Help! Airsense 11 with p10 mask - OSCAR data included

[Melko]

Hello everyone! I was recently diagnosed. I cannot for the life of me get my AHI below 5.5. The first 2 weeks I used the F20 mask and it really messed up my nasal bridge, so I recently switch to the p10 nasal pillow. I think they are super comfortable but my AHI seems even higher than before. Additionally, I have been using a soft cervical collar to assist with positional apnea. I am posting my OSCAR data from when I started using the p10. Any input on the data I am posting would be greatly appreciated! TYIA!


https://imgur.com/a/61tGTXK

[palerider]

You see that very first post, the one that says "Sticky: Newbies PLEASE READ BEFORE POSTING"?

Now you know what your next step is.

[Melko]

Thank you so much for redirecting me. I am so sorry about that. I think I may be better setup for assistance now.


I hope the images work…not entirely sure if I did it correctly as the wiki steps are a little different now. TYIA.


https://imgur.com/a/61tGTXK

[ozij]

You can see in both images that your maximum pressure (10 on Sunday and 12 on Tuesday) is basically stuck where you limited it.
You can also see that you're still snoring on both nights, more so when the pressure is lower.

Conclusion: Your machine would got to higher pressures if you would let it.

So, question number one:
On what did you base you decision for maximum pressure?
Question number two:
You said

I am posting my last 2 nights of OSCAR data.

Does that mean you didn't use the CPAP on Monday

[Melko]

I’m sorry about the confusion. I updated my post to say what I actually posted. I did use my CPAP all nights. On 4/30/23, I would say there isn’t much accuracy because I was up a lot with the baby who was sick. The reason why I haven’t increased my pressure is because the first time I set it to 15 I got an earache and a lot of bloating. I woke up burping. However, that was with the F20 mask. So now, I am slowly working my way up to 15 again with the p10. Think that’s what I should keep doing until I find the sweet spot? I am afraid to go high again with the new mask and wake up with ear pain and bloat again, it was miserable! Also, any insight on positional apnea? How do I know if my cervical collar is helping? Thanks again!!

[ozij]

I’m sorry about the confusion. I updated my post to say what I actually posted. I did use my CPAP all nights. On 4/30/23, I would say there isn’t much accuracy because I was up a lot with the baby who was sick. The reason why I haven’t increased my pressure is because the first time I set it to 15 I got an earache and a lot of bloating. I woke up burping. However, that was with the F20 mask. So now, I am slowly working my way up to 15 again with the p10. Think that’s what I should keep doing until I find the sweet spot? I am afraid to go high again with the new mask and wake up with ear pain and bloat again, it was miserable! Also, any insight on positional apnea? How do I know if my cervical collar is helping? Thanks again!!

You're absolutely right to go about it slowly, gradually. ResMed machines let you add pressure in 0.2 increments -- use that option to move up gradually.
Good luck!
Just curious: Why did you actually start at a max of15? And how did you decide on your minimum?

[Melko]

Thanks, I will probably go to increasing by .2 or .5 because going from 11-12 was a lot last night, but I do feel more rested. I went to 15 as suggested by someone on another board who helped me out while I was using the F20. I think I may have been going to 10 and so they suggested that would be my minimum. I’ll post that data if you’d like to see that as well.

ETA prior data while on F20 mask.
https://imgur.com/a/mGDgkWP

[ozij]

That last chart can't help us much, because you must haave changed pressure at the middle of the night.... the header says 4 min, 5 max, but the rest of the reprot has much higher pressures than 10.
Unless its unbearable, do try to stick to your chosen settings for a week or so.

[Melko]

Will do! Thank you.

[Melko]

Oh, I meant to ask should I be increasing both min and max pressures together or only max pressure?

[palerider]

Oh, I meant to ask should I be increasing both min and max pressures together or only max pressure?

Generally, the max pressure should be set to 20 (or 25 if your machine is a bilevel), and the *MIN* pressure needs to be raised to the point where the pressure trace for the night is relatively flat, without large pressure swings.

[ozij]

Oh, I meant to ask should I be increasing both min and max pressures together or only max pressure?

Generally, the max pressure should be set to 20 (or 25 if your machine is a bilevel), and the *MIN* pressure needs to be raised to the point where the pressure trace for the night is relatively flat, without large pressure swings.

The reason why I haven’t increased my pressure is because the first time I set it to 15 I got an earache and a lot of bloating. I woke up burping

There's a difference between "generally" and "specifically". Melko tried 15, and it was bad.

I agree that the minimum is too low - and you can see how snoring and flow limitations occur when the pressure drops.
If it were me, I'd try a minimum of 8 or more - and not gradually. I would raise the maximum gradually, from the highest tolerable pressure since in this, specific case, a "wide open" maximum has too many side effects.

@Melko: You've also been playing about with EPR. Keep in mind that EPR drops you effective pressure when you exhale, and that drop may not be doing you any good because it leaves you with pressure that is too low to keep your airway open at the end of your exhale - and then you start snoring because the inhale pressure doesn't kick in fast enough.

Check your data to find out the relationship between your snoring your EPR and your pressure settings.

[Melko]

These are great suggestions. Yes I tried going much higher for both my MIN and MAX at first. My MIN was set to 8 or 9 and MAX to 15. But, I barely slept that night because I felt so bloated and just keep burping the whole night. I felt awful the next day.

Now I’ve been gradually trying to get my pressures higher and it is much more tolerable.

Ozij - I have my EPR set to 3 full time. Standard response, ramp auto, and start pressure 5.4. Is there anything I should change in regards to EPR? I don’t really understand EPR much yet.

