3 months new user, questions

[GeneticCowboy]

Good evening, and first of all, THANKS! After three months, I was just about ready to give up on CPAP therapy, and after discovering this board a week and a half ago, was able to make some adjustments that's made it much more bearable. Thanks to the authors of the getting started and newbie wiki's, they're extremely helpful. That being said, I'm still having some issues.
I've loosened my mask to a fit that doesn't give me headaches and maintains a seal, but I still wake up with my nose hurting (AirFit F30).
I have a hose buddy that helps a lot, but cannot turn over onto my right side without pulling on the mask.
My sleep has improved since implementing changes a week and a half ago, but the three month journey so far has been pretty horrible, with my subjective sleep quality being worse until finding this forum, and being about the same as before with making adjustments (which is not good).
Most nights, I wake up to my mask blasting me at high pressure at some point (usually early, but sometimes later), and no matter how long I breathe normally, it continues to blast at a pressure that doesn't allow me to sleep, or will cause leaks because my mask has been wiggled to much during sleep. I've been resorting to turning the machine off, then back on again to get it to stop, but it's very disruptive to wake up to that.
I get that with the changes, the first three-ish months may not have been helpful at all, but any recommendations based on this?
Original diagnosis was an at home test: 15 AHI
First 84 days with CPAP 2.0-9.3 AHI
Last 1.5 weeks AHI 0.9-3.3

(From a couple of nights ago, forgot to put my memory card back in) You can see around 6:00AM the blasting that happens that I shut off, most nights it happens in the first hour of sleep, which is very disruptive.

[ozij]

The unpleasant blasting is clearly a response to flow limitations.
The flow limitations happen when your pressure drops.
Your pressure drops because it can - the minimum is too low for your needs.
And you really don't need a ramp of 4.0

I'd try to raise my minimum pressure.
Your aim should be to get to a minimum of 7 or 7.2 as soon as you can. By which I mean raise your minimum at a rate you find tolerable, I do not mean raise it quickly. You want to get to a point where the machine won't drop down to where you have flow limitations.
I suggest 7 or 7.2 because it looks like that to me on this single night's graph, and because that's your reported median pressure. Which means you spend half the night at or above 7.18, according to this chart.

I use an F30 when I use a full face mask, and I think you must be doing something wrong that makes it hurt your nose. ResMed has videos on how to fit that mask, and how to handle which type of leak.

Do your mask fitting when you're wide awake, during the day, not when you want to go to sleep.
Do it lying down, let your jaw drop gently to see how the mask maintains its fit when you do that.
Use the "mask fit" option - it lets you test the fit at the highest pressure the machine generates.
And by patient when looking for the correct fit.

Welcome to the forum!

[SDBud]

The unpleasant blasting is clearly a response to flow limitations.
The flow limitations happen when your pressure drops.
Your pressure drops because it can - the minimum is too low for your needs.
And you really don't need a ramp of 4.0

I'd try to raise my minimum pressure.
Your aim should be to get to a minimum of 7 or 7.2 as soon as you can.

I use an F30 when I use a full face mask, and I think you must be doing something wrong that makes it hurt your nose. ResMed has videos on how to fit that
mask, and how to handle which >type of leak.

I agree. Even small changes can make a big difference. I went from 12 to 12.4, and dropped my events from 5+ to generally under 2, and often 1 or even less.

I use the F20 masks, and switch between the AirTouch and the AirFit every 4-6 days, or I'll get a sore on the bridge of my nose, slightly different places from each mask.

[ChicagoGranny]

I've loosened my mask to a fit that doesn't give me headaches and maintains a seal, but I still wake up with my nose hurting (AirFit F30).
I have a hose buddy that helps a lot, but cannot turn over onto my right side without pulling on the mask.

That's why I use the ResMed AirFit F30i (https://www.cpap.com/productpage/resmed ... -face-mask). The hose does not attach to the mask. It attaches to the headgear and does not pull on the mask.

Find your model mask on youtube and watch some videos on fitting and adjusting.

Ozij is correct. Your minimum pressure is too low. That's why you are feeling sudden increases. You could change it to 7.0 or even 10.0. Check the results the next day in OSCAR and fine tune.

[Sheriff Buford]

Make sure there is enough slack in the hose, coming from the top of the Hose Buddy, to allow you to turn on both sides, when lying down. Thank goodness the hose is stiff enough to allow the excess hose to lie on the bed, and not on you. The Hose Buddy should "swivel" with you as you flip around.

