New CPAP user. Any tips from my first night? Oscar image attached

[thomasc1126]

I was diagnosed with moderate sleep apnea with an AHI of 28.6 back in October 2022.

After 6 long months, I finally received my CPAP machine (Resmed Airsense 11 Autoset) 2 days ago.
Night 1 - I was unable to sleep with it because I couldn't get a good seal. My ears also kept popping like I was on an airplane. It was a very uncomfortable sensation.
Night 2 - I spent a couple hours during the day just getting used to things. I figured out how to clear my ears & get a decent seal. I was able to sleep for ~ 5.5 hours (oscar data attached).

All I can say is that this CPAP is an absolute game changer for me. Despite the short amount of sleep and high leak rate, I cannot remember a time in my life I woke up well before my alarm, felt rested, and was not in a grouchy mood. Part of me worries this is too good to be true, but my gut and everyone I've talked to says CPAP changed their lives. My main complaint right now is my face mask.

I told the doc that I snore so they started me off with the F20 mask (tried both silicone and foam versions). I feel I only breathe with my mouth because I snore, and I only snore because I have sleep apnea. Logic tells me if the sleep apnea is treated, then the snores go away. If the snores go away, then so should the mouth breathing? Is there something I'm missing there?

Anyways, the foam version was very uncomfortable and dug into the bridge of my nose, but the silicone was manageable. It is also worth noting I have a full beard, trimmed down to a #1. Regardless, I ordered the P10 which should arrive tomorrow, so hopefully that will give me a better seal & comfort.

I would appreciate if anyone has any tips or additional insight into my graphs to improve!

Thank you!

CPAP configuration used:
PAP Mode: APAP
Min 6.0 Max 20.0
EPR: Full Time; 2
Humidity: 6
Temp: 74 F

Initial pressure settings set by my doctor were 5-20.

[chunkyfrog]

That machine is a miracle--not so much the masks--and there are so MANY.
You have loads of company.

[Miss Emerita]

It’s great to hear you’re off to such a good start! I didn’t see your chart; you may need to use Imgur to host the image and provide a link.

I think you’re smart to see how the P10 might work for you. Keep us posted!

[thomasc1126]

Whoops. here's the Oscar chart.

[Miss Emerita]

Yes, you'll want to address the leaks. Do you breathe through your nose during the day? If you do, you probably can during the night as well. Let us know how it goes with the P10. You may do very well with it right away, but if you don't, there will be some tricks for you to try out.

Do you like having the ramp? I see that it starts at 4, which for many people results in an air-starved feeling. Because your regular minimum pressure is only 6, I'd suggest turning the ramp off. That way you can get the full benefit of your EPR right away (the machine can't go lower than 4). -- That said, if you really like the ramp, don't change it.

I think it's fine to bracket your scattering of CAs as you assess how you're doing. They may well just reflect some "sleep-wake junk" -- brief arousals that wash out some CO2 from your blood and result in a pause between breaths.

[thomasc1126]

4/6/23 (night 3)

Adjustments made:
- up pressure range 6-20 > 7-20
- up epr 2 > 3
- up temp 23 > 25
- lower humidity 6 > 5
- lower ramp time 45 > 5

I gave the foam mask another shot and it felt better/less leaky than the silicone. Adjusted it to sit a bit higher, pretty much brow level with the bottom of the mask just below my lower lip. Still getting used to the pressure so a 5 minute ramp from 4 to 7 worked well.
Session cuts off after 3 hours because of rainout. The gurgling woke me up and I was too lazy to do anything so I turned the machine off and went back to bed with the mask on and slept terribly. Wife woke me up about 3 hours later because I was snoring. I emptied the water that was sitting in the hose and got about another hour of sleep with the machine on. The chart looks wacky so I'm not including it here. On the bright side I'm getting more used to wearing the mask.

Probably too many changes for only the third night, but I was happy with the results, until the rainout. Really looking forward to getting at least 7-8 hours of uninterrupted sleep.
The only changes tonight are switching to auto climate control and changing masks (F20 > P10).

[thomasc1126]

4/7/23 (night 4)

I got my p10 today and I gotta say it is 1000x more comfortable than the f20. However, I was unable to use it because I had a hard time exhaling. It felt like there was way too much resistance on the exhale. I tried numerous things -- EPR 1,2,3; lower pressure settings; ramp on/off; headgear adjustments; all tip sizes -- and it always felt like a labored exhale. I made sure the tips were just at the tip of the nostril and not inside my nose. Hell I even tried pushing them farther up my nose and ironically it felt easier to exhale when I did this. I will say I get a bit stuffed up in my bedroom specifically (I tend to breathe better out in the living room) so maybe that is the issue or it could be my nose structure, or simply a psychological barrier. I have 30 days to try it out so I am definitely going to be giving them another go. Any tips or suggestions on this?

