Help! Airsense 11 with p10 mask - OSCAR data included

[ozij]

You're very welcome - and you're going about it the right way!

[Melko]

I had the oddest night yesterday, I woke up feeling like an ice breathing dragon. My mouth would force open and air was coming out! I’ve seen a few YouTube videos on it, but I still don’t understand 100% what to do next…

So, last night I turned my MAX pressure back down to 12.4 because at 13 I got a lot of gas. I also turned ramp off and set EPR to 2 (use to be 3 with ramp on).

I will post the data of the past 3 nights with summary tomorrow, but noting it here so I don’t forget what happened and what I want to ask.

[Melko]

Here is my data for the last 3 days -

https://imgur.com/a/whq9j6L

My settings -

https://imgur.com/a/ojsVHfX

How I felt -

Friday, 5/5: I had my lowest AHI ever at 2.7, but I felt pretty bad during the night. I was shocked to have such a low AHI. I was up for what I thought was a lot because of bloat and gas.

Saturday, 5/8: even though OSCAR says that my EPR had ramp to auto, I actually had it off as you suggested with a start pressure of 8. I don’t know why that wasn’t accurately captured. I felt super odd this night. Again I thought I was going to have a bad AHI because I woke up with air literally blowing out of my mouth. I don’t think I am a mouth breather, but I do think I was a little congested and perhaps that could’ve caused that. I researched on YouTube a bit and decided for the next night to increase my tube temperature.

Sunday, 5/7: oh what a night! Big thumbs down. 1) I should’ve gone to bed earlier. 2) I tried to go without the collar and I’m not sure if that was the issue. 3) the humidifier increase caused condensation inside my nasal pillows and water was leaking! I’m exhausted. Again, OSCAR isn’t accurately depicting my EPR. I believe I left ramp on but at level 2 not 3.

I feel like my MAX pressure might be where it should be, but perhaps trying to get use to starting pressure of 8 without a ramp might be something?

Thoughts?

[ozij]

Here is my data for the last 3 days -
Saturday, 5/8: even though OSCAR says that my EPR had ramp to auto,

Not sure what you mean by this sentence, but I see your EPR at 2, and it was active full time.
The ramp, for that day was on Auto, and started at 6.
There is no inherent relationship between ramp and EPR.

Sunday, 5/7: oh what a night! Big thumbs down. 1) I should’ve gone to bed earlier. 2) I tried to go without the collar and I’m not sure if that was the issue. 3) the humidifier increase caused condensation inside my nasal pillows and water was leaking! I’m exhausted. Again, OSCAR isn’t accurately depicting my EPR. I believe I left ramp on but at level 2 not 3.

Ramp and EPR are not related. Sunday shows your EPR was 2, your ramp was still on Auto, meaning the machine only starts raising your pressure when it decides you're asleep. Your ramp setting of 6 basically tells the machine to keep the minimum at 6 until you've fallen asleep (according to its analysis).

I feel like my MAX pressure might be where it should be, but perhaps trying to get use to starting pressure of 8 without a ramp might be something?

I agree to both. No need to push up your max pressure.

Do you have a heated hose? A heated hose lets you have more humidity, if necessary, with a far far lower chance of running into condensation (called "rainout" in CPAPspeak.) Air rushing out of your mouth is mouth leaking - not necessarily mouth breathing.
Lets see what happens with no further changes. And for the next few days - keep the collar. We don't want too many change at once.

[Melko]

Great explanation. I don’t know why I keep correlating EPR and ramp. But hopefully now it sticks, appreciate your patience.

I do have a heated tubing, so I had changed from “auto” to “manual” and increased it by 1 degree from the preset. I switched it back to auto in the middle of the night and it was better.

I agree, no more adjusting of settings or anything else to see what happens. I can def deal with AHI of 2.73 (until my body starts getting tired again as it did with AHI at 5. LOL

Thanks so much for helping me through this…

[ozij]

I do have a heated tubing, so I had changed from “auto” to “manual” and increased it by 1 degree from the preset. I switched it back to auto in the middle of the night and it was better.

I don't think simply raising the hose

temperature

should result in rainout - unless your room is very cold, and there's a dramatic cool down in the short P10 hose. It it possiible you actually changed to manual and then added one level of humidity and not one degree of heat to the hose? Are you on Fahrenheit or Celsius as far as hose temp degrees are concerned?

