Need help optimizing therapy

[Khavoqi]

Hey everyone.

I'm a 19M, 165 lbs, 5'11, and I have a ResMed AirSense 10. I've been on therapy for around a month now, but have only had around 2 good nights on it. I'm getting a little frustrated with the constant trial and error, and wanted some help from knowledgeable people such as yourselves on what settings I should tweak based off my data.

Attached are a couple OSCAR data reports. I tried changing the pressure from 5.8, to 5.2 to 8.4, then to 10, then to 12. The increased pressure does seem to have helped a bit; however, it seems like as I increased the pressure, I increased the mouth leaks as well.

For starters, from my data, what would y'all recommend I use for the pressure? Would setting a small pressure range with automatic (maybe 10-12) also be another option, or is the automatic feature something you usually want to stay away from, due to the variability possibly disturbing you while you sleep?

Additionally, how do y'all prevent mouth leaks? Despite using mouth tape, I still seem to be getting tons of them.

And also, is EPAP worth using? I've seen people warn against it, as it can mess up the CO2 / O2 balance and cause central apneas.

And, one last question. Do y'all know what could be causing the blanks in my therapy in my 6/29 screenshot? I don't remember ever waking up and taking it off, and I don't have SmartStart on. I have no idea why there are breaks in there or what potentially caused it. And oops, I lied, one more question. Is my increased AHI on 6/29 something to worry about, and could that have been caused by the increase in pressure?

Sorry, I know I asked a bunch of questions; I really just want to make sure I get my CPAP settings right though so that I can get back to living.

Thanks. And just for context, I usually sleep on my stomach. Back is a no go as it worsens my apnea, and I don't really like sleeping on my side all that much.

OSCAR data: https://imgur.com/a/l9gnBXs

Original sleep study: https://imgur.com/a/PG7sfdw

[ozij]

You have practically no obstructive events on the pressure you're using here https://imgur.com/a/l9gnBXs.
No need for higher pressures. And do not, repeat not, go about changing pressures on a daily basis. Your body has to get used to the pressure settings.

My guess is that leaks were waking you up, and the machine is interpreting your wake breathing as breathing with central apneas.
Leave the pressure alone, concentrate on the mask fit. And on good taping.

[Khavoqi]

I gotcha.

Just checking, which night / pressure were you referencing? I had similarly low obstructive apnea events on both 5.8 and 12.

Also, would you recommend I switch to automatic, or should I just keep it at one stable pressure?

And finally, do you have any tips or tricks for preventing mouth leaks? I use MicroPore tape and purse my lips before putting it on, but I still apparently seem to be getting leaks.

Thanks.

[zonker]

And finally, do you have any tips or tricks for preventing mouth leaks? I use MicroPore tape and purse my lips before putting it on, but I still apparently seem to be getting leaks.

this works for me-
viewtopic.php?p=1089718&f=1&t=112758&p= ... s#p1086296

with some modifications.

good luck!

[ozij]

I gotcha.
Just checking, which night / pressure were you referencing? I had similarly low obstructive apnea events on both 5.8 and 12.

5.8

Also, would you recommend I switch to automatic, or should I just keep it at one stable pressure?

No need for higher pressures. You can keep it fixed.

[Khavoqi]

Are you sure about 5.8? People were telling me to increase the pressure, since it seemed like I was subconsciously ripping it off in my sleep, meaning that I maybe wasn't getting enough air. Could I try something like 6.6 or 7 instead?

[ozij]

I'm getting a little frustrated with the constant trial and error, and wanted some help from knowledgeable people such as yourselves on what settings I should tweak based off my data.

I am sure about one thing:
Changing your pressure on a nightly basis isn't doing you any good.

Are you sure about 5.8? People were telling me to increase the pressure, since it seemed like I was subconsciously ripping it off in my sleep, meaning that I maybe wasn't getting enough air. Could I try something like 6.6 or 7 instead?

Choose one of your two good nights, and stick to its settings for at least a week.

[Khavoqi]

Unfortunately, I don't have the data on those two nights; I didn't have an SD card, and it was on its factory range of 4-20.

Still though, if I'm ripping off the mask at night, does that usually means I need more pressure?

[ozij]

If you're changing your pressure every night it means that:
You may be getting bad advice
You may be ignoring good advice
You are not letting you body get used to sleeping with a CPAP.
You are treating your body as though it were a car or motorcycle that could be "tweaked" to perform better by daily changes.

Still though, if I'm ripping off the mask at night, does that usually means I need more pressure?

