Help a newbie adjust / Is my machine working right?

Hi everyone, I'm in desperate need of some advice (even if it is to suck it up and keep at it...)

I was diagnosed with mild obstructive apnea, and prescribed a machine which I received about 2 weeks ago. Machine is a ResMed AirSense 10 AutoSet, with a Philips Dreamwear full face mask. The mask is comfortable and not really an issue. I haven't used the machine every night, but finally found this board and loaded a data card a few days ago to see what was going on. I've had one really good night of sleep (6.5 hours) without waking up or struggling with the machine.

Here's the issue.. When I put on the mask and start up the machine, it takes a while to figure out my breathing pattern. While this is happening, it drops the pressure before I finish inhaling, and during exhalation, it pulses air at me. It usually takes about 10 minutes to settle in a bit, and I've started to put it on while watching TV or using my phone so I'm distracted, but it is still really difficult to work through. After this though, it seems somewhat random the rate it ramps up pressure, and generally keeps me from getting to sleep. Additionally, the pulsing while I'm exhaling is really what keeps me up, as it won't completely stop and happens during some breaths and not others. If I force myself to have a much sharper change between inhale and exhale it will not do this, but it isn't natural for me and again prevents me from getting to sleep...

I'm getting about 2.5 hours a night before I shut things down and just go sleep on the couch on my side (my AHI from the sleep test on my side was under 2, but was actually pretty bad on my preferred position on my back).

My DME contact hasn't been particularly helpful other than telling me to turn the ramp feature off, and adjusting the exhale relief to "3"

Is this normal and something I just need to power through?
Are there more settings I should be trying to adjust?
Should I be trying a different mask to help?
Do I just breathe weird and the machine is confused (don't laugh, if it's my fault, I'll own it... lol)?
Is the machine defective?
Should I be using a different machine that works better for me?

Oh, and just about all the apneas that I see in OSCAR are when I'm awake... so false positives ?

Thank you for literally any help... I'll take anything I can get at this point, I'm ready to throw the thing out the window, and hate bedtime!

-j

Attaching last night's data view.. first file is the whole session, second is a typical "start up" showing all the pulses I am feeling in the mask...

You are feeling the FOT that is used to distinguish central apneas from obstructive apneas.
I know you are awake but you are breathing irregularly and the machine doesn't measure anything but air flow...so it thinks something is going on with your breathing and it's trying to figure out what it is...so it is using the FOT.

https://www.respshop.com/manuals/ResMed ... %20her.pdf
explained page 8 of the manual.

Your machine is working properly but you are probably focusing on every little breath. The machine doesn't "learn" to adapt to you...you have to learn to adapt to it.

I can't tell what the settings are from the images you posted. You left out the stuff on the left side which tells us more information.
Might include that the next time.
See this for formatting tips.
viewtopic/t158560/How-to-post-images-for-review.html

I don't mean to sound harsh but to stop the FOT from annoying you ....you have to stop confusing the machine with your awake breathing irregularities.
Using the machine while awake and under no pressure to go to sleep is the best way to get used to it....watch TV, read a book or whatever.

I know this is all new and different but the best thing you can do is try to NOT focus on the mask, or machine or your breathing.

jcr159 wrote: ↑

Thu Jul 18, 2019 3:31 pm

Hi everyone, I'm in desperate need of some advice (even if it is to suck it up and keep at it...)

welcome to the forum!

yeah, suck it up!

joking. there are things to be done, i'm sure. and you are in good hands with pugsy.

what is your minimum and maximum pressure? that is one of the things missing from the left side of your graph.

do you sleep on your back? i ask because, discounting the ca count, the next most frequent event is oa. this CAN be attributed to sleeping on your back as apposed to sleeping on your side.

sorry! just read your post again and you say events are while awake. so forget my blithering above.

others will be by with advice shortly.

good luck!

If you really are using the AirStart Autoset machine you have in your profile, you were screwed by your DME. They really should have given you the AirSense Autoset.

LSAT wrote: ↑

Thu Jul 18, 2019 5:11 pm

If you really are using the AirStart Autoset machine you have in your profile, you were screwed by your DME. They really should have given you the AirSense Autoset.

He's got to be using the AirSense 10 AutoSet and just chose wrong in the equipment profile.
The AirStart AutoSet doesn't give any detailed graphs at all. So we wouldn't be seeing those graphs with the AirStart model.
I am not even sure if gives any summary data but for sure no detailed data.

