CPAP Improvements

[OwenUK]

Hi all,

Thanks for taking the time to read this thread.

I think that I've probably had Sleep Apnea for over 10 years. Last month I finally bit the bullet and had a home sleep study where it was found my AHI was around 122 with low O2.
I was prescribed CPAP (AirSense 10 with P10 Nasal Pillows) and sent on my merry way.

The first night my AHI was around 47 so I reduced my pillows from 2 to 1 and increased the pressure settings.

Since then my AHI is around 2-6 and overall I'm feeling much less fatigued, although I am still suffering from some residual tiredness.

I notice that I keep on waking up with the machine stepped up to a pressure of 19+ which then forces air out of the front of the P10 and makes my eyes water. It's also quite uncomfortable in general with this pressure setting.
To get around this I switch the machine off/on which starts it back on the ramp-up and I can fall back to sleep.

Does anyone have any tips to resolve this?

I've attached a copy of last nights OSCAR report which is fairly typical for what I normally see on OSCAR.

Thanks so much,

Owen

screenshot-20230404-085626.png

[loggerhead12]

Does anyone have any tips to resolve this?

No tips, those people will be along shortly.

But congrats on having your act together so quickly.

[Janknitz]

Good start!

Your treatment could still be better, by increasing the starting pressure and turning off the ramp. If you do that, your machine won't have to "chase" apneas and go up so high. You might start with 6 cm/H20, although you probably need 8-9. You can leave the upper pressure setting at 20, it will only go there if needed.

I notice that I keep on waking up with the machine stepped up to a pressure of 19+ which then forces air out of the front of the P10 and makes my eyes water. It's also quite uncomfortable in general with this pressure setting.

Regardless of pressure, the CO2 must vent, and that's where it vents from--and there shouldn't be a noticeable increase in the vent output whether at 4 cm or 20. I'm not familiar with that mask as to what adjustments might help the air flow up into your eyes, but I'm sure someone else will come along who knows. You might want to consider a different nasal pillow mask that doesn't direct the vent flow upward. Make sure that the vent isn't causing the air to bounce off your bedding and into your eyes.

I use an inexpensive sleep phones headband to listen to sounds to help me sleep. I pull it over my eyes because we do not have blackout shades in our room, and it also protects my eyes from errant leaks. That might be an option if you otherwise like this mask, and cannot find a solution.

[Pugsy]

might want to consider a different nasal pillow mask that doesn't direct the vent flow upward.

The P10 can't vent upwards at all. The vent holes are at the bottom of the frame where the nasal pillow is seated in the frame because the vent holes are in the frame.....if the air would touch anything it would be the upper lip area below the nostrils.

Now the idea of the vented air bouncing off an arm or the bed covers or whatever....that's a very real possibility.

But the vent holes on the P10 simply don't point anywhere close to upwards at all. They point downwards but it is entirely possible that maybe an arm gets up by those holes or maybe the vent holes are real close to the bed covers.

[zonker]

might want to consider a different nasal pillow mask that doesn't direct the vent flow upward.

The P10 can't vent upwards at all.

i'm wondering if he has the pillow upside down?

to the op: the size of the pillow is indicated on the base of the mask. this should be pointing down.

pls excuse me if you have it right. i just want to make sure.

[robysue1]

I notice that I keep on waking up with the machine stepped up to a pressure of 19+ which then forces air out of the front of the P10 and makes my eyes water. It's also quite uncomfortable in general with this pressure setting.

Where are you getting that 19+ number from?

In the data you posted, your pressure (top curve) is around 12-13 cm every time you turn the machine off and back on. That's still high enough to feel like a whirlwind since you are still starting out on APAP therapy. And yes, it's high enough to make some people uncomfortable.

My guess is that what is making your eyes water, however, is not the pressure. Rather, you have a low level rather constant unintentional leak for the whole night. And my guess is that the air from the leak is bouncing off your bedcovers and back into your eyes. Finding and fixing the leak is worthwhile. With a mask like the P10, the are four potential places where a low, constant leak can occur:

1) If one (or both) of the nasal pillows is not quite in the right place, you can get a leak around the nasal cushion.

2) If one (or both) of the nasal pillow cones has gotten inverted, that can cause leaks. (This can also be uncomfortable.)

3) Because the leak is near constant all night long, it's also worth examining the small hose that connects the P10 to the large hose. Make sure the pillows are correctly seated on the frame and check for small pinhole leaks near the top of the hose.

4) Your lips are very slightly (barely) open just enough for air to escape. (But usually this causes a larger leak that what you've got.)

To get around this I switch the machine off/on which starts it back on the ramp-up and I can fall back to sleep.

Does anyone have any tips to resolve this?

I've been PAPing for 12 years now and I still find myself reaching over and turning the machine off and back on when I wake up in the middle of the night. In my case, aerophagia was a huge problem and turning the machine off and back on to reduce the pressures was critical in keeping the aerophagia at bay.

