tkblizard - Therapy Help

[tkblizard]

Hi all.  Thank you for this forum - I have learned so much already just lurking around. 

I've had my Airsense 11 for about 2 weeks, and am on my second mask with a few night trials.  Because I am a big stomach sleeper, then side, and rarely back I have been trying mask versions with the hose at the top. My first mask was a nasal cushion, but because I am often congested and will mouth breath (working on the congestion), that failed miserably and I moved on to the ResMed full face F30i (sits under nose and covers mouth, not sure if this should be full face setting on Airsense).  This seems to fit fairly well, but I'd love your advice on a few things as I still spend much of the night awake:

1.  My biggest challenge is that increases in pressure wake me up. Through this board I learned it might be best to turn off ramp, which I think has helped some. My original settings were 5 to 18, which I tried changing to 6 to 10 to keep the machine from making me feel like I was in one of those tornado machines you see at amusement parks.  But I just picked those and don't know if 10 is high enough.  Or if I just picked a set pressure of say 9, would that be ok to try?  I attached OSCAR data cleaned up as best I could (not sure how to make left side bar text smaller so it all fits there), so you can see where there was a pressure increase that woke me up (@2:00) and the high pressure bothered me so much I reset the machine.  I also attached a zoom of that episode(s), not sure what happened and if some of the OA marked there are after me waking up and adjusting.

2. With the masks that send air through the headpiece like the F30i, when I am on my side and happen to cut off all of that air by laying on it - does the machine interpret that resistance as being a OA and increase the pressure?  The sound change is pretty bad, are masks designs with the hose below not so noisy?

3. Last night I was kept awake for a really long time after the big wake up @ 2:00 by what felt like tiny pulses during the second half of an inhale. This behavior wasn't there as far as I could tell during the first hour (was laying awake), but happened later on. I couldn't tell if the flutter was water in the hose (didn't find any), the tiny flaps in the mask where the air comes in, the small bit of mask that separates the nostrils or what.  In searching for pulsing on this board I learned about FOT (forced oscillation technique), which might have been the pulsing I felt.  But does it do that on every inhale, or only when you start to have an OA?  I was wide awake and breathing slowly (pressure was 6.0) and could feel it on every breath - feels like when you are trying to catch your breath during a big cry.  The quiet period after the 2:00 am period to nearly 4 am I think I was awake bothered by the flutter.

Thank you for any input or anything else you see!

   
   
   

[PeaceLoveAndPizza]

Most of what you are experiencing is due to it being a new experience. There is no tornado in the machine. In fact, even at maximum pressure it could not blow up a balloon. What you are feeling is very typical for many. 

Given time you will barely notice the machine, mask, and pressure. That statement is based on you finding a mask that feels right and pressure that handles your events.

To your questions…

#1: Your current settings need some tweaking as you are reaching maximum pressure due to flow limitations. Give the following a try:

Min pressure 7
Max pressure 12
EPR 3 full-time
No ramp

That should help with the comfort and handle most events. After a few nights post some charts and we can help tweak things from there. 

#2: Things sound far different to you as the wearer of the mask than to someone a few feet away. When you occlude one of the sides of a top connection mask, the other side has to increase to compensate so noise will increase a bit. Connections on front do not have this problem. It is a comfort thing. Different masks work different people.

#3: The pulsing could be FOT, but that typically is a very small increment in pressure and hardly noticeable. Most likely you are focusing on what is happening and being a bit obsessive about everything the machine is doing. We all do it as it is a new experience. Learn to relax, breathe with the machine, and you will find things go much more smoothly.

[Sleepster]

2. With the masks that send air through the headpiece like the F30i, when I am on my side and happen to cut off all of that air by laying on it - does the machine interpret that resistance as being a OA and increase the pressure?  The sound change is pretty bad, are masks designs with the hose below not so noisy?

Air has to escape through those vent holes (the exhalation port) to prevent you from re-breathing your own exhaled air. Some masks tend to be noisier than others, but I don't think it has anything to do with the hose placement. I don't know if it has any effect on the OA index or if it causes a pressure change. Regardless, it needs to be avoided because you don't want to re-breathe your own exhaled air!

I couldn't tell if the flutter was water in the hose (didn't find any), the tiny flaps in the mask where the air comes in, the small bit of mask that separates the nostrils or what.

I've had this problem when a tiny droplet of water gets on that flap.

I agree with PeaceLoveAndPizza's advice. Most of what you're experiencing is part of the adaptation process. Keep in mind that even though the goal of CPAP therapy is to get a better night's sleep, for many of us the first couple of months are spent getting a terrible night's sleep because the pressurized air, the hose, and the mask are all a bother. But you will get used to it. Soon you'll have to hold your hand near the exhalation port to verify that the machine is on, because you are so used to it that you don't notice it anymore. At first there will be the occasional morning where you wake up feeling like you got at least some good sleep. Eventually those mornings will get more and more frequent. You'll start noticing that you feel better than you have in years.

The key to adaptation is to use the machine every time you sleep, all the time you are sleeping. You're on your way to a better life ...

[tkblizard]

Thanks so much for the suggestions - it does make sense that it will take some (or a lot) of getting used to.  

