Hello All, I am a total newbie with OSA

HI my name is Dave, I'm 52 yo with recently diagnosed OSA. I did a home study thru Mayo Clinic here in Phoenix AZ and was told I have it pretty bad. I have been on CPAP for 4 nights now, its been hell, I feel like I'm getting suffocated. I dont think the med supply store set this machine up properly. A couple friends at work recommended changing some settings that they said might help. I found your site yesterday and I guess I'll start with my tests and my setups if that would show my situation. I have a Philips DreamStation machine and dreamwear full face mask. My main problems right now are waking up like I cant breathe out against the machine. I have no trouble falling asleep with mask, its not uncomfortable, It's just when that thing is ramping up later on I feel like I am being inflated. I wake up and take it off for a bit, then have to try falling back asleep. I downloaded their app to my phone and used it last night after making a change suggested by my coworker who has same machine and mask, I was hoping for a miracle, instead I had issues and when I checked the app data this morning, my AHI was at 26.6. Any recommendations or tips to make this work are appreciated, I need this to work, Thx. Here is what they listed in my test results at Mayo:
Study Result:

WATCHPAT ONE HOME SLEEP APNEA TEST

SUMMARY:
A home sleep apnea test was performed using a peripheral arterial tonometry device on January 22, 2021. We recorded 6 hours 46 minutes of valid data, of which 5 hours 47 minutes were thought to represent sleep. The patient estimated 6 hours of sleep. Apneas and hypopneas occurred 47.6 times per hour, while the number of respiratory disturbance events were estimated at 48.0 per hour. The mean oxygen saturation was 93% and the minimum was 61%. Oxygen saturation was less than or equal to 88% for 17.1 minutes . Snoring was captured to greater than 60 decibels with an average loudness of 44 decibels. Positional data revealed severe worsening in the supine position, moderate in the nonsupine position.This was a technically satisfactory study, scored using the 4% criteria for hypopneas.

IMPRESSION:
Abnormal home sleep apnea testing with evidence of severe OSA.

Here are some images from my recent use of Machine.

The bulk of your AHI is obstructive in nature (OA/hyponea) and you are spending a good chunk of your night at around the 12 cm max pressure.

Get this software so you can see more than the DreamMapper app shows you.

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

viewtopic/t158560/How-to-post-images-for-review.html

First thing to do....change the max to 20 cm. It's very possible you need more minimum as well but lets see what happens when the machine can do what it is designed to do first.

What is your Flex setting? It shows CFlex but not the setting.
I suggest changing it to AFlex and try all the settings available including off and see what simply feels better to you...and don't use the ramp feature when you are testing the Flex settings.

Go here and request the provider/clinical manual for your machine via email.
https://www.apneaboard.com/adjust-cpap- ... tup-manual
How to get to the setup menu area to make changes is explained in the manual along with some other useful information that probably isn't in the user manual.

Thanks so much for quick response. I know how to make the changes thru the menu system as I did change from 5 min-15max to 8min-12max myself and turned on Cflex to 3. I will raise max to 20 and try the Aflex tonite. My machine didn't come with an SD card so I ordered one from Amazon, will come today. Oscar is installed and ready to go as well. When you say Try A-flex setting and dont use ramp feature, do you mean turn ramp off in the settings just for testing before actually using machine for sleep??

Is it weird to say that I think my mask is inflating? When the machine is running full bore, its sounds like my mask is, well, farting lol. I should add that my mouth is dry as a desert when using machine. I was supposed to have a heated hose as well as it was stated in my script' but they never gave me that. Also I have humidity set at max which is 5. Thx so much for the help.

Don't use the ramp for the Flex comfort test because I want you to be testing at the higher pressure and not the starting minimum that you get with ramp.
I don't care if you use the ramp when actually falling asleep though.

Dry mouth is a common complaint even when a full face mask is used and even when maximum humidity is used.
Some people just get dry mouth easier than others for any number of reasons....or they mouth breathe more...or they are just unlucky.
You can try increasing the humidity setting but I don't know how much it will help...and without a heated hose to help prevent condensation in the mask or hose you might have a problem there but while rain out (condensation) is annoying...it won't actually hurt you.

Once you get the SD card you can insert it in the machine and actually get some detailed data that is stored in the machine's internal memory. You won't get flow rate as it gets written directly to a SD card because it is such a large file...but you will get the other graphs.

When you do...get me a detailed report of the night where you had the max of 15 if you can. Would be interesting to see it.
Might tell us that we should go ahead and increase the minimum right away and not wait.

The reason I asked you to try AFlex....it's actually the newer of the Flex options and I personally found it more natural like in breathing...now you may not feel the same way but since all I can do is offer ideas based on my own experience or what I have learned...I give advice based on personal experience. It's what you get from everyone here...their own ideas based on their own experience.
Now I happen to have coming on 12 years of cpap/apap experience plus I have experimented a lot and I have studied and studied and studied to help me in the areas I don't have personal experience to fall back on.
I do happen to have personal experience with Respironics apap...a much older model than yours but it is what I first started my cpap therapy with and the first machine had only CFlex which I thought was worthless but my second machine had AFlex and I fell in love with AFlex of 2. It totally mirrored my own respiration pattern and made it feel like I wasn't even fighting the machine to exhale.
Now you might like another setting better which is why I tell people to try all settings. Pick the one that feels more comfortable to you no matter what the setting is.