Be sure to keep us updated how things are going!

[Melko]

https://imgur.com/a/IWgzino

Here is my latest update. You’ll see for some days I didn’t wear my mask or I took a nap with it on. I was fighting a stomach bug that took over me around 1am Tuesday. I have not changed much of my settings for about 4 days, so I tried to removed my cervical collar last night because it’s so annoying! My AHI seems lower but I don’t really know the specifics. Last time I had someone review it, they said my OA was positional. If that’s right, then it would be reflected on last nights readings (Thursday 5/11).

It’s been a rough week, so it’s hard to say much about how I’ve been sleeping. But that’s my update! Hopefully next week will be better.

As always, thanks for your help Ozij!

[ozij]

Other health issues absolutely affect our sleep - I hope next week will be better in all senses.

Looking at your charts, I see two things:

• You're still using the ramp
• Most of the time, when your pressure drops, you have obstructive events or their precursors

https://www.resmed.com/en-us/sleep-apne ... -pressure/

How does my CPAP machine know when I fall asleep?
Your AirSense 10 will know you’re asleep no more than three minutes after. That’s because the moment you turn on your machine, AutoRamp is looking for three things:

30 breaths of stable breathing (roughly 3 minutes)
5 consecutive snore breaths
3 obstructive apneas or hypopneas within 2 minutes
Once any of those signs occurs, AutoRamp steadily ramps up your air pressure at a slow, comfortable rate until you reach your prescribed level.

Plus, no matter when you fall asleep, AutoRamp makes sure you reach your prescribed pressure no later than 30 minutes after you turned on your machine. This ensures that you get effective sleep apnea treatment, based on research that on average, most people on CPAP fall asleep in 20–25 minutes.

However, on your charts, there's no such thing as " AutoRamp steadily ramps up your air pressure at a slow, comfortable rate " - you are zoomed up the max very quickly. And, you rarely stabilize on you minimum pressure.

OSCAR has a vertical cursor that goes through all your charts. Put the cursor where your the snores or flow limitations appear and check what your pressure is. I'm eyeballing the charts - it seems to me that most of the time you start snoring before reaching you minimum pressure, and you rarely stay there. Please check that with your cursor. And note a which pressure you start snoring and or start having flow limitation.
This combined with the ramp behavior mean (in my opinion) that the ramp, and ever your minimum pressure, are too low.
Lets wait till you're sure your over you bug and its aftereffects, and then therea are a number of ways of trying to improve your sleep - I can't tell you which is best since it depends on how you feel.

• Get rid of the ramp
• See how you feel with EPR=1, and if that makes things better, aim to get to EPR=0 after a few nights on EPR=1
• If the change in EPR is not enough, start nudging your minimum pressure up - you aim is to find yourself spending more time at your minimum pressure.

All your present charts show you spent half the night at pressures of 10.3 or above - so your aim is to get your minimum setting to that vicinity. Do it gradually, think of your comfort - but do it.

[Melko]

Hello there!! It’s been a while since I’ve updated but I have been traveling a lot and unable to upload my data. I have been very inconsistently using my machine at night bc I keep waking up with so much gas and sharp abdominal pains. I start off the night great but then wake about 3 hours in because the gas pain is unbearable. I haven’t changed my settings since we’ve last discussed except for EPR back to 3 because the gas was even worse on 2. Not even sure if there is a correlation there or not. I have ramp off as well and start with 8.8 pressure with max at 12.4.

Traveling has made the gas issue worse and I’m thinking it has to do with my pillow? Could that be? I don’t remember being woken up so much by the gas pain with my home pillow, it’s the only thing I can think of. Also, I had already moved EPR back to 3 before traveling and I didn’t have this many issues with being woken up bloated… desperately wanting better sleep again!!!

ETA: I keep trying to remember what else I may have changed and remembered that I switched my nasal pillows to size XS from S. They feel so much more comfortable and zero leaks… per the machine (not Oscar). Not sure if that’s also another factor but again, at home EPR 3 with XS pillows was not causing so much gas. It looks like the only thing different when I travel is my pillow… could that really be it?