Also, I did have AHI of 3 day before last, I felt amazing!!!! I been bumping pressures up every so slightly every night… l will def put MIN to 8 tonight and MAX the next .2 or .4 bump up. Do you think that would be ok? I know you had suggested keeping to the same setting for a week, but if it’s only increasing the pressure by a little every night, will it be ok?

Again thanks for all the help Ozij! Here is my data from the last 2 nights.

https://imgur.com/a/pQfRLq1

[ozij]

Now I’ve been gradually trying to get my pressures higher and it is much more tolerable.

"Much more tolerable" is great - and very important.

Ozij - I have my EPR set to 3 full time. Standard response, ramp auto, and start pressure 5.4. Is there anything I should change in regards to EPR? I don’t really understand EPR much yet.

EPR=Exhale Pressure Relief. Once the machine senses you're exhaling, it drops the pressure by 1, 2, or 3, until it senses you started exhaling again. The Lanky Lefty (a registered sleep tech with a very helpful youtube channel) maintains that when EPR is used, the switch back from lowere Exhale Positive Air Pressure [EPAP} to the needed inhale pressure is too slow in some cases. EPR is a "poor man's" bi-level machine. The real bi-levels are more expensive, can have a larger exhale to inhale difference, and make the switch back to inhale pressure faster. EPR is a comfort feature - helpful for those of us who have difficulty breathing against the incoming inhale pressure.
Whatever you minimum inhale pressure, you effective minimal exhale pressure when you use EPR become the minimal IPAP (that Inhale Positive Air Pressure) minus the EPR. It that's too low - you start snoring.

Also, I did have AHI of 3 day before last, I felt amazing!!!! I been bumping pressures up every so slightly every night… l will def put MIN to 8 tonight and MAX the next .2 or .4 bump up. Do you think that would be ok? I know you had suggested keeping to the same setting for a week, but if it’s only increasing the pressure by a little every night, will it be ok?

As long as it's tolerable, then it should be OK. And if it's tolerable, but just "not so good", give your body more time to get used to the change and don't add more.

Again thanks for all the help Ozij! Here is my data from the last 2 nights.

https://imgur.com/a/pQfRLq1

The reduced need for pressure at the second half of the night on both nights is very impressive - is that a case of sleeping on your side (good) vs. sleeping on your back (not so good)?

If it were me, I would try moving from EPR=3 to EPR=2 to see how it effects my sleep and my results. Our natural breathing out is the result of relaxing the breathing muscles. With CPAP, we have to breathe actively agains the pressure, and we feel this demand for acitve breathing out when EPR is lowered. But we can get used to it - so don't panic if it feels a little difficult. You're not choking. Caveat: I'm assuming you don't have any diagnosed breathing problems like asthma or COPD....

If you really want to know for sure which is more important for you, you have to change one variable at a time -- my gut feeling (which could be all wrong) is the that lower EPR would help you avoid some of the snoring and restriction that could be the result of IPAP coming into force too late. Changing EPR from 3 to 2 effectively raises your minimum EPAP by 1 -- without changing your maximum IPAP at all.

"Ramp Auto" means the machine stays at ramp pressure for as long is it thinks you're awake based on your breathing irregularity. You can see how your pressure really zooms when the machine sees that a) you're asleep and and b) your airway indicates growing obstructions. If you can turn off the ramp, do so. That means you'll be starting the night at higher pressure - and maybe not obstructing (ffully or partially) like that the minute you fall asleep.

You used the term "positional sleep apnea" in the context of a cervical collar. But for some people, it means "on my back vs. on my side". Was that mentioned in your sleep study? Can you fall asleep comfortably on you side? Have you tried?

[Melko]

The reduced need for pressure at the second half of the night on both nights is very impressive - is that a case of sleeping on your side (good) vs. sleeping on your back (not so good)?

Good question. It appears to be a pattern for me and I have yet to figure it out.

If you really want to know for sure which is more important for you, you have to change one variable at a time -- my gut feeling (which could be all wrong) is the that lower EPR would help you avoid some of the snoring and restriction that could be the result of IPAP coming into force too late. Changing EPR from 3 to 2 effectively raises your minimum EPAP by 1 -- without changing your maximum IPAP at all.

Think you are on to something. Before I knew even a hint of what EPR was I had it set to 2 and ramp off. For some reason, someone had suggested the opposite but my gut has been telling me what your gut is telling you too. So I will go back to 2 ramp off tonight and we will see.

You used the term "positional sleep apnea" in the context of a cervical collar. But for some people, it means "on my back vs. on my side". Was that mentioned in your sleep study? Can you fall asleep comfortably on you side? Have you tried?

Again, another suggestion given to me based on someone else. Apparently, they said that my OAs appeared positional, so I put a collar on in hopes that it would help! But honestly, I’m just trying to figure it out and willing to try anything until I find what works for me. So, if it wasn’t hurting me, I’ve been keeping it on but would love to toss it because it’s annoying.

A update - Last night, I had the lowest AHI I have ever had since starting, it was a 2.7! I couldn’t believe it. I thought it was going to be super high because I thought I was waking up a lot. All I did was wake up with tons of gas and have felt bloated most of today. Unfortunately, I forgot to get a screen shot, but I’ll post it on Monday with the others. My pressures were AUTOSET 8.0 to 13.2. So I’m going to back down a bit from 13.2 until I can tolerate it better. I know I can do 8 fine so I did set it as my MIN as you suggested.

I truly appreciate all your help, you’ve been heaven sent and spot on with helping me out. Most of all, thanks for continuing to respond and giving me your time.