Finally took the test...

Does that mean I wake up multiple times every minute? Albeit, I am not really awake.

You are not really awake, but you are not really asleep either. There are four stages of sleep, three non-REM stages and REM sleep (the dreaming stage). When the airway is blocked, the brain in its wisdom causes an "arousal" to move to a lighter stage of sleep so we breathe, and therefore survive! So people with severe apnea do not get the deep restorative sleep (stage 3) or REM sleep that the brain and body needs.

Here is a link to a description of the sleep stages and the function of each stage:
https://www.verywellhealth.com/the-four ... ep-2795920

You need to relax... you're focusing on a high AHI from testing, but many of us have had those and within a week of Cpap, saw numbers fall to single digits... just give things a chance.

First night on bipap.....seems like I have some leaking problems with the Airfit N20. Might be opening my mouth or something. I did get up to use the bathroom around 4am. I also have a beard, do I need to look into other mask solutions?

How did I do?

Yes, a beard can make it close to impossible to not see leaks... very hard to fit masks... some just shave, others experiment and find masks that work... all depends and hopefully some will be around with ideas.

Also, it's best to follow info on Oscar for which graphs to post and which not to bother with... you have some we don't need, but I'll let experts comment on results.

How would you rate your sleep? Wake often or sleep soundly for the most part.
How long do you think it took you to fall asleep?
Answers to these questions affect whether or not maybe you should have a little higher minimum EPAP.

The mask leak...could be mouth opening or could simply be mask movement. Don't worry about trying a different mask at this time or actually trying anything other than making it a little more secure. We will worry about the leaks later if we see it it consistently or it worsens or you tell us that leaks are waking you up.

Did you have much dry mouth this morning or during the night?

For a first night...actually you did better than a lot of people. You got more hours using the machine than I did my first night. I think you did great for a first night. You kept the mask on for about 8 hours and there are many, many people here who can't say that. Obviously a lot of clutter and flagging but some of that could be awake false positive flagging and actually I would expect to see that the first night anyway.

Save yourself some work...no need to share the detailed graphs where you have tidal volume included (top graph)...we only need the detailed report that shows flow rate, pressure, leak, etc.
So one report image is all we really need. If we need anything else we will just ask.

The snore graph...that one time where it was so ugly was also a time of high leak and the leak was high enough to negatively impact therapy....maybe allow the airway to collapse a bit and the snores are maybe an indication the airway tried to collapse. We try to fix the leak first and then worry about what we see that remains.
Above 35 L/min leak line...the machine can have trouble sensing, recording and responding to events and you were way above that line. Was it mask movement or mouth opening??? Can't tell but I would lean towards mask movement at this time. If we see this sort of leak a lot then we maybe do some things to try to figure out if it is mouth opening or mask movement but I don't want to add more work for you just yet.

There's no need to shave when using a nasal mask for most people unless it involves minor trimming around the nostrils.
The N20 just doesn't really touch much area of the face where there is facial hair.
Now if you were trying to use a full face mask...different story maybe but even then there are people with full Santa Claus beards who use full face masks successfully.

Pugsy wrote: ↑

Sun Aug 01, 2021 5:46 pm

How would you rate your sleep? Wake often or sleep soundly for the most part.
How long do you think it took you to fall asleep?
Answers to these questions affect whether or not maybe you should have a little higher minimum EPAP.

Thanks for the info, Pugsy! I would rate my sleep last night as better than usual, ha. I feel like it took me about an hour to fall asleep and get comfortable with the mask on. Initially, I was laying on my back, but then I switched to my side before I fell asleep. I recall a point in the middle of the night that I was awakened by a leak, like the mask was against the pillow and caused it to lift off the other side of my nose. I will for sure tighten up the straps tonight. I didn't have them very tight last night.

I did feel a little euphoric when I woke up, almost like a body high that lasted a good 30 minutes or so, until I drank some coffee.

My only complaint is that my ears felt clogged when I woke up and throughout most of the day.

Oh, and I went to bed so late last night that my wife didn't even realize I came to bed because I didn't really snore like I usually do. Win win!

I just realized what your settings were last night.

These are your current settings.
Minimum EPAP 4
PS of 8
Max IPAP 25 which is no big deal.

This is what your doctor ordered????
The PS of 8 is likely the cause of the high number of central/CAs.
Did you have an in lab titration sleep study using a machine or are these settings just guesses???

You for sure need to cut the PS in half down to 4...and most likely will need to increase minimum EPAP to 6 at least and maybe more.

Horrible settings.....I am sorry but I didn't realize it before now. I thought the 4 was just the ramp and didn't notice the PS of 8.
PS (pressure support) over 5 is well known to trigger central apneas in a lot of people.
PS of 8 is pretty much a guarantee for central apnea trigger and is only used when people have specific respiratory or neurological issues.

...the plot has thickened a bit!

Pugsy wrote: ↑

Sun Aug 01, 2021 8:01 pm

I just realized what your settings were last night.

I didn't mess with any of the settings. Apria told me it would come "pre-programmed" with what the doctor ordered. I am not even sure what he ordered, as I was never provided with any documentation. I did a sleep study, but they never put me on a machine because all had been recalled and they took them out of the rooms. He did say that if they were to have had them in the rooms still, they would have hooked me up in the middle of the night....but no go.

I'll try to go into the clinician menu and follow your recommendations.

I updated to your recommendations. With the PS so high, could that cause my clogged ear feeling?

