Brand new cpap user! Some questions regarding my first night

[xdestry]

Hi guys I'm Ryan, I was diagnosed with an AHI of 21 and just received my cpap yesterday. I have the ResMed Airsense 10 Autoset with a F&P Simplus Full Face and also a Resmed AirFit P10 Nasal Pillow. My machine is on a ramp setting with the lowest starting at 4.0. My max pressure is set from 12.0 to 14.0. EPR at 3. Climate control off and humidifier at 1.

Last night was my first night sleeping with the cpap after the in lab sleep study. I did the sleep study with the full face mask but I also wanted a nasal pillow to see which one I would prefer so they also gave me the Airfit 10. I tried both out for a test run before I went to bed however the pressure was so high with the nasal pillow my ears would pop every time I swallowed and I ended up with a slight headache after testing it for just 5 minutes so I decided to use the full face overnight.

During the sleep study I think the technician had started me off at 8 or so but had to go up to 12 to fully get rid of the apneas so I think by the time I was at 12 I was pretty deeply asleep. However last night as soon as the pressure would ramp up to 12 I would wake up from the discomfort, as well as not being able to exhale all the way due to the pressure. Not being able to exhale all the way was extremely uncomfortable and after a while I felt some pain in my chest and I was feeling a bit dizzy so I decided to stop the cpap so I could get some sleep for work.

I have also been checking the myair app periodically and it seems like the data from last night has not been uploaded yet. I think I only logged about 3.5 hours with the mask on anyway. I think I fell asleep a few times but always ended up waking up again.

I have been doing some research today and I have a few questions.

1. Do I need to lower the pressure while using a nasal pillow as opposed to using a full face? If my technician went with 12 for the full face what would be the equivalent for the pillow?

2. Is my problem exhaling something I just need to get used to? I felt like I could only exhale about 3/4 of the way before I had to actually exert myself to push the rest of the air out. My EPR is already at 3, would a bipap be something I should look at?

3. Is the dizzyness and chest pain typical of a new cpap user?

My doctor advised me to not change any settings for a week or so until they get enough data but I am thinking I will drop the max pressure to 10 tonight and hopefully I can actually fall asleep, if I just end up taking the mask off anyway they won't get any data right?

Also I have been looking on craigslist and such and I see a brand new aircurve 10 vauto with only 1 hour of machine usage time on it for 400 dollars. You guys think I should jump on that just in case I end up needing a bipap?

Thanks so much for everyone's help. Looking forward to becoming a part of this community!

[Pugsy]

That is an extremely good price on the AirCurve 10 VAuto...snatch it up even if you don't end up needing bilevel. It makes a great back up machine.

I am confused with what your settings are and which mode because while awake it shouldn't be hitting 12 unless you are in fixed mode after the ramp time is used up (assuming you are using ramp).

Don't worry about MyAir...get OSCAR and let's see exactly what is going on


OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

viewtopic/t158560/How-to-post-images-for-review.html

Exhaling against the pressure can cause some chest wall discomfort because you are using muscles in the chest wall that haven't been used this way before. Dizziness isn't common though unless maybe you were stressed due to the discomfort and maybe hyperventilating a bit.

Nasal pillows can sometimes result in lower pressure needs but we don't normally automatically use different pressures with a nasal mask vs a full face mask.

[xdestry]

That is an extremely good price on the AirCurve 10 VAuto...snatch it up even if you don't end up needing bilevel. It makes a great back up machine.

I am confused with what your settings are and which mode because while awake it shouldn't be hitting 12 unless you are in fixed mode after the ramp time is used up (assuming you are using ramp).

Don't worry about MyAir...get OSCAR and let's see exactly what is going on


OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

viewtopic/t158560/How-to-post-images-for-review.html

Exhaling against the pressure can cause some chest wall discomfort because you are using muscles in the chest wall that haven't been used this way before. Dizziness isn't common though unless maybe you were stressed due to the discomfort and maybe hyperventilating a bit.

Nasal pillows can sometimes result in lower pressure needs but we don't normally automatically use different pressures with a nasal mask vs a full face mask.

Hi Pugsy! Thanks for the fast response!

I will jump on that Aircurve then! Hopefully the guy still has it.

The machine is only hitting 12 after it thinks I am asleep, but as soon as it ramps up I think I wake up from the change in pressure. I cant be sure exactly how long after it hits 12 I woke up though.

It's good to know that the chest pain is expected. I'll see if I get dizzy again tonight.

I have downloaded oscar and put an old SD card I had in the machine. I'll have to get a reader and hopefully I can post the results in a few days!