The minimum pressure setting is actually going to be your most critical setting to worry about but when I see reports where the max is severely limited I never know if more max is needed to allow the machine to do its job better or if we have to increase the minimum to give the machine a better head start.

Read the SleepyHead Tutorial at the almost top of the Announcements section. It will explain a lot of the basics and OSCAR is based on SleepyHead so pretty much everything there applies to OSCAR reporting as well.

Huge learning curve but you can get there...just take things in small steps. You can get there.

Mask farts is a commonly used descriptive term.
Make sure when you fit your mask you are using your therapy pressure and not the lower ramp pressure because what seals good at 5 cm might not seal so good at the higher pressures your machine wants to give you.
I think there is a mask fit/check feature on your machine...it will deliver the higher 90% pressure for about 3 minutes I think (explained in the manual) so you can actually fit it at the higher pressures.

If you still get leaks or farts that wake you up...maybe add a mask liner but we need to see just how much leak is going on first...on the software reports.

I am testing A-Flex as I type this and I like it! Now, how do I turn Ramp off on the dream station? Is it by setting ramp time to 0?

Yep...just setting the ramp time to 0 effectively turns it off.
Or if there is a ramp button to push on your machine...just don't push the button to engage ramp.
I haven't seen a DreamStation but all past Respironics machines had a button to push to start the ramp and even if the setting was for 20 minutes if the button wasn't pushed the ramp wouldn't engage.

Much better night last night with the changes, AHI down to 14.1 compared to previous nights 26.5, but the mask farts made me want to punch a hole thru the wall. Googled it and ordered some RemZzzz mask liners. I will post OSCAR data later as I have to goto work very early today.

last night.

For future screen shots. Omit the snore, tidal volume and resp rate graphs and make the other graphs larger.
We don't need resp rate or tidal volume and snores are flagged on the events graph.

Also lets fix the red line leak statistic. Go to Preferences/CPAP tab and upper right change the 24 L/min red line leak threshold to something more in line with your Respironics machine. The 24 L/min is a ResMed machine threshold and it's not going to work well with your machine. You need probably up around 70 L/min for your threshold. Respironics doesn't give us an exact number as a threshold because it moves with pressures used and with masks used...but 70 is close enough. Best way to evaluate leaks...look at the events graph up where the LL line is. That's large leak and if there are no flags there...you didn't have any large leaks.

For tonight...change your minimum pressure to 10 cm if you can comfortably use it...if not you can go up slowly over several nights to make it easier to adjust to.
Probably going to need more than 10 cm but too big of a jump can be uncomfortable and cause a problem falling asleep and without sleep none of this matters.
And sometimes we get lucky and don't need as much minimum pressure as first thought.

The bulk of your AHI is OA and hyponea which should reduce with more pressure baseline holding the airway open better.
Don't worry about hitting the max right now. Lets see where the max goes with a more optimal baseline.

Thx Pugsy

I tried mask liners last night, it helped with the farting issue alot, only managed around 5 hours of sleep though as I had to get up early to take care of some stuff. Here's last night with the changes Pugsy sugggested. I'm sorry if the screenshots from Oscar are too small, I tried re-sizing but my PC resolution is kind of big. Anybody have a suggestion on how to make em better I am all ears, Thx.

You can turn off short sessions so you won't have big blocks of blank space and then have the bulk of the night scrunched together.
Over on the left side below the statistics scroll down until you see the sleep sessions and click on the short session and it will be omitted from the graphs making the bulk of the night easier to see.

Tonight try 12 cm minimum and see how things go. If that's too much..try 11 for a couple of nights and then try 12.

Pugsy wrote: ↑

Wed Mar 03, 2021 5:32 pm

You can turn off short sessions so you won't have big blocks of blank space and then have the bulk of the night scrunched together.
Over on the left side below the statistics scroll down until you see the sleep sessions and click on the short session and it will be omitted from the graphs making the bulk of the night easier to see.

Tonight try 12 cm minimum and see how things go. If that's too much..try 11 for a couple of nights and then try 12.

Thx so much. I hope I am getting there lol,

Not so good last night. I usually fall asleep in my LazyBoy chair, I tried going into my bed. I have been sleeping in chair so I don't wake up wife when I get home at 2:00 am from work. I had my machine set up in bedroom, went to bed, fell asleep ok or so I thought. Apparently I had a large leak, probably from side sleeping. I think also my position of laying down versus my inclined position in my chair made some difference. For some reason I just cant get more than 3-4 hours with mask on. Maybe I have wrong mask? Maybe I should try nasal? My wife says my mouth is open just a bit when I sleep and I don't breathe thru mouth while awake. I am almost thinking that I am gonna fail at this.