sleepyveem's therapy thread

[sleepyveem]

Hi all,

I'm just discovering this resource as I've started to take my CPAP therapy more seriously.  I've had a lot of ups and downs since getting my Resmed Airsense Autoset 11 in March 2022 in APAP mode, after being diagnosed w/mild OSA. I appreciate any advice y'all have!

Main issue I'm experiencing:
My main issue is that I'm sleeping well until my first wake-up, when I go to the bathroom and come back and fall asleep just fine.  But then, I continue to wake up repeatedly for a few mins at a time which also results in me usually shifting my sleep position.  And this happens repeatedly throughout the night. It is on the rare occasion that I wake up feeling rested (see below, this happened on 9/7) but many nights are like 9/6 where I feel so unrested and wake up feeling terrible. 

After looking at OSCAR, I can see that my machine goes up to 7, 8 or 9cm and falls closer to 5 or 6cm after I come back to bed after peeing.  And it feels like that may be related to my constant wakings - the change in pressure?  I can't figure it out so everyone's help is much appreciated.  Also I understand that my AHI is pretty low (usually below 1) but I still wake up feeling like crap.  

I also do appreciate that my pressure range is pretty low (starting at 4 and maxing out at 10) so I'm not sure if an EPR of 3 is a good idea or not.  I also note that some of my wakings are stress-related; i.e. on vacation, I don't think about work and so I tend to sleep generally better, but its not always the case.

Masks:
I've switched to N30i from the P10 (I toss and turn a lot at night and N30i helps) and more recently switching back to P10 to try out the nasal pillows and liking it (much quieter than the N30i), and next trying the P30i next as I think it'll be best of both worlds.

Settings:
You'll see most of them on the OSCAR posts, but I've been wondering about EPR if it helps or not.  Its on, at 3cm, but I wonder if its contributing to my wakings.

Attachments:
I've appended below my doctor's test results from 3/22. I've also attached the OSCAR screenshots from two recent days - 9/6 I had a night of average sleep, while 9/7 I had a night of sleep where I woke up feeling rested.  I'd love to get some help in fine tuning my settings since my sleep doctor left me with the default settings for APAP without a follow up (I do have a follow up with them later this month though).  One thing to note is that I have lost some weight since this 3/2022 diagnosis.

March 20, 2022
Height: 68 
Weight: 181 
BMI: 28 

SLEEP STUDY TECHNIQUE 
Watch-Pat Study conducted as an outpatient ambulatory sleep study 

WITHOUT CHAIN OF CUSTODY - 4 CHANNEL RECORDING SYTEM - PNEUMO-OPT PROBE, PULSE OXIMETRY HEART RATE, BODY POSITIONERSNORE PROBE, RESPIRATORY EFFORT IS DETERMINED BY USING PAT. STUDY DATA Ambulatory

Watch pat Sleep Study Medicare cut-off for OSA is 5.0, the ranges are: 
Mild OSA = 5 -15 
Moderate OSA = 15-30 
Severe OSA = 30 or more events per hour 

Total Study Time: 8.2 hours (489 minutes) 
Start Study Time: 22:17:15 PM 
Stop Study Time: 06:26:15 AM 
Sleep Time: 401.5 minutes 
% REM of Sleep Time: 15.4 
Technical Signal Quality : 100 % 

RESPIRATORY INDICES 
pRDI4%: 16.8 (REM: 23.3; NREM: 15.6) 
pAHI4%:7.5 (REM: 4.9; NREM: 8 
Total AHI4%: 7.5 

pRDI4% supine: 24.3 
pAHI4% supine: 12.1 
pAHI4% non-supine: 3.6 

POSITION 
Supine Time: 3 hrs. 3 min. minutes 
Non-Supine Time: 3 hrs. 38 min. minutes 

OXYGEN SATURATION 
Oxygen Desaturation Events (ODI4%): 6 
ODI4% (Supine): 10.2 
Saturation < 90%: 0 minutes 
Saturation < 80%: 0 minutes 
Saturation < 70%: 0 minutes 
Lowest Oxygen Saturation: 90% 
Average Desaturation: 92.5% 
Average Oxygen Saturation: 94% 

PULSE STATISTICS (beats per minute) 
Mean: 61; Min: 46; Max: 101 

RESULTS - 
Mild positional OSA 
- Most significant sleep disordered breathing were noted in supine position 
- No significant Oxygen Desaturation 

RECOMMENDATIONS 
- APAP equipment has been ordered for member. 
- Positional therapy may be an alternative therapy option in this case

   

   

[Deborah K.]

