wake you up.

[morgana]

Thanks for responding. I'll try your suggestions.

[SeePak]

Hi Morgana.

A moderator may want to combine your threads to keep your info. together in one place.

[OpalRose]

morgana,

Your two threads have been merged and retitled. This makes it easier for those that advise to see your history in one place.

Going forward, please use this thread. Thanks