I mentioned the general stuffiness I tend to get in my bedroom, and last night I actually slept in the living room because even with my f20 it felt harder to breathe last night.
I still felt constricted with the p10 in the living room, but at this point it was nearly 3 am and I was getting anxious, so I went back to the f20 memory foam and was able to get to sleep. I loosened up my headgear quite a bit to get comfortable which lead to a lot of leakage.

This night is actually a good test between living room vs bedroom. I slept 5.5 hours in the living room, and then an additional 2 hours in my bedroom.

First image shows both sessions. Any insight as to what happened around the 9:20 AM mark? Pressure starts to climb and flow rate gets choppier. I'm not entirely sure what flow limit means but that starts to increase.

Second image is zoomed in around the 9:20 AM mark.

Third image is zoomed in on the hypopnea event. The flatlining of the flow rate jumps out to me. Is that indicative of a CA; where I'm essentially holding my breath?

[Miss Emerita]

Your leaks improved a lot on night 3, then got worse again on night 4. Do you have a sense of why that is? Do you think you were opening your mouth? Or was the mask getting jostled?

The period with the flagged hypopnea shows some irregular breathing. Hypopneas can be either central (no airway resistance) or obstructive in nature, and I am not able to tell from the flow rate what is going on here. I wouldn't worry about it though. Also, just so you know: most CAs are pauses between breaths rather than breath-holding. (By the way, you can customize the Y axis on your graphs by right-clicking the graph title and using the options there. I set the top and bottom of my flow rate Y axis so that it the trace is a tight fit. This makes it easier for me to see what's going on.)

Your pressure goes up in response to flow limitations. The ResMed machines are especially sensitive to FLs. FLs are limitations within your airway that aren't OAs or Hs. They may originate in your nose, if you have swelling in your nasal cavity, or the may originate in your pharynx, where the tissues lining your airway may sag. EPR can help with the latter but not the former. So do keep your EPR at 3. Do you think the pressure changes woke you up?

Try using the P10 outside your bedroom while you watch TV, read, or do something similar. You want a bit of distraction to see whether your brain can get comfortable with the way it feels when you breath with the P10. Also play around with the positioning of the straps, which will change the tension exerted.

Could you say more about what you mean when you describe your bedroom as stuffy?

[Dzyan]

4/7/23 (night 4)

I got my p10 today and I gotta say it is 1000x more comfortable than the f20. However, I was unable to use it because I had a hard time exhaling. It felt like there was way too much resistance on the exhale. I tried numerous things -- EPR 1,2,3; lower pressure settings; ramp on/off; headgear adjustments; all tip sizes -- and it always felt like a labored exhale. I made sure the tips were just at the tip of the nostril and not inside my nose. Hell I even tried pushing them farther up my nose and ironically it felt easier to exhale when I did this. I will say I get a bit stuffed up in my bedroom specifically (I tend to breathe better out in the living room) so maybe that is the issue or it could be my nose structure, or simply a psychological barrier. I have 30 days to try it out so I am definitely going to be giving them another go. Any tips or suggestions on this?

I mentioned the general stuffiness I tend to get in my bedroom, and last night I actually slept in the living room because even with my f20 it felt harder to breathe last night.
I still felt constricted with the p10 in the living room, but at this point it was nearly 3 am and I was getting anxious, so I went back to the f20 memory foam and was able to get to sleep. I loosened up my headgear quite a bit to get comfortable which lead to a lot of leakage.

I am also new and have been using СPAP for a little over a month. For me, the most comfortable masks are nasal pillows, especially Nuance & Nuance Pro Nasal Pillow CPAP Mask with Gel Nasal Pillows. The gel cannulas do not irritate my nostrils, the straps also have a gel that does not irritate the skin of my face, and the main thing for me is that the Nuance & Nuance, unlike the P 10, has ventilation holes that ventilate the air well in my nasal mask . But unfortunately due to the hypertrophied and swollen soft palate, my exhalation is sloppy when I try to breathe exclusively through my nose, through the nasal pillows. Especially, it is felt when I lie on my back. I can't exhale and my cheeks puff up as I do so. Therefore, I had to return to the AirTouch F20 mask. There is still hope for a series of F 30 masks, but the F 30 i don't like the vents on the edges of the mask, and the F 30 lacks the L size.
One problem with full face masks is the air leaks that wake me up and appear when I sleep on my side. This is due to the fact that my face is pressing on the strap and the mask is shifting and there is an air leak.When I tighten the straps to get rid of air leakage, the mask starts to give a lot to the face, which causes discomfort. On the forum, I was advised to use Pad-a-Cheek from air leaks https://www.padacheek.com .Pad-a-Cheek additionally stabilizes my mask and removes air leaks. That's why I'm currently testing two versions of homemade Pad-a-Cheek.
The first option is kapron women's pantyhose, cut out in the shape of a circle, from the buttocks part of the pantyhose.
The second option is an elastic bandage.



