New CPAP user looking for guidance

[jasonkelly214]

have you made a real effort to not sleep on your back (whether with stuff in behind you or some other way)? It would bring all those hypopneas way down.

yeah I can't actually sleep on my back at all so I'd be very surprised if I was on my back at all for these captures.

no, it's quite common. i'm very susceptible to it myself. as julie mentions, one way to eliminate it is to reduce pressure. but you don't want to do that because it'll screw with your good numbers.

I used to have it happen when I would sleep with my head on my desk in high school but that was 10+ years ago which is why I was wondering; it felt the same.

The quietest, best diffused vent on a nasal pillow mask has got to be the ResMed P10.

I'll see if I can give that a shot.

So since I'm already sleeping on my sides, are there other suggestions for reducing my AHI further? Should I increase pressure further?

[Miss Emerita]

You can't hurt yourself creeping your pressure up .5 at a time. Always give it a few days before making another change, unless the results are awful. In your last chart, it did look as though a little more pressure might take care of some more obstructive apneas and hypopneas. It's a reasonable experiment to take it up to 9.5 and see what happens. If it looks good, then 10. Feel free to post charts along the way.

It is possible some of the central apneas are happening while you're awake. When we're awake, our breathing is not very regular. During the day, try noticing; you'll probably see that you pause between breaths when you're concentrating on something. If you're awake at night and pause 10+ seconds, boom, you get a CA flag, because the machine doesn't know whether you're awake or asleep.

For some people, increases in pressure can induce more centrals during sleep. There's no particular reason for you to expect that, but if your central index goes up with a pressure increase and stays up, you'll want to back the pressure down a notch for a while before you try inching it back up.

[jasonkelly214]

I will try 9.5 tonight, thanks.

Another question for you all. When do you mask up? In my first couple days I was turning the machine on while I watched the to fall asleep to but I didn’t want it to record useless data from me being awake. But then occasionally I fall asleep without the mask and end up sleeping half the night without it.

[Pugsy]

When do you mask up?

While sitting on the edge of the bed before I ever lay down.

I would rather have useless awake data that is easily discarded either using the software or just mentally....than risk falling asleep without the mask on have hours of untreated sleep apnea sleep and zero data except to know I feel like total crap.

If you find that you are having trouble falling asleep and you think the chances of there being a lot of SWJ clouding the picture... just reach over an turn the machine off and right back on again but keep the mask on. This will create a break in therapy and a new session and the prior known awake session can be easily omitted from the reports. We can omit sessions from data calculations that are separate by turning them off from within the software itself.

Now SWJ at the end of the night and we haven't had the presence of mind to create a separate session...we have to learn to mentally remove it and it can be done.

What's more important? Numbers or making sure when you sleep that your apnea is treated?

[Miss Emerita]

For most people, it's actually best not to be watching a screen right before bed. Just as an experiment, you might want to try lights out when you get into bed (masked up, of course).

If it helps, here's the full list of "sleep hygiene" guidelines:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

[zonker]

I will try 9.5 tonight, thanks.

Another question for you all. When do you mask up?

right before i turn on the machine.

my circumstances have changed(long story) recently. i used to put it on when laying down after i'd turned out the light. but recent move to temporary quarters has me masking up while sitting on the edge of the bed.

either way, it's the last thing i do before lying down to sleep.

[jasonkelly214]

I need some more help from everyone. I’m getting good numbers right now, around 4-4.5 ahi at 11 pressure. But I’m having a really hard time stopping leaks. I’m using the p10 which is mostly comfortable, but I can’t get it to not leak. Tight. Loose. Straps together on the crown of my head. Open with straps separate. Small pillow. Medium pillow.

Please help me be successful. I’ve even been coating my nose with some balm that has lanolin. Granted I’ve yet to try nipple cream since I already had this other stuff.

It seems like I get the best contact with straps together on my crown but it hurts my nose, and the straps slide down or up off my head. And my wife is waking me up in the middle of the night because of leaks. I don’t have a big nose so I would have figured small would work for me but it seems to leak a lot more than medium. Do I need to give large another try? Help me with the straps what can I do better?

I trimmed my beard down from 3+ inches to just a tight 1/4 inch (unrelated) so I could go back to my full face mask and see how that goes but I was definitely enjoying the minimalism of the p10.

[Julie]

Try mask liners to help with leaks, from Padacheek.com.

[Pugsy]

P10 strap movement is a known problem for a lot of people. When I used the P10 I would have it happen myself and it was always the back bottom strap that would move. I would start the night with that back strap down below the occipital bone at the base of my skull and sometimes I would wake up and it was up there on the top of my head. Fortunately the pillows themselves pretty much stayed put though.

Headgear was always a PITA for me which is why I went to the Bleep (see link in my equipment profile).

