Newbie seeking help to reduce AHI as low as possible - Oscar data

[ArtieZiff]

Hello,

I have been reading the forum for months, and I am hoping that you might be able to help me to drive down my AHI below 1.0. Honestly, I've used my machine for a year and a half, and on only one night did I feel anywhere near rested. It was a night with a very low AHI.

Machine: Resmed AirSense 11
Mask: F&P Simplus
Conditions: I definitely suffer from dry mouth, and possibly mask leaks. I also move a lot during the night, mostly sleeping on my side.

I see the doctor very infrequently, and am kind of flying solo on this. I am hoping that some setting tweaks will help me, but I do not know what. I also would appreciate any suggestions for a better mask. This one whistles significantly.

Here is my data from Oscar for a fairly typical night. If I've done this wrong, I ask for your patience, as I am totally new to posting.

[Pugsy]

Could you replace the mask pressure graph with the regular pressure graph, please?
The mask pressure graph isn't all that useful unless we are zooming in for a breath by breath look.
You don't did to redo this one but keep it in mind for future report sharing.

Are you experiencing any or much nasal congestion?

Do you absolutely have to use a full face mask?

[ArtieZiff]

My apologies. Hopefully this one is correct.
As for full face masks, I am a mouth-breather by far. I do not think a nasal mask would work for me.

Thank you!

[Pugsy]

I haven't ever used a full face mask so I have zero personal experience to draw upon but there are some newer (newer than the Simplus) full face mask models out there that you might find more to your liking.
They have less real estate touching the skin so less area to potentially leak.

F & P has the Evora full face
https://www.cpap.com/products/evora-ful ... 0383082812

ResMed has a couple of similar masks
the AirFit F40 https://www.cpap.com/products/resmed-ai ... 0759882044
the AirFit F30 https://www.cpap.com/products/resmed-ai ... 0759882044
the AirFit F30i https://www.cpap.com/products/resmed-ai ... 5689979196
or the clear version memory foam version
https://www.cpap.com/products/resmed-ai ... 0829035836

[ArtieZiff]

Thank you for the masks. I’ll have to take another look at the under-nose variety. I initially had trouble with them due to my jaw dropping open at night and the nose part pulling away. That said,
I’m sure there has been progress since then.

[ozij]

According the present graph you're spending half the night at a pressure of 13.92, or above it.

If you look at the way the pressure change, you can see it zooms up in response to flow limitations, resolves them, and then drops back down to where the FL's start happening, at which point your sleep is already disrupted, you may be opening your mouth, and the machine starts playing catch up.

This makes me think that if your minimum pressure were higher, you'd have less FL's and better sleep. FL's disrupt your sleep, possibly make you opein your mouth and that causes leaks.

So if this were my data, I'd start raising my minimum pressure gradually. How gradually? Depends on your tolerance for the change. And keep the new setting for a number or nights before adding more: our bodies and brains need time to get used to the change.

Take a look at your other nights and pay attention to the median pressure, and to the relationship between the flow limitations and the pressure.

[zonker]

in behind ozij to support what she says.

the good news with having a resmed machine is that you can raise your minimum pressure by increments of .1 which can be helpful if you find too much pressure gives you aerophagia.

also want to say that at this point in your journey, don't be too concerned with getting your ahi at 1. a better goal is to find the right combo of settings to let you sleep through the night and wake up feeling rested. you never know, that ahi might just be 2!

good luck!

[ArtieZiff]

Thank you both so much! I increased the minimum to 9.0 and the EPR to 3 to see what would happen. There seemed to be fewer incidents, but the leak rate seems a bit more dramatic. Tonight I will pay extra attention to the mask straps and fit. I think it might be trending in the right direction. I also appreciate the advice about just finding a comfortable sleep, without worrying about the 1.0 AHI. I will definitely say that I felt a difference last night; I agree--satisfying sleep is the goal, not numbers! This was my data last night:

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[Sleepzilla]

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[ArtieZiff]

Wow! I appreciate the thoughtful explanation, and I am finally coming to feel a bit more confident about this equipment.