I will try the same settings as last night with the full face mask and see if I fare any better... wish me luck! I would like to switch to the nose pillow due to the discomfort of the full face but the pressure is just too high for now. Hopefully I can get some data to post on here

[Pugsy]

The nasal pillows do offer a more direct air flow line and it can sure seem like it is "too much" sometimes especially when new to cpap.
There's a reason the machine wants to go to 12 and I hesitate to limit the max because of the reason it wants to go there. If it's something critical then you might not get good therapy if the machine can't go high enough to deal with whatever it is wanting to go kill.

Being able to actually see what is going on when it goes to 12 will help us decide if limiting the max is a safe option. We don't want limiting the max to maybe allow a truckload of apnea events happen.

[xdestry]

The nasal pillows do offer a more direct air flow line and it can sure seem like it is "too much" sometimes especially when new to cpap.
There's a reason the machine wants to go to 12 and I hesitate to limit the max because of the reason it wants to go there. If it's something critical then you might not get good therapy if the machine can't go high enough to deal with whatever it is wanting to go kill.

Being able to actually see what is going on when it goes to 12 will help us decide if limiting the max is a safe option. We don't want limiting the max to maybe allow a truckload of apnea events happen.

I believe the minimum (actual therapeutic pressure) is currently set to 12 with the max at 14. So the machine starts at 4 (start pressure) during the auto ramp period, and as soon as it detects that I am asleep it goes to the autoset mode minimum of 12 (decided by my sleep doctor in my in lab sleep study) and can possibly go to 14 depending on if the machine decides if I need it or not. So while I am asleep the min is 12 and max is 14. Don't know if that makes sense but I think it's what the doctor explained to me.

[Julie]

You can leave the max at 20 (the usual) without a problem, it's the min. pressure that does the work and if I were you I'd try a lower one, e.g. 8 or 10. Not sure why the max was set so low to begin with.

[Pugsy]

Yes, that does make a bit more sense.

Minimum of 12 and max of 14 is how we refer to it. Auto mode and EPR set to 3.
I need to see the detailed graphs for confirmation as well as see what might be happening.
It is possible that apnea events are causing wake ups and not the higher pressure causing the wake up.

If you want to change anything....that 12 minimum would be the first thing I would change and not the max of 14.

[xdestry]

Hey guys it took a few days to get my SD card reader and I wanted to try one more night with the full face to get some more data, but here's the graphs! The first night and last night (24 and 27) were with the full face, it seems like I can actually stay asleep with it and not want to rip it off halfway through the night. I think the difference between the full face and the nasal pillow is just that the nasal pillow has way too much pressure and I cannot breath out as easily. It takes me forever to fall asleep and I don't really think I ever truly fall deeply asleep, it feels like the whole night is just me trying to breath out through that mask.

The full face I have is the FP Simplus mask but it feels just way too bulky. Are there any other masks you guys think I should try? Budget is not really an issue, I just want to find the best mask for me even if I have to get a dozen before I find the perfect one. Ideally I would just be able to use a nasal pillow type but so far the Airfit P10 has not worked out too well.

The chest pain has largely gone away however I seem to have problem with aerophagia in the form of burps and just generally feeling a lot of air in my stomach. Also there was one day where one of my ears would suddenly start ringing and then suddenly I couldn't hear as well through it. That was one of the nights where I was trying the nasal pillow.

My original diagnosis when I did the home sleep test was 21 AHI. My in lab results have not yet been sent to me but I will post those as soon as I get them. To reiterate my sleep technician went up to 12cm pressure during my in lab test to get rid of my apneas. I came back with my machine set from 12-14 but the pressure was so high I lowered it to 10-12. It seems like the machine never went past 10.8 or so during the night. Of course I only really have two real nights of data so far but what do you guys think I should do for the next week or so? I am thinking the following.

1. I still really want to get used to the nasal pillow for the comfort would I be able to try and slightly lower minimum pressure with it? Maybe set the minimum to 8 or so and see how it goes?

2. I picked up the Aircurve 10 VAUTO as well, it was in perfect condition with only an hour of use. Would I be able to switch to the biPAP and try the nasal pillow to see if it is more comfortable? If so what should I set the settings at in the Aircurve?

3. Do you guys have any other recommendations for more comfortable masks? This full face just feels like I'm Bane from batman and if I don't have it really tight I can't move at all without it leaking once it ramps up to full pressure.

I think the two nights with the full face were relatively successful, especially last night. I really appreciate everyone's help, it is comforting to know there are so many people out there who are also in the same situation and also to know that other people have done this before and have had success. Please let me know if there are any other graphs you guys need to see in oscar and I can post them asap.


24

25

26

27

[Pugsy]

What size nasal pillows were you trying?

Looks like you might have the ramp setting to "auto ramp" ...is that true?

If that is true you were only using 4 cm pressure at the beginning of the night and EPR isn't available at 4 cm so is it possible that your problem exhaling was more because there just wasn't much air movement????

Reducing the minimum pressure might help with the aerophagia issues...or we might need to limit the maximum even more but I would start with a lower minimum...like the 8 you were thinking about or even maybe 7 cm.