"Usually" and what is going on your specific case are not the same thing.
It is unusual for people to change their pressure daily.
It is unusual for people to switch from a pressure of 5.8 and hardly any obstructive events to a pressure of 12 within 5 days.

Do I think the data you shared means you need more pressure? No.
Do I think we can learn much from all those pressure changes? No.
What do I think you should do? I said that in my previous responses.

If you still don't understand, maybe somebody else will explain it better.

[Khavoqi]

I maintained a consistent pressure of either 5.2 or 5.8 for around 2 weeks, but I was still feeling pretty tired, so that’s why I asked for advice and started changing my pressure accordingly. I appreciate the comment, but it kind of feels like you’re dancing around the answer, only leaving me more confused.

Are you saying that I’m ripping off the mask because my body isn’t used to it? I very much feel comfortable wearing it, and considering I didn’t rip off the mask as much at higher pressures, there is some credence to the idea that I was ripping it off because I wasn’t getting enough air, due to a lower than needed pressure.

Also, considering the fact that my original AHI in my sleep study was 6, along with a high RDI, wouldn’t looking only at my OA number be a misguided indicator of how well a specific pressure is working?

Again, I appreciate the comments and the quick responses, but I don’t really get exactly what you’re trying to say. No, my body isn’t a vehicle, but at the same time, there’s still an optimal pressure or pressure range, and a suboptimal pressure or pressure range. What causes people to rip off their masks; inadequate pressure, or their bodies not being used to it just yet? And if it’s the latter, then why isn’t it happening as much with higher pressures? I’m not trying to be combative or argumentative, but just genuinely want to understand the situation. Thank you for your help; I truly appreciate you taking the time to analyze my situation and write up your comments.

[Miss Emerita]

People take their masks off in their sleep for all kinds of reasons, so no one can tell you with certainty why you're taking yours off. But as ozij noted, in the one chart you provided, you removed your mask after a period of high leaks. So if you could get your leaks down, you might well find you're not taking your mask off as much. It's also possible you just need some more time getting used to the new experience.

You can try putting some tape over the straps of your mask, anchoring the tape on both sides to the skin on your face. This will mean the tug of the tape will wake you up enough to get you to leave your mask alone. Some people also get good results from wearing socks or mittens on their hands.

Sleep is variable from one night to the next, so aside from disasters, you're not going to learn anything useful from one or two nights of data at a given setting. As ozij says, you'd do best to pick a pressure and stick with it. This will enable you to see longer-term trends, and it may also speed up the process by which your body gets used to PAP therapy.

Are you sure your leaks are coming from your mouth and not from your mask? And at the end of the night, is your tape still in place or has it come loose?

[Khavoqi]

Thanks for the response.

As far as I can tell, the leaks are happening both with the mask and my mouths On the nights with high mask leaks, my mouth felt horribly dry when I woke up, which points to my tape getting a little loose during the night, despite it still being on my face when I wake up. My mask also seems to leak regardless of what I do; I always feel and hear a tiny jet of air going in each direction. I thought that was normal though. Could that possibly mean I’m using a size too large for my nasal pillows?

[Miss Emerita]

If you think the tape gets loose in a particular spot, e.g., the corner of your mouth, try buttressing it with an extra pice of tape. You should most certainly experiment with different sizes of pillows for your P10. Also check whether it’s a bit too loose. Washing the headpiece can shrink things up a little, and you can adjust the tension via placement of the straps on your head.

[Khavoqi]

Hello again.

I've been having really rough nights as of late, and don't really know what has been causing them. I seem to be getting huge tidal volumes out of nowhere, with nasty, downward sloping breaths. I don't know what they mean and would appreciate anyone's input on them.

I also seem to have this pattern where I have a flatline, and then take off the mask. What could be causing this?

And, one last question. Based on my breathing patterns, would y'all recommend I try a bilevel? With my limited knowledge, it seems like those downward sloping breaths are an indication I'm struggling with exhaling, something bilevel would address.

https://imgur.com/a/xbi2jHw

[Khavoqi]

Just wanted to bump this back up to the top of the threads.

Does anyone have any idea what those weird breathing patterns are?

Also, does anyone have any idea why I keep on taking the mask off and putting it back on? It happened to me again last night, pictured here: https://imgur.com/a/1gZldmW

I understand if y'all don't know exactly what's going on with the downward sloping breaths, but could y'all at least take a stab at the reason for me taking my mask on and mask off? I see the views going up and up, but don't get any responses. Please, even if it's just conjecture or an educated guess, I'd appreciate a comment. I seem to have tons of flatlines both before and after them, and am not quite sure why it's happening.

Thanks,

-Khavoqi