Newbie from The Netherlands needs advice

[Dawn nl]

Good day to all and greetings from the other side of the big pond. Firstly I want to apologize if my English is full of mistakes but I'm Dutch.

I've been diagnosed with OAS of 40 per hour in November last year. I've been using my Airsense 10 Autoset faithfully although I've had various issues with masks. Currently I use the Dreamwear with nasal pillows and I like it although I wake up several times because the band behind my head slides up and consequently my nose hurts.

In these past three months my AHI's are average 1.85. OA's average index 1.09; Hypoapneu 0.63; CA's 0.11 but none in the last month. Oh and after triation I have a fixed pressure of 7.

I have an appointment with an specialized nurse previous to the appointment with the specialist doctor next month and I would like to know if I need to point uit any detail to optimize the therapy. I have the impression that my breathing pattern is shallow and quite slow but I can be wrong.

Would any of the many wonderful experts on this forum have a look at my screenshots? I'd appreciate it. The graphics text are in Dutch but they are in the order required and explained by Pugsy.

Thanks in advance

[Pugsy]

Welcome to the forum.

You have chosen the wrong machine in your equipment profile. Look down in the R's for the ResMed AirSense 10 AutoSet.
It helps avoid confusion when you show the correct machine in your profile.

What gives you the impression that your breathing is shallow?

How bad will they slap your hands if you go messing with the settings?

Are you having very much nasal congestion?

[Dawn nl]

Hello Pugsy,
I couldn't find my machine when I had to choose one. I'll try again.

About my breathing I never expand my chest and stomach unless I consciously try. Just a personal impression. On the other hand except when I walk stairs when I breathe through my mouth I always have my tong against my front teeth to open the airway and breathe through my nose.

I don't think I can change my settings but if I bring forward a suggestion based on something "real" to improve my therapy plus the three month's graphics from OSCAR, I'm pretty sure they would have to listen. Here they wan to reach an optimal fixed pressure.

I don't have a nasal congestion since Christmas.

[Pugsy]

Your Flow Limitation graph is quite a bit "active". If you were in auto adjusting mode the machine would be increasing the pressure trying to clear up some of those flow limitations. Flow limitations are when the airway is restricted but not to the point of earning an OA or hyponea flag. They can be disturbing in terms of our sleep so that we don't get good sound sleep.
To give you an idea what a flow limitation graph looks like when it doesn't have much flow limitations going on here is one of mine.
This one is probably one of my "busiest" FL graphs and it really doesn't have much going on.
This may or may not be a problem for you though.


I know that in your country they are big on fixed pressures and they don't want patients messing with the settings.
You can change them if you want to and are comfortable doing the changes. It's easy. The provider manual explains how.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

All that said...other than the FL graph I don't see any urgent reason to go changing things. You could probably stand to use a little more pressure...maybe around 8 cm when going with fixed pressures and the AHI will likely drop a little and the FL graph would likely clean up a bit.

A lot will depend how you are feeling in general and how you are sleeping.
If feeling good and sleeping good then probably not urgent that anything gets changed.
If not feeling so good and not sleeping so good (other than mask issues) then maybe more pressure or a change to auto mode might be something to consider.

[Dawn nl]

Thank you, Pugsy for your detailed answer.

Last time I had an appointment with this nurse she wanted to fix pressure on 6.8 but I asked to be let on 7. I'll ask her if 8 is a possibility at least for a few weeks.

I'm still feeling tired though not as much as before starting with the therapy. I usually sleep between 5 and 7 hours per night. Sometimes I have a nap after lunch but not every day.
The biggest improvement has been in my brain, I think more clearly and have better short-time memory. Before I was asking myself 'where is...?' dozens of times a day. It was quite unnerving as I've always had a photographic memory and objects got lost or misplaced at the office or in our home.

Less irritable too although I have less stress now since I retired in January. Less stress is relatively speaking of course because all our plans to enjoy retirement traveling around are now on hold due to the corona virus crisis. We'll have to wait if we survive this one until a vaccin or medicine is found.

Anyway, thank you again for your advice. Very much appreciated.

[Miss Emerita]

I would suggest that you ask why no pressure relief is being provided. Expiratory Pressure Relief (EPR) allows you to exhale at a lower pressure than your pressure for inhaling. It can be set at 1, 2, or 3. For example, at your current pressure of 7, an EPR of 3 would allow you to exhale at 4. With EPR of 3, though, you would want to raise your pressure to something like 10 so that you'd still be getting 7 on exhale.

I bring this up for two reasons. One is that you might find it more comfortable. The other is that it might help to address your flow limitations. Perhaps your FLs are not troubling your sleep in any way -- that's certainly possible. But perhaps they are. Flow-limited breathing can require more effort, and when it goes on all night, that can mean the sustained effort contributes to tiredness.

So this might be another aspect of your settings to discuss. You might want to take your laptop or some Oscar printouts with you to your appointment so you can show your view of the data, including FLs, to the nurse.

[Janknitz]

As for the headband sliding up in back:
1. If you have long enough hair, make a pony tail just above the strap and it will hold the strap down.
2. If you have short hair, you can sew some Velcro hook tape (the scratchy side) in the back of the strap so that the little hooks grab onto your hair--it's not uncomfortable and stops most of the sliding.

[Dawn nl]

Miss Emerita, thank you for your views.

I find your suggestion about EPR very helpful and interesting. And it makes sense as I sometimes find hard to exhale despite the low fixed pressure of 7. Maybe that's the reason why I wake up a few times and not so much because the mask's headband slides up or because I experience a nightmare.

I'd greatly wish I could feel more rested and less tired and EPR may help. Let's try that.

I'll take as you suggest, my laptop and all the OSCAR's data to discuss with that nurse.

Thanks again.

[Dawn nl]

As for the headband sliding up in back:
1. If you have long enough hair, make a pony tail just above the strap and it will hold the strap down.

2. If you have short hair, you can sew some Velcro hook tape (the scratchy side) in the back of the strap so that the little hooks grab onto your hair--it's not uncomfortable and stops most of the sliding.

1. I've tried but it doesn't help. I've ordered the Dreamwear headgear with arms from the USA. It will arrive in a few weeks.
I think they send it swimming or something

2.Ouch! No way I'll damage my hair more than it's necessary.

[Pugsy]

If you decide to turn on EPR and use it....you may or may not need to increase that pressure to compensate for the drop during exhale.
For some people that drop ends up allowing some apnea events to happen but it doesn't always work out that way. It really depends on how close you are to the line where the airway is trying to close up.

If you want to turn on EPR...just turn it on first and watch your AHI and if it climbs very much in terms of OAs or hyponeas then you might need a little more pressure. If it doesn't then you don't need to increase the pressure to compensate for that drop during exhale.

EPR exhale relief is pretty sweet. I use it myself just because it is so comfortable.

[Dawn nl]

Thank you, Pugsy.
I'll ask EPR to be turned on and watch my AHI's.

[bluper@cableone.net]

The Dreamwear with arms made a big difference for me.