[xdestry]

What size nasal pillows were you trying?

Looks like you might have the ramp setting to "auto ramp" ...is that true?

If that is true you were only using 4 cm pressure at the beginning of the night and EPR isn't available at 4 cm so is it possible that your problem exhaling was more because there just wasn't much air movement????

Reducing the minimum pressure might help with the aerophagia issues...or we might need to limit the maximum even more but I would start with a lower minimum...like the 8 you were thinking about or even maybe 7 cm.

Yes the setting was at auto ramp however I have changed it to no ramp as the lower pressure was not too bad. I start right at 9 CM now. I slept last night with my minimum at 9, heres the graph.



It seems like my apneas are all still central... i thought most of my apneas before were obstructive, I guess the cpap has gotten rid of those. I'll try another night tonight at 9 and hopefully can resist the urge to rip it off halfway thorugh the night. Thanks again for all your help.

[Pugsy]

I wonder how many of those centrals are arousal/awake breathing related because they tend to be clustered around known awake times.
Go here and watch the videos and learn how to distinguish awake/arousal breathing from asleep breathing.
http://freecpapadvice.com/sleepyhead-free-software
If you weren't asleep then they aren't real and they don't matter except to point to not being asleep.
We call them SWJ or sleep/wake/junk.

[xdestry]

Hi guys, its been about a week since my last post, I have been trying out the aircurve bipap vauto that I picked up and results are pretty inconsistent. My current settings are at 7epap 12ipap 2 PS. The problem seems to be mainly with CAs which seem to occur in clusters. A lot of the CAs seem to be right after a small blip in the leak rate graph, do those mean they are not real ones? I watched all the videos Pugsy linked to and it seems like that's what the guy is saying. I have also included some zoomed up photos of the graphs from the night of the 6th of some of the clusters of CAs.

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[xdestry]

6th, and zoomed in screenshots of CA clusters.

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[xdestry]

Sleep Study https://drive.google.com/file/d/1dX7pXe ... sp=sharing

Oscar Screenshots (about 3 weeks worth) https://imgur.com/a/wrnfyKQ






Hi guys, been a while since my last post here but I finally received my sleep study from my doctor. The treatment lately seems to be getting a bit better. I have switched back to the CPAP for now so the doctor could get the data (and also for insurance reasons) and my AHI has been at a consistently low number each night. I am currently at a pressure of 6.0 to 12.0, and the machine stays usually at the lower end of that. I have EPR at 3 on only ramp, and off during the rest of the time.

I am now exclusively using the airfit p10 mask and taping my mouth using the micropore 3m strips. The mask however is really uncomfortable sometimes and I will be switching to the bleep dreamport to try as soon as I can get one.

My events still seem to be mostly central, but it seems like there are a bit more obstructive events recently than the first few weeks of treatment. I have stopped taking diphenhydramine(benadryl) to sleep, but am still taking 5mg of melatonin each night.

The last time I posted I was suggested by some members to ask my doctor about possibly going on ASV, it seems like the centrals are lessening but not completely going away so do you guys think even with an AHI of 1-2 it would still be recommended to switch? It seems like there were some central events indicated in the sleep study as well.

A few questions I have are :

1. Does the current pressure of 6-12 seem fine to continue on for now? Also if I wanted to switch back to the aircurve bipap what would the best settings be to try?

2. Would you guys be able to take a look at the sleep study for me and see why they recommended such a high minimum pressure? It seems like the doctor just kept raising the pressure till there weren't any more events, but now it seems the machine never really goes past 8 or 9.

3. Have you guys seen any evidence of sleep aids like benadryl or melatonin causing central events? I stopped taking benadryl to sleep a week ago and it seems like the AHI dropped from around 3-4 a night down to 1-2 immediately. I am still taking melatonin now but am considering slowly weaning off it.


Treatment has been going better and I am feeling a lot more energetic through the day and have been needing less sleep to feel like that.
Thanks again for any help anyone can provide!

[Pugsy]

You would need to consistently be seeing an average of 5 or more centrals per hour pretty much every night to warrant ASV. So no need for ASV based on recent reports. I expect with time and as you sleep better...they will continue to drop in numbers but don't panic if you see some centrals every now and then.
It is normal to have a few central apneas a night anyway. Not a big deal unless they are numerous and causing a problem.

Your pressure setting of 6 to 12 appear to be working quite well. Most of the nights with the little bit higher AHI is primarily central apneas and more pressure won't fix those.

How are you sleeping and feeling?

As for why the RX idea of 12...I think they wanted a worse case scenario and you never got much REM stage until they happened to test 12 and often we need more pressure in REM. Stupid idea to use 12 all night just to deal with the 15 to 20 percent of the night we might be in REM and need more pressure. Overkill. Best to use lower when lower works and let the machine go up to 12 or so if it needs to and obviously