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New here, trying to optimize treatment - sweetbobby - 02-05-2024
I have been trying to get serious again about my treatment, and I have settled on using nasal pillows on my ResMed Airsense 10 machine. My mouth tends to open when I sleep, but I find the nasal pillows more comfortable and have a much lower AHI score with them than the full face masks. That said, I am open to trying to commit to a full-face mask if it is the right decision in the long run. I'm currently using a chin strap but it has been falling off during the night, so I imagine I'm getting mouth leaks after that happens.
I've posted shots of the last three nights (on the second night, my son woke me up and I fell back asleep in his room). I think I need to increase the minimum pressure, since every time it goes down toward the minimum I have events and the pressure shoots right up. if the 95th percentile of pressure is about 16, should I try to work my minimum pressure to about 14 or 15? What do you all think?
RE: New here, trying to optimize treatment - icipher - 02-05-2024
What types of full face masks have you tried? I use a resmed F30i FFM. It is very comfortable and less intrusive than the old Mirage Quattro I used to have. One thing I love about it, is that it acts like a breathe-right strip as the pillow part of it inflates up against your nostrils and opens them up so you can breathe through your nose better.
RE: New here, trying to optimize treatment - sweetbobby - 02-05-2024
The nasal pillows I use are the P10. The full face mask I have is an AirTouch F20.
I tried the F30i in the past. I think part of the problems I have is that I have a big face/nose, and even the large sizes don't feel like they fit well around my mouth and I end up waking up with big leaks (whose sounds my wife does not appreciate). I had ruled out the nasal pillows in my first, failed attempt at CPAP because of the mouth leaks, but now that I have more knowledge I don't necessarily want to give up on them just yet. If anything I might try to go for the P30i since I move quite a bit when I sleep.
RE: New here, trying to optimize treatment - OpalRose - 02-05-2024
Everything on your graphs points to the need for higher pressure. The Obstructives, high flow limitation, Hypopnea, Reras...... and snores.
If you can tolerate higher pressure, start your minimum pressure at 15 with maximum set to 20. Keep EPR at 3.
Change the response setting from soft to standard. If you must use ramp, set it closer to the minimum pressure for 5-15 minutes. Try ramp at 10 or 12.
One thing, watch how you are sleeping. There is some evidence of positional apnea, where you may be sleeping in a position that cuts off air. Watch for clumps of apnea (Obstructives and Hypopnea) on your graphs. It's not too bad though, so no worries for now.
Try these settings for a few days and see how you feel.
RE: New here, trying to optimize treatment - sweetbobby - 02-05-2024
(02-05-2024, 11:18 AM)OpalRose Wrote: Everything on your graphs points to the need for higher pressure. The Obstructives, high flow limitation, Hypopnea, Reras...... and snores.
If you can tolerate higher pressure, start your minimum pressure at 15 with maximum set to 20. Keep EPR at 3.
Change the response setting from soft to standard. If you must use ramp, set it closer to the minimum pressure for 5-15 minutes. Try ramp at 10 or 12.
One thing, watch how you are sleeping. There is some evidence of positional apnea, where you may be sleeping in a position that cuts off air. Watch for clumps of apnea (Obstructives and Hypopnea) on your graphs. It's not too bad though, so no worries for now.
Try these settings for a few days and see how you feel.
Thank you for your advice. I think I will take a stab at it tonight with a full-face mask and see how it goes. I've also been trying to condition myself to sleep on my side to avoid the positional apnea.
RE: New here, trying to optimize treatment - OpalRose - 02-05-2024
Perfect!
Post another couple charts when you're ready...
RE: New here, trying to optimize treatment - sweetbobby - 02-07-2024
(02-05-2024, 12:30 PM)OpalRose Wrote: Perfect!
Post another couple charts when you're ready...
Thank you so much for your kindness and generosity!
OK, so obviously two is still a very small sample size, but my RDI did go down with these pressure adjustments. I slept with the full face mask both of these nights, but this past night after the break I tried my nasal pillow mask (and yes I did change the machine settings). One of the questions I have now is whether I should keep the max at 20cm. Before I went to bed, I ran mask leak tests at 20cm and I had to tighten the mask significantly to not fail it, to the point that my nose bridge felt bruised when I was awakened after 3:30am last night, which led me to switch masks.
Looking at the first night I did the change, the pressure would peak at about 17cm and then come down a bit. The moments where pressure did spike seem to be clustered, so it could be positional apnea (I move a lot at night). The cluster around 12:20am last night was also probably triggered by positional apnea.
I think the full face mask is doing a much better job containing leaks (though my P10 nasal pillows and strap are fairly old, so I wonder if new ones would improve the leak rates), but I fear that keeping the max pressure so high does more harm than good. Should I reduce the max pressure down to 19cm or 18cm and REALLY try to make sure I don't sleep on my back?
Note: I do have a Releaf soft cervical collar that I could use and have not been using.
RE: New here, trying to optimize treatment - OpalRose - 02-07-2024
Actually, move the max pressure down to 17.
The EPR 3 doesn't seem to be bringing the FL down, maybe due to leaks and movement, but to keep it from raising pressure for no reason, change the response setting back to soft.
Which mask are you most comfortable with? I will say this... when you use a P10 mask, you need to be sure your nasal pillows are not stretched out. They tend to get soft and floppy and won't seal properly. Also, the straps should not be over tightened.
What mask you used on the 6th, second half of night seems to be better.
sweetbobby's apnea treatment - sweetbobby - 02-08-2024
(02-07-2024, 10:19 AM)OpalRose Wrote: Actually, move the max pressure down to 17.
The EPR 3 doesn't seem to be bringing the FL down, maybe due to leaks and movement, but to keep it from raising pressure for no reason, change the response setting back to soft.
Which mask are you most comfortable with? I will say this... when you use a P10 mask, you need to be sure your nasal pillows are not stretched out. They tend to get soft and floppy and won't seal properly. Also, the straps should not be over tightened.
What mask you used on the 6th, second half of night seems to be better.
Good morning! Thank you so much again for taking the time to help me out. I paid it forward somewhat when I helped a good friend with his settings yesterday when it came up on a phone call (poor guy had ramp set at 4 with EPR 3)! I heeded your advice and brought the max pressure down to 17 and used my P10 nasal pillows, which seem to generate way fewer flow limit issues than the F20 mask as you noted. I slept without a chin strap and still had a RDI of 0.94, which is one of the best I've had, so this is encouraging. There do seem to be some mouth leaks toward the end of the night, but no associated events. I do still wake up multiple times during the night and think a lot of the events may have occurred during arousals. I'm also getting a new pillow and head-strap today, so I hope they help. I'll keep going at the current settings and see how it goes. Hopefully I'll eventually get to more restful sleep... I still wake up feeling exhausted!
RE: New here, trying to optimize treatment - OpalRose - 02-08-2024
Looking better! How do you feel with using ramp? Does the change in pressure bother you? If it does, you can move it up closer to the minimum setting or try to not use it.
The 95% FL is down, so that's good. I would try to stay with these settings for a few days and then reevaluate. How you feel is important. Hopefully, in time, you'll be able to sleep more soundly.