Also, I did not have enough fresh air in the AirTouch F20 mask. Maybe this is just my case, as far as I understand, other users have enough air. This issue is discussed in this thread. Be patient, find time to read the forum (there is all the necessary information here), and in no case do not give up! Little by little, you will find the solution to all your problems related to СPAP therapy.
viewtopic/t186442/AirtouchAirfit-F20-relief-holes.html

[thomasc1126]

Your leaks improved a lot on night 3, then got worse again on night 4. Do you have a sense of why that is? Do you think you were opening your mouth? Or was the mask getting jostled?

Night 4 I loosened my mask quite a bit, and then tightened just a tiny bit until I got a seal at therapy level pressure, not max pressure. I think the leaks were do to pressure increases during the night and/or repositioning during the night.

Do you think the pressure changes woke you up?

Nope. My wife woke me up because it was nearly noon lol

Try using the P10 outside your bedroom while you watch TV, read, or do something similar. You want a bit of distraction to see whether your brain can get comfortable with the way it feels when you breath with the P10. Also play around with the positioning of the straps, which will change the tension exerted.

Could you say more about what you mean when you describe your bedroom as stuffy?

Good idea. I'll try this out. I am curious about the p30 and whether that vents better than the p10 though.
By stuffy I mean I usually wake up with a stuffy nose. Not completely clogged but enough to be an annoyance. I think it is due to poor air circulation and/or outside air is leaking into the room (we have an exterior door that could be the culprit).

[zonker]

Do you think the pressure changes woke you up?

Nope. My wife woke me up because it was nearly noon lol

pressure changes/wife.

it's always something.

https://www.youtube.com/watch?v=aPgoWxT1PMc

[Dzyan]

Good idea. I'll try this out. I am curious about the p30 and whether that vents better than the p10 though.
By stuffy I mean I usually wake up with a stuffy nose. Not completely clogged but enough to be an annoyance. I think it is due to poor air circulation and/or outside air is leaking into the room (we have an exterior door that could be the culprit).

What exactly do you mean P30i mask or N 30?
The mask N 30 did not fit me (perhaps they did not guess with a measuring tape). The N 30 mask, in my opinion, is worse than P10 in that it does not have pillows that are securely fixed in the nostrils. So in the N 30 mask I couldn't remove the air leak and I would have constant problems with leaks when I moved at night.
I have not used the P30i mask, but I have used the F30i mask. These two masks are similar in that there are two silicone air ducts on the sides of the face, which irritate the skin of my face and cause me additional discomfort. I prefer the hose like the P10 or the Nuance & Nuance Pro Nasal Pillow CPAP Mask with Gel Nasal Pillows.
With ventilation in P30i or N 30 masks, everything is fine.

[Miss Emerita]

Dzyan, really interesting leak solutions -- thanks for posting them! You might even want to paste that post into a new thread with a title like "leak solutions" so it'll be easier for other people to find it.

Ideally the air in your bedroom would be fresh and cool. I wonder whether you'd benefit from opening that door to the outside a little bit. Just a thought. You could also try Flonase nasal spray before bedtime. It takes several weeks to kick in fully, but it might help you keep your nose clear.

About the P30i and the N30: like Dzyan, I couldn't get a good seal with the N30. The P30i didn't bother my skin, but the air moving through the pieces resting on my face made a rustling sound that drove me crazy. -- All that said, the mask that is best for you is the one that is best for YOU.

[thomasc1126]

Dzyan, really interesting leak solutions -- thanks for posting them! You might even want to paste that post into a new thread with a title like "leak solutions" so it'll be easier for other people to find it.

Ideally the air in your bedroom would be fresh and cool. I wonder whether you'd benefit from opening that door to the outside a little bit. Just a thought. You could also try Flonase nasal spray before bedtime. It takes several weeks to kick in fully, but it might help you keep your nose clear.

About the P30i and the N30: like Dzyan, I couldn't get a good seal with the N30. The P30i didn't bother my skin, but the air moving through the pieces resting on my face made a rustling sound that drove me crazy. -- All that said, the mask that is best for you is the one that is best for YOU.

I live in South Florida so opening the door would probably make it worse lol.

4/8/23 (night 5)

Woke up feeling really tired.

First image are 2 sessions of me relaxing with the p10. First session is with the large pillows, second session is with the medium size pillows. I felt both sessions started okay but the pressure just kept rising. Once it got to 8-9 it became very uncomfortable. Any thoughts on this?

Second image is actual sleep with my airtouch f20. I had the mask just tight enough to get a good seal on 6 pressure. Once the pressure started to rise so did the leak rate. What triggers the airsense 11 to increase/decrease pressure?

Thanks for everyone's help thus far, I really appreciate it!

[thomasc1126]

4/9/23 (night 6)

Finally got a full 8 hours. Still feel tired though.