LSAT wrote: ↑

Thu Jul 18, 2019 5:11 pm

If you really are using the AirStart Autoset machine you have in your profile, you were screwed by your DME. They really should have given you the AirSense Autoset.

If they had an airstart, they couldn't have posted data.

jcr159 wrote: ↑

Thu Jul 18, 2019 3:31 pm

Here's the issue.. When I put on the mask and start up the machine, it takes a while to figure out my breathing pattern.

It doesn't figure out your breathing pattern, it just raises pressure a little when you inhale, and drops it when you exhale (that's what EPR does).

jcr159 wrote: ↑

Thu Jul 18, 2019 3:31 pm

While this is happening, it drops the pressure before I finish inhaling, and during exhalation, it pulses air at me.

Because you're breathing so slow that it thinks you're having an apnea, so it starts (after 6 seconds of no breathing) to try and figure out whether it's a central or obstructive apnea.

https://www.youtube.com/watch?v=4GW97Xk06N8

also:

https://www.youtube.com/watch?v=-gie2dhqP2c

In addition, you have the wrong machine selected, look here: wiki/index.php/CPAP_models to find what to put in your equipment listing.

I went through the same problem with trying to learn to breathe at beginning of night. Just take a normal breath! I kept telling myself. But breathing just isn't something we think about while awake. Every time I'd start thinking about it during the day, I could tell that just focusing on it made me start breathing abnormally.

Laying in bed one night I realized that I wasn't using my diaphragm when breathing while using the machine. All lungs. Once I got this worked out, things got better real quick.

So - just take normal breaths! Problem solved.

Truth is, I can tell from my flowrate chart that I still don't breath "normally" while falling asleep. But I'm very comfortable with it.

Stick with it, you'll figure it out.

Thanks for all the replies so far... I did indeed select the wrong machine, though the AutoSet for Her seems the closest match in the equipment list, so that's what i just selected in my updated profile...

When I say the "machine adjusts to me", I'm basically saying that after a bit of time, it keeps pressurized through my entire inhalation, and stops recognizing my slow exhalations as apneas... I have some links to read up and watch still that everyone posted, thanks!

Sounds like the FOT is the issue. I'll dig in more and probably have more questions...

Here is a better screenshot, sorry I'm still working on it.

Look down in the Rs for the AirSense 10 AutoSet. For some reason it got stuck down there instead of up in the As with all the other AirSense/AirCurve models.

Pugsy wrote: ↑

Thu Jul 18, 2019 8:15 pm

Look down in the Rs for the AirSense 10 AutoSet. For some reason it got stuck down there instead of up in the As with all the other AirSense/AirCurve models.

Thanks! At least I finally figured this part out

Don't worry....you aren't the first to make that mistake and certainly won't be the last.
Happens at least once a week it seems.
We have asked the powers that be to change it...but no one ever did.

jcr159 wrote: ↑

Thu Jul 18, 2019 8:02 pm

When I say the "machine adjusts to me", I'm basically saying that after a bit of time, it keeps pressurized through my entire inhalation, and stops recognizing my slow exhalations as apneas...

The machine *does not change* how it behaves, you're breathing fast enough that your every breath doesn't seem to be an apnea.

The majority of your events appear to be centrals. I don't know if they're really centrals or just SWJ (sleep wake junk). Try adjusting the exhalation relief (up, down or completely off) and see which setting is the most comfortable (or gives the best results).

You AHI should be under 5 (I think lower, but we'll worry about that later). Of course, if your baseline is 30, then 8.18 is a big improvement.

D.H. wrote: ↑

Fri Jul 19, 2019 2:11 am

The majority of your events appear to be centrals. I don't know if they're really centrals or just SWJ (sleep wake junk). Try adjusting the exhalation relief (up, down or completely off) and see which setting is the most comfortable (or gives the best results).

You AHI should be under 5 (I think lower, but we'll worry about that later). Of course, if your baseline is 30, then 8.18 is a big improvement.

You are correct, all but a couple of the events occur while I was awake watching TV/using my phone.

My baseline was 13.7 supine, and 6.6/7.1 on my sides.

I can't really sleep on my side with the mask I have, it doesn't stay sealed well, and airflow feels cutoff. More importantly, my breathing pattern changes and the FOT makes it really hard to get back to sleep...