Sheriff

[GeneticCowboy]

The unpleasant blasting is clearly a response to flow limitations.
The flow limitations happen when your pressure drops.
Your pressure drops because it can - the minimum is too low for your needs.
And you really don't need a ramp of 4.0

I'd try to raise my minimum pressure.
Your aim should be to get to a minimum of 7 or 7.2 as soon as you can. By which I mean raise your minimum at a rate you find tolerable, I do not mean raise it quickly. You want to get to a point where the machine won't drop down to where you have flow limitations.
I suggest 7 or 7.2 because it looks like that to me on this single night's graph, and because that's your reported median pressure. Which means you spend half the night at or above 7.18, according to this chart.

Thanks for the explanation, I raised my minimum to 6.0, will increase again to 7.0 tonight. Just looking through the data with your explanation has helped my understanding a lot. Just to make sure I'm understanding, from my original graph,
It looks like events happen with more frequency when my pressure is below 7.5, then the CPAP increases the pressure to get me through the event.
Flow limitation precedes or marks the start of each event, indicating that the CPAP needs to increase pressure.
A rapid increase in pressure may be causing me to wake up, so with that understanding, and the above:
Increasing the minimum pressure will
1.) reduce the number of obstructive events I have and
2.) reduce the need for the CPAP to increase the pressure significantly, reducing the amount I wake up

Is my understanding correct here? Pressures <= 11 don't bother me, I can tell it's a higher pressure, but I very rarely have problems at that pressure.

I'm making a trip to the CPAP equipment supplier to get fitted on a different mask, although the F30 is much better than the AirTouch F20, it's still not great. I'm looking at the Amara View primarily, but any recommendations are welcome. For reference, I have a long, lean face with a large nose and big, full beard.

Last thing, looking through multiple nights with my wife, we both noticed that I have significantly more events when I drink... which makes perfect sense, but it's sobering (lol) to see the data show that consistently. Yet another reason to work on reducing my alcohol intake.

[Pugsy]

then the CPAP increases the pressure to get me through the event.

No the pressure increase isn't going to "help you through the event that is happening" because none of the auto adjusting algorithms will ever increase the pressure DURING the apnea event (they can't generate enough pressure to blow open the sagging airway). Instead they wait until the airway is open and then it evaluates what just happened and then decides whether to increase the pressure in an effort to better PREVENT that from happening again.

Snores, Flow Limitations are also part of the evaluation process.
It's not just OAs and hyponeas that drive the pressures.

The whole idea of minimum pressures is to use enough to prevent the bulk of the airway collapses and if it needs a little bit more pressure for random oddball stuff it can get their quickly enough to prevent further collapses.

Your minimum pressure setting is your most critical setting choice to make.

[ChicagoGranny]

I'm looking at the Amara View primarily

I used that mask for a couple of years. IMO, the ResMed F30 and F30i are better masks. I prefer the F30i.

Find the masks you are interested in on cpap.com. There you will find pics, specifications, ratings and reviews.

[GeneticCowboy]

then the CPAP increases the pressure to get me through the event.

No the pressure increase isn't going to "help you through the event that is happening" because none of the auto adjusting algorithms will ever increase the pressure DURING the apnea event (they can't generate enough pressure to blow open the sagging airway). Instead they wait until the airway is open and then it evaluates what just happened and then decides whether to increase the pressure in an effort to better PREVENT that from happening again.

Ok, that makes more sense to me now, and why minimum pressure is so important. I really appreciate the help, my most recent appointment with the DME was great, and she seemed very disappointed that my sleep doctor so obviously didn't examine my case (recommended losing weight, I'm on the low end of BMI, and would be underweight if I didn't work out regularly).

I've adjusted my minimum pressure up, removed the ramp auto time for just a 5 minute ramp, and I've been living with it for some days now. Much better, haven't had a leaf blower to the face incident since I revised up. AHI's are lower on average, I've had a couple of nights below 1.0.Generally feel better (finally!). Tried the Amara View, absolutely hate the plastic on it though, so I'm going to return it for the F30i, and keep using the F30 for now. Last night's graph below. I'm thinking that I'll bump the min pressure up more, I'm not having any problems with the pressure at all now, so if I can prevent more events, so much the better.