The trick (in my case) has been to learn how to turn the machine off and back on and get back to sleep quickly enough that I don't remember these wakes (most nights) unless I look at the data in Oscar.

[palerider]

I notice that I keep on waking up with the machine stepped up to a pressure of 19+ which then forces air out of the front of the P10 and makes my eyes water. It's also quite uncomfortable in general with this pressure setting.

Where are you getting that 19+ number from?

Max pressure, 19.67

[robysue1]

I notice that I keep on waking up with the machine stepped up to a pressure of 19+ which then forces air out of the front of the P10 and makes my eyes water. It's also quite uncomfortable in general with this pressure setting.

Where are you getting that 19+ number from?

Max pressure, 19.67

My point is that there is no evidence that OwenUK woke up when the max pressure of 19.67 was hit during the night. But he thinks that when he woke up, the pressure was at 19+ cm.

[OwenUK]

Hi All,

Thanks so much for all of your replies and assistance, it's truly very, very appreciated.

I spent a bit of time last night and then again this morning to see where it's leaking from and I think you're right that it's just the vents that then deflects off my arm/pillow and goes into my eyes. I tried it sitting up and I can feel a strong flow from the vents at the higher pressures but the airflow isn't in my eyes unless something is deflecting the air upwards.

I've changed my min setting to 13, ramp from 8 and left max at 20 and will see how that goes tonight.

Just want to stress to anyone reading this that I honestly do feel so much better than before I started my treatment. Considering it's less than a month ago, to not feel that level of fatigue and irritability is a miracle. The fact that I'm here to try to improve an AHI less than 5 speaks the wonders of CPAP treatment and my only regret is not embarking on this journey sooner.

Thanks again,

Owen

[loggerhead12]

Considering it's less than a month ago, to not feel that level of fatigue and irritability is a miracle.

It seems to me that people with really high untreated AHI adapt more easily to CPAP, maybe because our sleep was so crappy to begin with.

[OwenUK]

Considering it's less than a month ago, to not feel that level of fatigue and irritability is a miracle.

It seems to me that people with really high untreated AHI adapt more easily to CPAP, maybe because our sleep was so crappy to begin with.

That's a fair theory! I nearly baulked when I saw an AHI of 122!

[palerider]

I can feel a strong flow from the vents at the higher pressures

Strange, you shouldn't feel more than a gentle waft of air from the P10, shouldn't even been able to feel it more than a few inches away from the mask. 'regular' (undiffused) masks you can feel a foot and a half away.

[OwenUK]

Hi all,

I don't like to draw conclusions from 1x night of data but last night I upped my min pressure to 14.0, left max at 20.0, started ramp at 8 and EPR on full time at 3 and got some pretty good results.

I've got terrible (unrelated) toothache at the moment at woke me up between 0050-0130 and it looks like there was some positional OAs close to when I woke up but a decent improvement on the previous night.

05APR23.png

[Dog Slobber]

Hi all,

I don't like to draw conclusions from 1x night of data but last night I upped my min pressure to 14.0, left max at 20.0, started ramp at 8 and EPR on full time at 3 and got some pretty good results.

I would also consider increasing your ramp.

8 is way to low. Notice how during ramp, your snoring (evidence of too low pressure) and then your pressure skyrockets well above your minimum. Your falling asleep, and before the Autoramp therapy shifts to therapy mode you're experiencing symptoms of a closing passageway.

Consider:

• Turning Auto-ramp off (i like autoramp on, but way closer to my minimum therapy needs)
• Increasing Auto-ramp pressure to a value close to your therapy needs. 13-13.8
• If that 13ish pressure is too high while you're awake than gradually move it up.

BTW, when I was on AirSense, I loved Autoramp, I could look at every nights data and se how long it took to fall asleep. I could also tell if there was a power interruption because I would see a value slightly less than my minimum.

[OwenUK]

Hi all,

I don't like to draw conclusions from 1x night of data but last night I upped my min pressure to 14.0, left max at 20.0, started ramp at 8 and EPR on full time at 3 and got some pretty good results.

I would also consider increasing your ramp.

8 is way to low. Notice how during ramp, your snoring (evidence of too low pressure) and then your pressure skyrockets well above your minimum. Your falling asleep, and before the Autoramp therapy shifts to therapy mode you're experiencing symptoms of a closing passageway.

Consider:

• Turning Auto-ramp off (i like autoramp on, but way closer to my minimum therapy needs)
• Increasing Auto-ramp pressure to a value close to your therapy needs. 13-13.8
• If that 13ish pressure is too high while you're awake than gradually move it up.

BTW, when I was on AirSense, I loved Autoramp, I could look at every nights data and se how long it took to fall asleep. I could also tell if there was a power interruption because I would see a value slightly less than my minimum.

Hey, great advice - thank you. Let me try tonight on 13 and see if it's too uncomfortable or not.

Cheers,

Owen