I think I will, as advised, leave it as-is for some days, just to acclimate to it. My mask adjustment from day to day is a bit of “you win some, you lose some.”

In days to come, I will most likely try bumping the minimum up to 10 and the maximum down a bit. Hopefully the higher minimum will be sufficient to keep the airway open!

In the long-term, I will ask the doctor for a different full-face mask—possibly one with foam instead, and also order a better chin strap. I am currently using the ResMed one, but I don’t think it has any effect.

Thank you all for your assistance. I am learning so much!

[ejbpesca]

By raising your Min pressure, the Med and 95% pressures came down. The machine quit tapping out at 20 cm, and AHI lowered as well as Flow Limitations. This is evidence of what improvements can be made with a pressure adjustment. Congratulations.

Some may suggest a bit higher Min pressure to decrease FLs more. Others realize FLs can be caused by issues other than what PAP therapy can resolve. Your call.

[ArtieZiff]

Thank you! I have been acclimating myself to the pressure changes, and after seeing the results, I do think that bumping up the minimum and bumping down the max might be helpful. Here is a recent night, if anybody has time to take a look:

[zonker]

Thank you! I have been acclimating myself to the pressure changes, and after seeing the results, I do think that bumping up the minimum and bumping down the max might be helpful. Here is a recent night, if anybody has time to take a look:

yup. minimum could be 10 or higher, up to you.

I see no need to reduce the maximum. machine won't go higher than it needs to anyway.

good luck!

[ejbpesca]

Med (median) pressure is up, indicating Min will be more effective at a higher setting. Raising Min until it is close to Med is fine tuning your therapy pressure for fewer fluctuations.

You can see from the red line that Min 9 is not your optimum therapy pressure. Trying Min 10 will help find it.

AHI is good, but there are Flow Limitations to consider. Look back at OSCAR charts at the 95% FL scores. There are debates over these scores. FLs can be caused by factors that PAP therapy cannot address. Some go to great lengths to improve the scores, feeling that FLs disturb their sleep. I have come to accept my scores of Med 0.00 and 95% 0.07 as doing well. Your 95% score of .18 on Dec 29 may be normal for you. You may want to research Flow Limitations to understand them.

Using EPR 3 is often said to be accompanied by Min pressure addition of 1cm per cm of EPR pressure relief, which is another reason to raise the Min.

No CAs, or Large Leaks and Leak Rate 0.00s is something you have that many struggle to achieve, but never make it. Good for you.

Max can be left at 20 or fine-tuned down as long as it is not reached. Your setting of 19 was bumped once. That is not significant, so 19 is okay. The higher you raise the Min, the less you will see the red pressure line rise. A smooth red pressure line can help with sleep quality.

[ArtieZiff]

Hello! Based on spousal feedback (the old F&P mask was too noisy, despite meticulous efforts to keep it clean), I switched over to the ResMed AirTouch F20 with memory foam. The noise problem is largely solved; however, I am now "back to the drawing board" in terms of results. I do like the new mask much better, as the old one was also waking me up. However, I am disappointed that my median pressure from the last 30 days has increased to 14.72, an increase from the upper 12's with the F&P mask. To me, it appears that a similar pattern is occurring, compared to my last one. That said, I am worried that CA has appeared a couple times since the new mask. It may be me holding my own breath when I am lightly awake due to the shock of the high pressure... I have also been informed that, even with the high pressure, I am still snoring with the mask on.

I would appreciate the wisdom of the board, if possible. I would really like to make this new mask work. I am fairly certain it is due to the memory foam. I had a lot of flapping issues with the silicone-only edges of the past.

I am sad to report that I am never well-rested when I wake up. The only time this has happened is when my AHI was like 0.75, once. I would very much like to feel rested, no matter what the numbers say.

Thank you for everything you do. This form is quite informative.

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