Trouble Getting Started

[4638675696]

Hello,

Upon the below feedback from my doctor, I got a ResMed AirSense 10 AutoSet with a warm air humidifier and an AirFit N20 mask. I have used it a few times during the day and can breath fine, but each time I try to sleep with it (3 nights) I simply cannot fall asleep, eventually take it off, then toss and turn the rest of the night from the initial disruption. The mask is comfortable enough, but it being on my face keeps my from sleeping. My mom swears by the "Philips DreamWear under the nose nasal mask" that she uses. I sleep on my stomach 70% of the time, back 20%, and side 10%. Any tips? I'd really like to progress with my use of it, but am struggling with work after multiple poor nights of sleep trying to adjust. AeroCare is my supplier and insurance will cover trials of different mask types.

Feedback from doctor:
Do not have full OSA
Hypnogram shows fragmented sleep
10.6% deep sleep
Deep sleep later in the night
Apnea-Hypopnea Index: 1.5/hour
Respiratory Even Related Arousals elevated: 20.2/hour
Respiratory Disturbance Index: 21.7/hour
"my brain is likely waking up from these RERAs"

[4638675696]

Hi Folks. I am writing to follow up again on this. I have been using the Philips DreamWear under the nose mask now and it is comfortable enough that I can wear for hours to practice during the day while awake. Right as I am about to fall asleep whether during a nap or if I try it at night, the pressure change of my APAP wakes me up, and then I am unable to get back to sleep until I take the mask off. I've waited as long as 2 hours+ after these awakenings and no luck. I am simply wide-awake unless I remove the mask.

I've been working with the respiratory therapist at AeroCare and following his advice, but still have never once been able to fall asleep with it on after trying for more than a month.

Any additional tips? I would really like to be able to reduce my RERAs and more restorative sleep.

[LSAT]

Talk to a real doctor..you may need a med for a while until you get used t the equipment

[4638675696]

Talk to a real doctor..you may need a med for a while until you get used t the equipment

Agreed and I am seeing a sleep doctor though, who prescribed the CPAP for this treatment, advised me to work with AeroCare, and then I have a followup appointment with him in June to maintain insurance compliance with the CPAP coverage. I can see him sooner if advisable, but want do so only if necessary as he is about $250/session, out of network, and I still have a ways to go before hitting my out of network insurance deductible.

Based on my numbers, a poster on another website today said that I probably have UARS. Does this have any impact on my current treatment - APAP with the help of a respiratory therapist?

[Miss Emerita]

Hello! Could you fill out your profile with your equipment? And are you using the Oscar software yet? And—sorry for so many questions—what are your pressure settings and EPR or flex setting?

[4638675696]

Hello! Could you fill out your profile with your equipment? And are you using the Oscar software yet? And—sorry for so many questions—what are your pressure settings and EPR or flex setting?

Thank you for your reply. I have updated my equipment in my profile. My ramp up time is set to auto, pressure starts at 5, max is 15, and I do not see the option for me to view or change EPR in the setup that AeroCare has provisioned to the device. I am open to using Oscar, but hadn't set it up yet since I've not actually achieved any asleep time while wearing it.

I have been reading more about UARS and some have said that a BiPAP or ASV may be better than CPAP for those with UARS vs. OSA. Any thoughts on either of these being a better option with the trouble I'm having getting to sleep?

[Pugsy]

Go here and download and read the clinical/provider manual for your machine if you haven't already.

https://www.respshop.com/manuals/ResMed ... %20her.pdf

EPR is the ResMed form of exhale relief. With the minimum pressure being 5 cm you aren't likely going to really experience it since the machine can't drop below 4 cm.

If you want to use EPR...you can make this current machine function like a bilevel machine...limited bilevel but bilevel nonetheless.
Using EPR drops the pressure upon exhale...a per cm drop per the setting but it can't drop below 4 cm since that is as low as the machine will go.
So you can try EPR at 3 (will need a higher minimum to feel the benefit though) and that's the same as using a bilevel with PS..pressure support...at 3. Pressure support is just the difference between inhale and exhale.

You might find that adding in EPR makes the breathing feel more natural and more comfortable and maybe more likely that you can fall asleep with it. Try it during the day....turn on EPR ...full time...set it at 3....change the minimum pressure to 7...and play with it to see how it feels to you....
This would be like a bilevel machine feels like except the bilevel can go with a PS higher than the 3 you can get with the AutoSet.
It will at least give you somewhat of an idea what bilevel feels like and functions like.

[4638675696]

Go here and download and read the clinical/provider manual for your machine if you haven't already.

https://www.respshop.com/manuals/ResMed ... %20her.pdf

EPR is the ResMed form of exhale relief. With the minimum pressure being 5 cm you aren't likely going to really experience it since the machine can't drop below 4 cm.

If you want to use EPR...you can make this current machine function like a bilevel machine...limited bilevel but bilevel nonetheless.
Using EPR drops the pressure upon exhale...a per cm drop per the setting but it can't drop below 4 cm since that is as low as the machine will go.
So you can try EPR at 3 (will need a higher minimum to feel the benefit though) and that's the same as using a bilevel with PS..pressure support...at 3. Pressure support is just the difference between inhale and exhale.

You might find that adding in EPR makes the breathing feel more natural and more comfortable and maybe more likely that you can fall asleep with it. Try it during the day....turn on EPR ...full time...set it at 3....change the minimum pressure to 7...and play with it to see how it feels to you....
This would be like a bilevel machine feels like except the bilevel can go with a PS higher than the 3 you can get with the AutoSet.
It will at least give you somewhat of an idea what bilevel feels like and functions like.

Thank you! I will review this and give it a try.

[Miss Emerita]

OP, you're in the best of hands with Pugsy.

I want to follow up on one thing you wrote: " Right as I am about to fall asleep whether during a nap or if I try it at night, the pressure change of my APAP wakes me up, and then I am unable to get back to sleep until I take the mask off."

It sounds as though you might be using the ramp feature. If you are, I would suggest that you turn it off to see if that helps to avoid the pressure change that disturbs you.

Try that and see if it helps. If it doesn't, I would recommend setting your max to equal your min to equal 7, still with the EPR of 3. This is probably not going to be optimal, but we need you to be able to sleep with the machine so you can generate some sleep data and share them via Oscar charts. Only then can we help you optimize your settings.

[4638675696]

It sounds as though you might be using the ramp feature. If you are, I would suggest that you turn it off to see if that helps to avoid the pressure change that disturbs you.

Try that and see if it helps. If it doesn't, I would recommend setting your max to equal your min to equal 7, still with the EPR of 3.

Thanks! This type of adjustment is exactly what I was seeking. An insurance compliance person from the company that provided the CPAP called me to discuss lack of total hours, and asked if they can help me with any of the settings. I asked if they can make the pressure constant and keep it from raising right as I fall asleep and they said no. I look forward to testing this out when awake.

[Miss Emerita]

And to be clear: THEY can't make the change if it wasn't ordered by a doctor, but YOU can.

[4638675696]

Update: Tried with pressure level of 7 and EPR of 3 a few times since my last post and it did make a difference, but I still couldn't fall sleep. With my UARS situation, after listening to this podcast episode with Dr. Krakow interviewed by Dr. Park

https://doctorstevenpark.com/krakowinsomnia

I really want to try the AirCurve 10 ASV and plan to speak with my doctor about it tomorrow to see if there is any way to get it covered by insurance and have AeroCare switch it for me vs. the AirSense 10 Auto I have now.

Any overall advice or input on this? Is this particular model still the gold standard for ASV?