Advice/Guidance on my journey back into CPAP

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Glasswalker
Posts: 2
Joined: Wed Oct 13, 2021 2:41 pm
Location: Auckland, New Zealand

Advice/Guidance on my journey back into CPAP

Post by Glasswalker » Sat Oct 16, 2021 7:58 pm

Hey everyone, visited the forum before, but first time posting. I was diagnosed back in 2014, I don't still have my original paperwork from this diagnosis, but I believe my untreated AHI was 35-40, and the doctor considered it "severe". I should also note that Apnea runs in my family. My father, his father, and all of his brothers have been diagnosed, and sleep with CPAP as far as I know.

Anyway, I've had an on again/off again relationship with my CPAP therapy. My first machine a ResMed S9, worked ok, and I used it fairly regularly for a year or two, but after struggling with some other health issues, I fell out of the habbit of using it, and struggled to get back on the horse.

This post might be a bit long, apologies if so, I'm providing a bit of context first, which I hope will help in reviewing the data I post later.

In 2017, I moved from Canada to New Zealand, for work. And before moving, decided I needed to get my act together and really make another go of using the CPAP. So I got a new Philips Dreamstation 1 before leaving Canada, as I had insurance to cover it, and got back into using it. I used it for the first year a fair bit, at that time I was using a ResMed AirFit F20 mask (I'm a mouth breather when I sleep, and could never get chin straps or tape to work, also have facial hair I'd rather not entirely get rid of which complicates things), and I had a wave of really struggling with leaks keeping me up, but the final straw was my first winter in NZ I got hit with a cold, which turned into a string of major respiratory issues (constant congestion, colds, several respiratory infections, at one point was using an inhaler for asthma symptoms, something I've never suffered from before, etc). And at one point I simply couldn't deal with the continuing leak/comfort issues with the mask, and the ongoing respiratory issues, I would wake up feeling a very heavy feeling on my chest, as if someone had been sitting on my chest after sleeping, and I usually felt terrible. After throwing in the towel a second time, I actually felt great, but I still slept terribly, snored excessively, and occasionally felt pretty tired. (fairly typical of how it was pre-diagnosis).

So leap ahead a couple years, and getting a bit older, and getting more concerned about my day to day health as I want to improve things before getting too much further over the hill, so want to start losing weight, and dealing with many lingering things I've been neglecting. One of them was to try and get back on the horse again, and put some real focus on my apnea, give it a solid go and try to make it work this time, as the health complications it can cause are a serious concern.

So I unpacked the old DreamStation, and went to fire it up, only to see "Service Required" on the screen... Upon going online to look it up, I quickly found out about "FoamGate" (the recall) and was disturbed by that whole situation (and based on what I described above that I began suffering immediately after using the Philips machine, makes me wonder if I was dealing with symptoms from the bad foam... Though it could have also just been new allergens/pollens in NZ etc, who knows).

Anyway, so I've registered for the recall, but I don't trust Philips as far as I can throw them, so I've gone out and bought a brand new ResMed AirSense 10 Autoset, out of pocket... I really want to commit to getting this right this time around. I still had a spare (unused) AirFit F20 mask, but I found out about the AirFit F30i mask, and thought I'd give that a go.

Fast forward to yesterday, got the new machine, unpacked it, cleaned everything up, and was actually excited to give it a go. Tried on the new mask, and wow, it's FAR more comfortable than the F20, Did a quick fit test, and had no leaks at all, I love the top of head hose, as I'm a very "violent" sleeper, (I toss/turn/kick/squirm/roll/fall off the bed/etc). And I found the hose on the face constantly pulled at the mask and caused it to leak when I moved around. With this one in a quick (while awake) test in the bed, I found it didn't leak when I rolled around on my pillow in the same way, because the mask protrudes less...

So I setup the machine with a max pressure matching my previous prescription of 16cmH20, set most of the other settings to their defaults or auto settings, and had a go at sleeping with it last night.

Things I noticed before falling asleep:
  • I felt the EPR worked way better than the Philips version. It was much easier to breathe naturally
  • I found the mask much more comfortable, and the initial pressure level starting low was super comfortable prior to falling asleep
  • I fell asleep easily and quickly, probably 15-30min at most
I managed to make it a 9 hour night, without taking off the mask, which is awesome, I don't think I ever had that kind of success with prior machines.
Overall I felt pretty good when I woke up.