I also wondered about upping the settings given it seems to be maxing out a few times.  I will try that - I did make it night before last for 4 hrs with relatively few events.  I zoomed into the one at the end that caused me to wake up and then de-mask - is the FOT actually the pulses I've circled in the attached image?  It looks like the machine is testing then finally decided to up the pressure?  If it only does that during events, then maybe the pulsing I'm feeling is something else or over-sensitivity.

What I find very interesting is when I do wear the mask, my restlessness seems to be about half of what it is without the mask (according to my Garmin watch).  I don't know if I am moving less because trying to be careful with the mask, or because I move a lot normally because I need to reposition to get air.

   

[BoxcarPete]

Yes, that is FOT circled in your chart. I doubt it was the FOT that woke you up, more likely the apnea did. You noted that you notice it during later portions of inhale, that should not be the case since the machine should only trigger the pulses in response to four seconds of zero detected flow. I suppose if you inhaled slowly and steadily enough it could be confused with a small leak, which could happen if you were awake and taking long deep relaxation breaths, but otherwise I don't think that's what it would be.

If you still have your nasal mask, you can try taping your mouth with the nose gear on. I have personally found that a full face mask doesn't treat my OAs as well as a nasal mask for some reason, and comes with a whole host of other trouble, so I have been taping with 2" cover-roll tape lately instead. Keep working on stuff, try new things, and most importantly stick with it. I've had some nights where I was afraid to put on the mask for fear of the aerophagia, along with apnea clusters which were every bit as bad as my initial sleep study au naturale, so I made another change. Maybe I'll get sick of looking at the roll of tape and dread sticking it to my face, so I'll put the full mask on again.

If you get half the night, it's a victory. If you get 3/4ths, it's a better victory. If you go the whole night, pat yourself on the back and do it again. Your smartwatch has noticed that your sleep is better, and I don't think it's just because you're subconsciously avoiding tossing and turning to keep your headgear on.

[PeaceLoveAndPizza]

Yes, those are the FOT oscillations. You can see it in the flow rate as well.

it is not a bad idea to bump up your pressure a wee bit. Basically to what I said in my previous post.

Min pressure 7
Max pressure 12
EPR 3 full-time

Depending on how things go you may want to drop EPR to 2, but give those settings a try for a few days and decide.

[Sleepster]

What I find very interesting is when I do wear the mask, my restlessness seems to be about half of what it is without the mask (according to my Garmin watch).

Why are you sleeping without the mask? All that does is increase the length of the adaptation process and increase the risk of cardiovascular disease and stroke.

I would urge you to follow the advice given about your pressure settings, and then update your profile to indicate the new settings.

Take a look at your flow rate graph just before those pressure oscillations. You see how it takes on a weird shape? Check the flow limitations graph, I would be interested to know if it spiked during that period of time. Weird-shaped flow rate graphs can often precede apneas, raising the flow limitation, and causing a rise in pressure. It's the machine's algorithm's attempt to preempt an apnea and prevent it from ever occurring. Looks like it didn't this time!

[tkblizard]

Hi all, so appreciative of this board.  I have learned so much from you all!  I received my AirSense 11 last Dec/Jan and I tried several nights back then to hone in on good settings, learned OSCAR etc, tried a few masks.  Then I got a horrible cold/congestion, weeks of coughing, think I cracked a rib, and it all went out the door and I stuffed everything in the closet.  After excessive daytime sleepiness, I pulled it all out again two weeks ago and have been giving it another go and have made better progress with some titration and following advice seen here on the boards. Some nights seem pretty good and others not so much, even with similar settings. One of my main challenges now seems to be I can make it through the first four or so hours, but then all heck breaks lose and I get leaks, or a pressure surge wakes me up and I get frustrated and want to sleep without having to adjust anything.  

I'm currently using the F30i mask, but have ordered out of pocket two other similar masks (under nose, over mouth) to try soon as I think leaking might be part of the problem? I would say before this journey I was a stomach sleeper (think I've trained myself to do that to avoid snoring too much) and a mouth breather.  Now I think I might actually prefer nose-breathing but my mouth still opens maybe positionally? I also have an appt with an ENT soon as my nasal passages are super narrow from we think inflamed turbinates.  I tried a neck brace but ended up with crazy neck cramps. 

Anyhow, would love to have your all look over some of my data and see if anything jumps out at you?  Sorry if these paste huge - not sure if they turn into thumbnails after I post.  I wish I could correlate/track my body position to see if I am switching to back sleeping in the wee hours! I get pretty depressed right before going to sleep knowing I'll have to manage things all night.   Here also is a link to Sleep HQ  T's data not sure if it shows all the data I have or not (Oct, Nov, last Dec, Jan)

Attachments:

A good night, I think?
   

Pretty awful towards morning (maybe I was on my back and the max pressure not high enough?)
   

Last night - could only stand it until about 3 in the morning, then the leaking kept bothering me and I just couldn't deal anymore
   

Many thanks for any ideas!  I'll post my sleep study next

[tkblizard]

My sleep study

Page 1
   

Page 2 (my O2 never seemed super low - can someone have moderate apnea, but mostly because I snore a lot - is it really bad enough to need cpap?)

   

[staceyburke]

The night with all of the O events in the morning, 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.