Problems getting started. I have questions on ramping and PS settings

I've got an Aircurve 10 ASVAuto

Settings are EPAP 9-15 PS 4-9
I've played with the EPAP setting, pulling down the high end a bit, but it seems to make things a bit worse if anything.

I'm seeing UAs and Hypopneas.

I was set up with pillows and did the sleep study with them, they actually worked well for a little over a month before I started having a bad mouth leak. It said my AHI was under 5, but I suspect that's because when it ramped up, it couldn't register them because of the leak.

I loved the pillows, but I can't seem to get them to work because I can't keep my mouth shut .

My second try is with a Full mask. My AHIs are higher. 7-9, but I've just recently started using the full mask.

Will those come down over time? Should I give it a couple of weeks before worrying?

It looks like most of them are while ramping up, shortly after it ramps up or in REM sleep (The times roughly match my Fitbit) and just before waking up. I'll probably try increasing the ramp pressure to see if that helps.

I've also recently (twice) ripped the mask off while sleeping. That one bothers me the most.

I'm looking for suggestions. I can play with the EPAP settings until they are about right, I don't want to develop an intolerance, and with the mask I haven't seen any leaks. But how do I adjust the PS setting, or should I? I didn't see anything about what to look for while adjusting it.

Thanks,
Ralph

More minimum EPAP is needed for obstructive apneas and hyponeas.

How did you come up with the current settings? Did you have a large number of centrals during your sleep studies?
Doctor just guessing or did you have an in lab sleep study using the ASV machine where they came up with those settings?

Max PS of 9...not optimal for treating centrals is why I asked. First thing I would do is change max PS to 15 (it won't go there if it doesn't need to for treating centrals/breathing for you).

Use available software and let's see what's going on ...just a recent detailed report.

https://sleep.tnet.com/equipment

and how to post the images along with examples of format
viewtopic/t158560/How-to-post-images-for-review.html

Welcome to the forum.

I've never seen an obstructive or central apnea in sleepyhead, only unknowns.

Those settings are based on a sleep study.

I'm going to go back to the stock settings for a while, but remove the ramp and bump of the support pressure and see if I can get a full night's sleep before posting anything more detailed for people to look at.

If your mask is leaking, more pressure will increase the problem, not fix it, so which mask is it? Don't overtighten though as that can cause more trouble... better to get fitted well, in the right size etc, or try other FFMs.

RalphT wrote: ↑

Sun Jul 29, 2018 6:50 pm

I've never seen an obstructive or central apnea in sleepyhead, only unknowns.

Yes....with the ASV machine all it does is report unknowns or unclassified. Even if you were to use ResScan that's all you would get...hyponeas and unknowns.
In theory those unknowns are obstructive apneas because if you were having centrals the machine would deal with them and breathe for you...only that PS of 9 might not be enough...need to see the SH report and see what the PS average and max are. If it isn't needing to use PS of 9 it doesn't matter.
The PS increase is what is breathing for you when you don't breathe on your own due to a central apnea...it increases a lot and quickly..that's how it forces you to breathe.

welcome aboard, ralph!

here is some reading you may find helpful-

viewtopic/t172378/Sticky--Newbies-PLEAS ... fbd0fb8ddf

and you may want to try this to help keep your mouth closed-

viewtopic.php?f=1&t=112758&st=0&sk=t&sd ... i#p1086296

good luck!

You might want to read this. While it is from a different brand the premise behind how it works is the same no matter which brand.
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf

ResMed has a similar guide but I seem to have lost the link to it.

Julie wrote: ↑

Sun Jul 29, 2018 6:51 pm

If your mask is leaking, more pressure will increase the problem, not fix it, so which mask is it? Don't overtighten though as that can cause more trouble... better to get fitted well, in the right size etc, or try other FFMs.

When I tried the pillows, it leaked through the mouth, which is what got me started with sleepyhead. I've haven't had it leak yet with the FFM. It's uncomfortable, but I suspect it has to be to seal
tight. I may try loosening it a bit and see if it still holds.

Pugsy wrote: ↑

Sun Jul 29, 2018 6:57 pm

RalphT wrote: ↑

Sun Jul 29, 2018 6:50 pm

I've never seen an obstructive or central apnea in sleepyhead, only unknowns.

Yes....with the ASV machine all it does is report unknowns or unclassified. Even if you were to use ResScan that's all you would get...hyponeas and unknowns.
In theory those unknowns are obstructive apneas because if you were having centrals the machine would deal with them and breathe for you...only that PS of 9 might not be enough...need to see the SH report and see what the PS average and max are. If it isn't needing to use PS of 9 it doesn't matter.
The PS increase is what is breathing for you when you don't breathe on your own due to a central apnea...it increases a lot and quickly..that's how it forces you to breathe.

Thanks! That's good to know, I didn't know it reported all of them as unknown. I just figured I wasn't having the other ones. I'll have to research what the difference is.

I'll bump PS up to 15 see what that does. the max was 9 and average last night was about 6, but that's probably on the high side for average, it was a bad night. I wonder if they capped it at 9 because I was using the pillows.