Your starting pressure is way too low for almost all adults.  4 is designed for small children.  I suggest you raise your starting pressure to 7. You will get better therapy that way, and your EPR setting will finally work. You need to have pressure of at least 7 for EPR 3 to work.  This change will improve your therapy and comfort.

Best of luck!  

[sleepyveem]

Thanks Deborah!  I will try this and report back.

[sleepyveem]

Had much better sleep last night, the only thing I changed was min pressure to 7cm (overall AHI is 1.84) (Thanks Deborah!).  I did find that it felt like a lot of pressure, and found myself having to adjust but I will try it again tonight to see if I adapt.  But there are still numerous CA's and OA's towards the end of the night starting around 3:55a which I don't think is related to the 7cm change; its definitely a pattern as you can see in my prior OSCAR screenshots.  I did toss and turn a lot during this time, but I don't think I woke up much.  I did stay awake a bit after getting up a bit past midnight but I think that's because I'm getting used to the 7cm.

Anyway, here is the overall screenshot, and then another one zoomed into the period where the CA's and OA's begin, and then a third into one cluster of CA's and OA's to see that it looks like REM sleep and pressure is changing in response possibly to changing position.  Any help would be most appreciated, and thanks in advance.

   
   
   

[Deborah K.]

Did you have a lot of CAs in your sleep study? If you don't know, request a copy of your sleep study from your doctor's office. In the US, if you request a copy, by law, they have to provide it.

[sleepyveem]

I have a feeling I didn't have many CA's in my original sleep study, but I have requested it to confirm.

[sleepyveem]

Here's my Sleep Study report conducted on 3/20/2022 with WatchPAT.  Any insight would be appreciated.  I do have more data from recent nights, haven't been getting great sleep but willing to continue to power through.  I switched to a P30i last night, which stayed on my head better, and doing tongue training.  But any thoughts after looking at the report?

   
   
   

[sleepyveem]

I wanted to get everyone's advice on some changes I've made in my settings.  On 9/9/2024 I changed my min pressure to 7cm and it felt like a lot but I kept that setting until 9/12/2024 where I felt some aerophagia (medium discomfort in my stomach) and instinctively felt the pressure to be too much.  So in the middle of the night, I changed the setting to 6.4cm and EPR to 2, which as you can see on 9/12 I slept much better after.  Since then, I've kept the min at 6.4 and then the max at 8.4, and from the last couple of nights I've noticed that nearly every arousal at night is connected to a leak of some kind.  Just last night, I woke up 3 times from either mask leak or mouth leaks, so I'm thinking that if I zero in on minimizing leaks, then my arousals should decrease. 

To do that, I switched to the p30i (I've been a long time user of n30i) after trying the p10 for some time I liked it and its a lot less noisy than P30i/N30i and feels a bit better but I didn't like the way the p10's hose would make it difficult to change positions (I often change from side to stomach sleeping at night) but maybe there's a better

I also switched to a better sealing mouth tape.  I have facial hair so that's been interesting - I still notice some mouth leaks.  Also I'm trying to train my tongue as well.

Anyway, some insight based on my charts to corroborate my thinking would be great (or to not corroborate!)

9/10
   

9/11
   

9/12
   

---

Also here's last night's OSCAR result with the new settings - qualitatively I felt ok, but also went to bed late after a concert, so I don't take this one as a data point.  I'll find out tonight how it works for me.

9/13
   

[larrygreg]

I have always used nasal pillows, but as a side sleeper I found it created a lot of leaks.  Saw a video on Philips and bought the dream wear under the nose nasal mask. 
I use the small size but had 3 others
The hose ataches to the top of the frame. 
If you want you can keep the frame and switch to nasal pillow or full face mask. 
Found the under the nose hardly leaks.
Also wearing a cervical collar and using mouth tape

[Jay51]

Here are some mask leak tips from our Wiki:      Mask Primer                  Mask leak solutions