However I did have some issues during the night:
  • I was suffering from pretty severe back pain in the middle of the night, it wasn't bad when I went to bed, but I woke up several times uncomfortable, tossed around a lot trying to find a comfortable position where my back didn't hurt (this is not abnormal for me, reasonably common)
  • I woke up several times to the sound of leaks. The leaks weren't bothering me in the normal way (coldness, blowing in my eyes, etc) but I woke up hearing the blowing/whistling. Usually this is because I'd contorted my body in a wierd way and was putting pressure on the mask in some way that caused it to leak on one side or the other. So I'd roll over/correct and it would be fine. But I woke up this way probably 10+ times through the night.
  • I woke up early morning (probably 3-4am but I don't really know, didn't check the time) with a pretty severe leak, tightened the lower straps a bit, and that seemed to solve it, went back to sleep.
All that said, it was my first night, and I am sure a lot of the waking up wasn't actually the cpap's fault, more just a combo of me not being used to sleeping with the mask on, and my back pain, meaning I was easily woken by small things.

So I consider it a pretty successful night.

But then I looked at the data in Oscar, out of curiosity. I'm not planning on juding anything by the first night, but was just curious how it went. And I found a few oddities I wanted some input on (hopefully the above context helps in interpreting this). I found that the AHI through the night was 6.58, which was much higher than I saw with the Philips machine (between 1.0 and 2.0 usually). And most of them were clustered together in a period slightly after midnight (about an hour and a half after I went to bed). During this cluster it was reporting a localized peak AHI of 35.

When I looked at the data zoomed in on that period, I found an odd pattern, when looking at the flow rate, which appeared to indicate I was taking 2-3 breaths with diminishing flow, and then having a 2-3 breath obstructive event, on a constant repeating cycle, which seemed very strange to me.

Anyway, here are the charts, would love any feedback/tips/advice/guidance anyone wishes to throw my way.

I'll continue at it through this week, and may make a few minor adjustments, then will post back on this thread with updates on my progress as I go.

Thanks in advance! Now for the screenshots:

Here is my nightly overview for last night:
OSCAR_Screenshot_Oct_16_2021_Overview.png
OSCAR_Screenshot_Oct_16_2021_Overview.png (225.65 KiB) Viewed 451 times
And here is a zoomed in area of one of the clusters of events:
OSCAR_Screenshot_Oct_16_2021_Zoomed_Event_Cluster.png
OSCAR_Screenshot_Oct_16_2021_Zoomed_Event_Cluster.png (204.37 KiB) Viewed 451 times
And finally a section zoomed in on an area free of events for comparison:
OSCAR_Screenshot_Oct_16_2021_Zoomed_No_Events.png
OSCAR_Screenshot_Oct_16_2021_Zoomed_No_Events.png (200.15 KiB) Viewed 451 times
If you'd like to see any other specific data, or additional charts, or if you would like me to answer any other questions I'm of course happy to do so, just let me know what I can do.

Thanks!

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: ResMed AirFit F30i Full Face CPAP Mask with Headgear
Additional Comments: Just got ResMed due to "FoamGate", bought it outright, can't wait for Phillips. Currently using F20, but trying F30i for something new.
Machine: ResMed AirSense 10 AutoSet
Mask: ResMed AirFit F30i

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Respirator99
Posts: 339
Joined: Mon Jul 05, 2021 12:39 am
Location: Australia

Re: Advice/Guidance on my journey back into CPAP

Post by Respirator99 » Sat Oct 16, 2021 8:37 pm

G'day Glasswalker. Thanks for the detailed context - it really helps that we are not guessing about things.

Ignoring those clusters, your numbers aren't too bad, so I suggest we focus on the clusters first. To me, it looks like a postural problem, where your sleeping position is putting stress on the airway. Typically this occurs when your head tilts forward and your chin drops down to your chest. This causes stress on the windpipe, making it prone to obstruction. You can demonstrate this while awake - just let you head fall forward, chin on chest and breathe deeply. You should notice a distinct obstruction or limitation. There are several ways to overcome this, but the use of a soft neck support collar seems to work for many people. There is a detailed discussion here: http://www.apneaboard.com/wiki/index.ph ... cal_Collar
* Download Oscar
* Oscar help
* An alternative to Oscar - try SleepHQ

I have no medical training or qualifications. Take my advice for what it's worth.

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palerider
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Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Advice/Guidance on my journey back into CPAP

Post by palerider » Sat Oct 16, 2021 10:00 pm

Glasswalker wrote:
Sat Oct 16, 2021 7:58 pm
, as I'm a very "violent" sleeper, (I toss/turn/kick/squirm/roll/fall off the bed/etc).
You may find that stops when you're adequately treated.

I'm in the process of helping a friend who just thought she snored, however she'd manage to turn her blankets 90 degrees in the middle of the night, as she flopped around... after a few nights on cpap, her covers are much less disturbed.
Glasswalker wrote:
Sat Oct 16, 2021 7:58 pm
[*]I felt the EPR worked way better than the Philips version. It was much easier to breathe naturally
Many people have said this :)
Glasswalker wrote:
Sat Oct 16, 2021 7:58 pm
I managed to make it a 9 hour night, without taking off the mask, which is awesome, I don't think I ever had that kind of success with prior machines.
Many people have said that too.
Glasswalker wrote:
Sat Oct 16, 2021 7:58 pm
[*]I woke up several times to the sound of leaks. The leaks weren't bothering me in the normal way (coldness, blowing in my eyes, etc) but I woke up hearing the blowing/whistling. Usually this is because I'd contorted my body in a wierd way and was putting pressure on the mask in some way that caused it to leak on one side or the other. So I'd roll over/correct and it would be fine. But I woke up this way probably 10+ times through the night.
[*]I woke up early morning (probably 3-4am but I don't really know, didn't check the time) with a pretty severe leak, tightened the lower straps a bit, and that seemed to solve it, went back to sleep.
Pretty good for a first night, you're on the right track, and things should get better.
Glasswalker wrote:
Sat Oct 16, 2021 7:58 pm
When I looked at the data zoomed in on that period, I found an odd pattern, when looking at the flow rate, which appeared to indicate I was taking 2-3 breaths with diminishing flow, and then having a 2-3 breath obstructive event, on a constant repeating cycle, which seemed very strange to me.
That's a classic indication of your pressure being too low. Your min should probably be closer to 11, (and max at 20, unless there's a good reason to have it lower.

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Additional Comments: S9 VPAP Auto
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Miss Emerita
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Re: Advice/Guidance on my journey back into CPAP

Post by Miss Emerita » Sun Oct 17, 2021 11:56 am

You're getting such good advice here. I would suggest trying palerider's recommended revision to your pressure settings first to see whether that takes care of the problem. You might want to start by raising your minimum to 8. (That will also allow you to get the full effect of the nice EPR right at the start of the night.) And you might want to turn off the ramp, if it's on. If all feels fine with those revisions, then try going up to 9, 10, or 11, whatever you feel ready to try. In other words, you can do the increase in stages.

If these changes make no real difference and your events continue to be clustered, then please do try a soft cervical collar. Your back pain and restlessness may well mean you are tucking your chin down toward your chest from time to time. I would recommend doing this first, but it's an extra piece of gear to get used to, and if you don't need it, it'd be nice not to have to add it to your routine.

You have a great machine there, and it's wonderful that you're using Oscar. Congrats on the good night's sleep!
Oscar software is available at https://www.sleepfiles.com/OSCAR/

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Glasswalker
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Joined: Wed Oct 13, 2021 2:41 pm
Location: Auckland, New Zealand

Re: Advice/Guidance on my journey back into CPAP

Post by Glasswalker » Sun Oct 17, 2021 6:41 pm

Hi Everyone, and thanks for the great replies so far!

So last night I adjusted the pressure range as per advice from palerider, I've set the minimum to 10, and max to 20. No other changes this time around.

Last night I had less back pain, and overall got a much better nights sleep, I found I woke up much less due to leaks (I did wake up around 1:30am, and adjusted the mask straps one more time, which helped deal with some more minor leaks).

I definitely felt more rested, and felt overall good in the morning. And felt like I woke up far less this time around.

Again I'm aware it's only night 2, and still lots of ups and downs to come, while getting used to things.

Here is the chart from last night, noticed a few things:
  • Seems my AHI overall was up, but less clustered, more spread out...
  • Total time in apnea almost doubled
  • Obstructive seems to be about the same, but most of the increase seems to be from Clear Airway. And this time around had reduction of Hypopnea
  • Overall leaks seem better, less percentage above the redline.
OSCAR_Screenshot_Oct_17_2021_Overview.png
OSCAR_Screenshot_Oct_17_2021_Overview.png (222.78 KiB) Viewed 351 times
Will keep it here for a bit, and run this for a few days, see if any trends emerge.

Your comments that some of the events may be postural makes sense, as I said I can do some wierd stuff when sleeping :)
(I've woken up with blankets all on the floor, or me on floor with blankets, blankets tied in a knot around my head, all kinds of wierdness).

I'm wondering if I should do a timelapse of me sleeping so I can correlate events or data in the timeline with my sleeping positions, see if there are any patterns.

Will definitely look into cervical collar to see if that's something I can do, and if it helps. Also looking into buckwheat pillow, see if that helps any, my current pillow is quite thick and fluffy/soft, I think a more firm and easily "moldable" pillow might help a bit.

Anyway, Thanks again for the advice so far, more updates to come!

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: ResMed AirFit F30i Full Face CPAP Mask with Headgear
Additional Comments: Just got ResMed due to "FoamGate", bought it outright, can't wait for Phillips. Currently using F20, but trying F30i for something new.
Machine: ResMed AirSense 10 AutoSet
Mask: ResMed AirFit F30i