The pillows wouldn't really have anything to do with the PS unless they were thinking that the pillows couldn't handle higher PS which isn't true.
I have used an ASV machine with the nasal pillows and they don't go flying across the room when the pressure gets up there.
I often saw pressures up around 22 when I was using the ASV...probably for a random sleep onset central which isn't a big deal but the machine will still try to do something about it.

And yeah...if the mouth opens a lot and just won't stay shut then sometimes we have to use a full face mask if all those other things which can be tried to keep the mouth shut don't work.
Full face masks do have more real estate touching your skin so more areas involved that need to seal.
Be careful with tightening...sometimes less is more and the cushion needs to inflate to seal and when too tight they can't inflate to seal and you end up trying to tighten more and that can make it even worse.

Also..maybe the full face mask you have simply is the wrong size or even the wrong mask for your facial structure.
Sometimes we just have to try a different mask.

Also with a full face mask often we need a higher EPAP than we need with a pillow mask. I think that is because of the way that lower strap pulls the jaw back a little and makes the airway a little bit smaller.

Which full face mask did you get and have been trying?

If increasing the PS doesn't bring the AHI down...then more EPAP minimum...so maybe try 10 EPAP minimum from the 9 you were using.

Pugsy wrote: ↑

Sun Jul 29, 2018 9:00 pm

Which full face mask did you get and have been trying?

It's the resmed mask. It hasn't been leaking, the pillows were, but I'll adjust the straps again to make sure they aren't too tight. I'm also having to get used to sleeping on my back, so fun times all around It's actually been a lot less uncomfortable that I've heard other people found it and I generally fall asleep right away.

Interestingly, my fitbit is showing a lot more REM and deep sleep than it was. I'm not sure if that is the mask, sleeping on my back, or a bit of both.

Thanks,
Ralph

Just because you use a full face mask doesn't mean that you have to sleep on your back (which can make OSA worse and cause more pressure to be needed). Now figuring out how to sleep on your side with the mask on can be a challenge but it can be done. People even sleep on their stomachs with full face masks.
I don't know which ResMed FFM you are using but some are better than others in terms of comfort and ResMed mask a wide variety of FFMasks...

But did you know about this mask.
Relatively new to the market and just released late spring.
https://www.cpap.com/productpage/respir ... dgear.html
Very little plastic on it and it's fairly flexible and when I tried it I could even sleep easily on my stomach.
There's a good video that shows how flexible.
https://www.youtube.com/watch?v=RUwIa3xnsDQ

Pugsy wrote: ↑

Sun Jul 29, 2018 9:45 pm

Just because you use a full face mask doesn't mean that you have to sleep on your back (which can make OSA worse and cause more pressure to be needed). Now figuring out how to sleep on your side with the mask on can be a challenge but it can be done.
https://www.cpap.com/productpage/respir ... dgear.html
Very little plastic on it and it's fairly flexible and when I tried it I could even sleep easily on my stomach.

Thanks Pugsy,
I'm using a ResMed F20. The seal leaks very easily because of it's size, and I tend to move around a lot so I'm concerned that lying on my side would inevitably make it leak. I'll give it a try. Last night, I managed to open my mouth below the mask so had a huge leak. I'll keep at it and see if I can get used to it.

I tried on the Respironics mask, but I'm worried about the seal around the nose. It seemed like the weakest point and most likely to cause me issues. Having the smaller seal may be worth it though. I may try it if I can't get used to the one I have.

Thanks,
Ralph

I actually used the DreamWear Full Face mask for a week to try it out.
I toss and turn all night long because I can't stay in any one position long because of pain issues.
It took me about 3 nights to get the DreamWear dialed in so that it didn't leak or move around and actually that under the nose thing is a lot more stable than you think.

Much less footprint on your face...highly recommend that you at least try it for 2 or 3 nights. It does take some tweaking but once you get it there...very stable and you really can sleep on your stomach and not have it move and it doesn't have to all that tight to do it either.
I won't wear a mask that has to be tight and might cause discomfort...simply won't do it.

You don't know me much but I am NOT a fan of full face masks for several reasons but for me to keep it and recommend it is saying a lot. I am a tough nut to please when it comes to masks...especially full face masks.

Pugsy wrote: ↑

Sun Jul 29, 2018 9:45 pm

Just because you use a full face mask doesn't mean that you have to sleep on your back (which can make OSA worse and cause more pressure to be needed). Now figuring out how to sleep on your side with the mask on can be a challenge but it can be done. People even sleep on their stomachs with full face masks.
I don't know which ResMed FFM you are using but some are better than others in terms of comfort and ResMed mask a wide variety of FFMasks...

But did you know about this mask.
Relatively new to the market and just released late spring.
https://www.cpap.com/productpage/respir ... dgear.html
Very little plastic on it and it's fairly flexible and when I tried it I could even sleep easily on my stomach.
There's a good video that shows how flexible.
https://www.youtube.com/watch?v=RUwIa3xnsDQ

Pugsy, I own the Dreamwear FFM and although it's comfortable, I was highly disappointed with how the pressure drops when especially when you lay on your side. That's the one major flaw about the Mask in my opinion and which is why I don't like it especially if I'm using a fixed pressure because sometimes I can't control how I Toss and turn at night and the pressure will fluctuate if I turn to my side.

Any feedback about that concern?