There are also a couple of other nasal pillow masks with a more traditional headgear that are probably less likely to move as much as the P10 back strap that are pretty nice. The F & P Brevida is a nice mask and if you think you might like a hose connection at the top of the head there is the ResMed AirFit P30i or Respironics DreamWear gel pillows. The Brevida has an optional diffuser so it is more silent than the others. F & P has a new mask that I haven't tried called the Evora.

Sorry...no help with a full face mask because I just don't use them but a mask liner might help but with any facial hair at all there are going to be extra challenges. People can meet those challenges but it's going to take extra work for sure.

[jasonkelly214]

Hi Everyone.

I ended up having really bag aerophagia so poured into the forums more and found some info from users about pressure and how it relates to the LES. I decided to go back to auto mode, but to tighten up the pressure range. I set my low pressure to 8 and my upper to 14. I had a couple good days but I figured I'd bump the pressure up to 9 for the low and and have had a couple more good days. My AHI has been under 5 for the past 4 days but I wanted help looking at the data.

Also the lower pressure has helped a lot with the P10. I'm fearful that because of the lower pressure and looser fit there is air escaping out but I'm not sure how to tell. My machine always says 100% leak rate but I do see here in OSCAR you can see the actual values. They seem low enough to me, staying under 10 to 15 but mostly spiking after higher pressure events.

I'm also wondering what to do, if anything, about my clear airway apneas/periodic breathing. Can I get my AHI lower? Or is this the best it can be for me?

And lastly how are my pressure settings? When I went back to auto my 90% pressure was 8.8 so I set that low end at 9. And I didn't see any events that needed more than 12 to clear.

Tuesday


Wednesday

[Miss Emerita]

Jason, you've made impressive progress, at least by the numbers. Are you feeling more rested during the day?

You'd be getting a large-leak marking if you were having leaks that could interfere with your treatment, so if leaks aren't waking you up, you have nothing to worry about on that front.

Keep in mind that sometimes aerophagia will diminish over time, especially if increases to minimum pressure are made after a period of time and are made in the smallest increments (for you, .5). So if you creep your minimum up and start getting aerophagia, go back down and give it at least another few weeks before trying again.

I'm going to bet the CAs are mainly from mini-arousals. Could you post a 10-minute zoomed in view from that 10/8 chart in the green area that starts at around 4:30?

[jasonkelly214]

Are you feeling more rested during the day?

Sort of. I'm waking up better and without large headaches. I think that I feel more rested but I haven't had a consistent stretch of good numbers yet to say for certain, and I've had to get up earlier than normal a couple times this week.

The main thing that lead me to sleep apnea was brain fog and general tiredness/sluggishness and maybe some depression type symptoms. But sleepiness/falling asleep less so but I also do use a lot of caffeine. The longer I would sleep the harder it would be to get up in the morning. At least now I'm more or less popping out of bed. My motivation level is also higher than before. There were days before the CPAP or when the CPAP was still at the wrong settings, where I'd just exist in my bed all day.

You'd be getting a large-leak marking if you were having leaks that could interfere with your treatment, so if leaks aren't waking you up, you have nothing to worry about on that front.

Ok good to know about the leaks. My mask is actually mostly comfortable now and not waking me and my wife up.

I'm going to bet the CAs are mainly from mini-arousals

What is a mini-arousal? Or are you just saying that's me being generally restless? I had also high CA numbers when the machine was doing the auto pressure reduction.

Could you post a 10-minute zoomed in view from that 10/8 chart in the green area that starts at around 4:30?

I notice that the pressure went up from 9 to 10.5 just before this event but I'm not sure why.

[Pugsy]

http://freecpapadvice.com/sleepyhead-free-software

Arousal/awake breathing.....false positive flagging. If you aren't asleep it doesn't matter except to be a reminder we weren't asleep and sleep is the goal.

That little zoomed in cluster flagged as PB for part of it. You weren't asleep.

[Pugsy]

I notice that the pressure went up from 9 to 10.5 just before this event but I'm not sure why.

Normal test pressure probe where the machine increases the pressure 1.5 cm just to test the waters so to speak. They look like saw teeth sort of on the general overview report. It's just something that Respironics does .

[jasonkelly214]

So my numbers were really low the past week, but my sleep felt really bad. Morning headache, dry mouth, fatigue, lack of motivation during the day. I was starting to wonder if my mask was leaking more than my machine thought and then one night I actually woke to air coming out of my mouth.

So I did two things the past couple days. I turned a-flex off (which I had turned off a couple months ago anyways so I'm not sure how it turned back on). And I put a headband on as a chin strap. The last two nights my numbers stayed in a similar AHI range but the apneas changed a lot. They were low obstructive, high clear air...now they're the opposite...but my sleep felt better with the headband and a-flex off

Before changes...felt bad this morning:


After changes, felt better: