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+--- Thread: [CPAP] Starting therapy - 3 days in, help and recommendations (/Thread-CPAP-Starting-therapy-3-days-in-help-and-recommendations)
Starting therapy - 3 days in, help and recommendations - joedes - 04-18-2024
Hi everyone,
I am a male, 47 years, BMI within normal range, no smoking, no other underlying conditions.
Since forever, I've had a deviated septum, my nose is often blocked (diagnosed with enlarged turbinates), and large tonsils.
I was diagnosed with severe OSA recently, following a sleep study that showed an AHI of 63, and a low SaO2 of 81%;
also exhibiting no N3 sleep and very little REM sleep (5.6%), indicating poor sleep quality and structure.
I started APAP therapy 3 days ago, using a Lowenstein Prisma Smart, and APAP set by the doctor at 4 - 15, with ERP of 2.
Using a Philips Dreamwear pillow nasal pillow - I also continue using nasal strips (breatheright) that I have been using for a long time, and that I feel help me a bit with breathing.
Normally I sleep on my stomach, since CPAP started, I have slept on the side, as on the stomach it's difficult for me.
In the last 2 nights, OSCAR shows AHI of 15 and 13. My device (Prisma) showed 13 and 10 on their app.
My experience so far has been a bit odd. I wake up and can't sleep when the pressure goes high (above 10 or so).
- You can see in the first night, I actually moved the max pressure to 9 manually in the middle of the night.
- For the second night, I set the max to 12 and it worked (as in, I was able to get some sleep). However I only used CPAP after falling asleep in the sofa, so the night shows shorter than it was
- I have also learned how to move my tongue up while sleeping, but from time to time I still move it done and open my moth with air coming out
Although it seems the AHI numbers are quite high, and I get a very low % of deep sleep, it's strange but I feel more rested in the mornings than usual.
I'd appreciate if you can help with the Oscar results attached, with any recommendations on pressures, or treatment approach or any tips.
* I have tried to capture the essential data in the screenshots, but given I am on a Lowenstein, I think some charts (like Flow Limitation) are not available.
Let me know if I should provide any more charts.
[attachment=62887] [attachment=62886]
RE: Starting therapy - 3 days in, help and recommendations - Deborah K. - 04-18-2024
Your beginning pressure is too low for anyone but a small child. I suggest that you raise it to 7.
Your flow limits are very high. I can't see your EPR settings, but I suggest you raise them to 3 full-time, and turn off ramp if you are using it.
You have tons of positional apnea. No setting can fix this. This shows when you have apneas clustered together (except for CAs). These are caused when your chin is tipped toward your chest causing a bend in your airway, like a kink in a hose. You need to do something to keep your chin up. Most here buy and use a soft cervical collar. When I used them I tried a lot of models but liked the Caldera Releaf Collar the best by far. You can get this on Amazon.
That should give you a start in improving your therapy and comfort. Good luck!
RE: Starting therapy - 3 days in, help and recommendations - PeaceLoveAndPizza - 04-19-2024
Deb K is spot on. I would take it a step further and recommend:
Min pressure 7
Max pressure 15
SoftPAP 2
SoftSTART OFF
That way we will know more about how you respond to the pressure support and if it impacts your flow limitations that are driving pressure up. Once you have a few nights we can start tweaking from there.
RE: Starting therapy - 3 days in, help and recommendations - joedes - 04-22-2024
Thank you so much for the advice.
This is what I have done since the first post, as recommended:
- Moved APAP min to 7 and max to 15
- Set SoftPAP at 2 (I have a Lowenstein, 2 is the highest setting, I understand this is equivalent to EPR?)
- SoftStart off
In addition:
- I have started using a soft cervical collar that I had from a past neck injury. Ordered Caldera Releaf collar too but it has not arrived yet
- Every day, I have used a nasal strip (breathe right), and also started using fluticasone propionate, as I read it helps some people with blocked sinuses (like me)
- I have experimented with various levels of mask tighteness, to try and find the minimum tightness that works
Btw, I realized I am using a Philips Dreamwear nasal mask, not pillow (as I wrongly thought in my first post)
Experience so far and observations for the last 3 nights (with OSCAR screenshots below):
- The AHI still 'high', varying from 11 to 15 depending on the night
- I understand that most of the apneas are hypoapneas, rather than obstructive apneas
- Not sure if they are still 'positional', as I don't know how to interpret the data
- I believe I have a very high number of Flow Limitation. I believe Inspirational but might be wrong.
- The last 3 nights, I wake up quite tired, with mild headache, and a 'foggy' feeling
- AHI is much lower than the baseline on the sleep study, but I still have many sleep interruptions, with very little deep sleep
- Since the pressue auto-adjusts to 15 often, the noise of the machine, and even more of the mask, is quite noticeable and disturbs my sleep
- Also, at times I wake up from the pressure built up in my mouth, which I keep closed with tongue up most of the time
- Overall I am having a poor sleep experience, perhaps even worse than before using CPAP/APAP
Next steps:
- I have now ordered a Resmed N30i nasal mask, and a pillow accessory too, to try if the noise is more bearable, but have not received them yet
Questions:
- I am diagnosed with inferior turbinate hypertrophy. A doctor recommeded I do surgery actually but have resisted for now.
Could this be the cause for the high flow limiation? Any advice on how to proceed?
- Since the noise is disturbing me when reaching a pressure of 15, should I try to lower APAP max setting to release some pressure and perhaps get a better sleep?
- Would you recommed taking chamomille / valerian? I do it sometimes to help me sleep, but not since CPAP treatment started
I have hope, but so far after a week, I am not better off in terms of feeling in the morning.
Any other advice much much appreciated.
Oscar screenshots below:
[attachment=63021] [attachment=63022] [attachment=63023]
RE: Starting therapy - 3 days in, help and recommendations - joedes - 04-24-2024
Updating and hoping to get your thoughts.
After the previous post 2 days ago, this morning I felt slightly better after some adjustements to mask position and increasing the min pressure to 8.5 and reducing max from 15 to 12.5.
This adjustement gave me an AHI of 10.45, slightly lower than other days, but I got 10% of deep sleep, which other nights was close to 0.
I felt a bit more rested, but still far from optimal.
Not sure if reducing max is 'correct', but I have noticed with pressure above 12.5, I simply cannot sleep...
I still have lots and lots of flow limitations, I suspect it is because of my deviated septum and turbinate hypertrophia.
And also a large number of leaks.
Below is my Oscar data for last night, and a zoom in of the flow rate.
Any advice?
[attachment=63107] [attachment=63108]
RE: Starting therapy - 3 days in, help and recommendations - HalfAsleep - 04-24-2024
IME if your nose is blocked, it's going to be difficult to get effective therapy with a nasal mask. I tried this a while ago. It made me need to breathe through my mouth; this meant my leaks were functional (i.e. I needed them to breathe), and not just from positioning.
I recently had septoplasty and turbinate reduction. It has made a big improvement on my quality of life in general. It seems very strange to be able to breathe through my nose. So, I suggest you consider the surgery not just as a sleep-quality thing, but as more of a generalized life quality improvement.
As far as sleep aids, IMO most people have their favorite things. Sometimes, just winding down over a few hours works, sometimes herbal tea, sometimes less screen time, sometimes melatonin. A board member here suggested a bedtime cereal. This is my new fave.
RE: Starting therapy - 3 days in, help and recommendations - Deborah K. - 04-24-2024
You have positional apnea. On your chart, this shows up as obstructive apnea and/or hypopneas that are clustered together. This happens when your chin tucks toward your chest. It is similar to a hose that has a kink in it, slowing down the water that should flow through. Positional apnea slows down the air that needs to get through. No setting can fix this. You need to try sleeping on a lot flatter pillow. If that doesn't work, most people buy and use a soft cervical collar. The one I liked best was the Caldera Releaf Collar which I bought on Amazon. Good luck with solving this.