JLROhio wrote: ↑

Mon Jul 26, 2021 9:02 pm

I am curious as to if there will be an SD card. I contacted ResMed a few weeks back to ask them this directly and they indicated that they have not provided SD cards in machines for the past couple of years. They also recommended any SD card over 2Gb would work. Since this is a Bi-Pap machine, I'm wondering if it just might contain an SD card.

Also, I'm curious if anyone has been prescribed the Oximetry Module to go with their CPAP equipment. Since the OP needs supplemental oxygen, one would think that someone (doctor) would want to also measure the oxygen levels while they are asleep, along with the other CPAP data...

BTW, it came with an SD card.

Well....Crapria isn't exactly known for getting stuff correct (they are well known for screw ups though)...and doctors do sometimes pull setting ideas out their butts when they don't understand the actual machine or how it works and when a doc jumps on a bilevel machine just because of a high diagnostic AHI on a sleep study...does make we wonder what he/she is thinking though.

The most commonly prescribed PS settings are 4 and 5 when someone actually does an in lab bilevel titration sleep study and in fact they usually start people out at 4 PS.
Higher than 5 PS is saved for special situations and if someone hasn't had a titration study and doesn't have seriously impaired lung function then we have no idea if someone qualifies for a special situation or not and when we don't know...we go conservative with ideas. PS of 8 is NOT anywhere near conservative.

Let me know if you can get in and make the changes.
I do think you will do better with 6 minimum EPAP and most likely will need a bit more but lets start small and see what happens. Might get lucky and you won't need as much as I might think.
PS of 4 for now....See what the centrals look like tomorrow.
I have a friend who gets about 15 centrals per hour with PS of 4 but essentially none with PS of 3...so sometimes there is a fine line between success and a problem.

A few/handful of centrals is normal...no big deal.

AND a big yes....the PS of 8 most definitely could be contributing to the ear issues.
While not exactly like what altitude pressure changes do to the ears...sort of similar and would be like going high up really fast and coming down really fast and what it does to your ears...like when you fly in an airplane. Big roller coaster kind of thing...really, really tall roller coaster.

Side note...whispering...crossing my fingers that PS of 4 doesn't cause ear issues...I don't want to scare you but sometimes any pressure causes ear issues. Not common by any means like it would be with a high PS but not totally impossible either.

zrob wrote: ↑

Sun Aug 01, 2021 8:20 pm

JLROhio wrote: ↑

Mon Jul 26, 2021 9:02 pm

I am curious as to if there will be an SD card. I contacted ResMed a few weeks back to ask them this directly and they indicated that they have not provided SD cards in machines for the past couple of years. They also recommended any SD card over 2Gb would work. Since this is a Bi-Pap machine, I'm wondering if it just might contain an SD card.

Also, I'm curious if anyone has been prescribed the Oximetry Module to go with their CPAP equipment. Since the OP needs supplemental oxygen, one would think that someone (doctor) would want to also measure the oxygen levels while they are asleep, along with the other CPAP data...

BTW, it came with an SD card.

Do you know what year your machine was produced?

I found this out about possibly determining year of production from an earlier thread:

The serial number tells place and year of manufacture:

i.e. 2211xxxxxxx

22 = Australia
23 = Singapore
11 = 2011
xxxxxxx = Serial number

Be careful looking at your machine, make sure you remove the water tank before looking at the back of your machine!
I wonder if your machine was possibly a 2017, 2018, or 2019 made one...since it's more specialized (rare) than most...and thus had the SD Card included.

Pugsy wrote: ↑

Sun Aug 01, 2021 8:32 pm

Well....Crapria isn't exactly known for getting stuff correct (they are well known for screw ups though)...and doctors do sometimes pull setting ideas out their butts when they don't understand the actual machine or how it works and when a doc jumps on a bilevel machine just because of a high diagnostic AHI on a sleep study...does make we wonder what he/she is thinking though.

Amen on Crapria. They wanted to "rent" me a oxygen concentrator for like $125/month. I flat out asked them how much it would cost to just purchase one. They said they would "get back to me". Well, I found Philips Respironics EverFlo 5L for pretty cheap and just picked that up. Not like I can use it, because ol' Crapria didn't include an O2 adapter thingy for my hose. So, I just bought a ClimateLineAir OXY on my own, so I don't have to call Crapria anymore. It should be here this week and I'll get to add the supplemental 2L oxygen like the doctor wanted.

Oh, and I just watched a YouTube video on my mask. I was using a medium, when I should have been using the small. SMH. I was in a rush to get going with treatment, that I didn't even think to measure my nose with the card they provided. Hoping that will help with the leaks too!

I really appreciate all your knowledge. I hope my numbers are better tomorrow. I'll be sure to post them.

Something to think about since you are going to be adding Oxygen...make sure you still need it once the sleep apnea is optimally dealt with.
Often that is all that is needed...kill the apneas and the O2 levels will normalize.
My O2 went to 73% during my in lab sleep study but once I was on cpap...stayed well in the mid 90's where it is supposed to.

You can get an overnight recording pulse oximeter that will integrate with OSCAR so you can verify what is going on.

OSCAR has a list of compatible recording pulse oximeters in the help section I think it is.
Amazon or EBay a good source and not horribly expensive depending on the features you want.
I used to have a CMS 50 Dplus which is the basic model..no frills but it did what I needed it to do which was tell me I no longer had any desats.