New-ish User, Terrible Results Taking a Nap

decker12 wrote: ↑

Tue Nov 01, 2022 12:15 pm

You mentioned that my minimum set to 8 is probably too low. What is the best way to determine how high the minimum should be set? Is the goal trying to minimize the amount of "jump" the pressure has to do to when I have an event? Meaning, look at the graphs on SleepHQ, and try to find a minimum pressure setting that is moth comfortable, and evens out the spikes with the valleys a bit more?

Yes. Exactly. Espeicially the valleys and canyons.
You could also track your median (50%) pressure. That number tells you you're spending half the night at pressures above it.
And a reminder: you can change setting in 0.2 increments. It may be necessary to do that when you're trying to get therapy without that "full" feeling.

decker12 wrote: ↑

Tue Nov 01, 2022 11:10 am

I was able to get to sleep, but it was definitely different. My inhales were something new to get used to as yeah, it's blasting me twice as strongly. I was okay with it though but after 30 minutes of trying to fall asleep, I did consider switching it to a 6 - instead I just stuck with 8 all night and eventually fell asleep. My exhale felt.. easier? Smoother? Tough to explain but it was distracting because it was different from what I was used to. The only other difference I noticed is at the very end of every exhale, right before inhaling, I had a brief sensation like you get when you go down a dip on a roller coaster. Like that slightly weightless feeling you get in your body when you drive fast down a hill?

Was this the first night you used EPR = 3? Was this the first night you had a beginning pressure above 7cm so that you get the full pressure relief of 3cm when you exhale?

That feeling you are describing used to drive me bananas back when I was still using a Resmed S9 AutoSet with EPR = 3.

If it's really bothersome, you might try turning EPR down to 2 to see if that's less distracting.

Before changing this setting, with Auto Ramp enabled at set to 4's, my exhale during the period before sleep, it felt like I had to push harder.

EPR doesn't kick in until the pressure rises above 4cm. And you don't get the full 3cm drop in pressure on exhale until the pressure is up to 7cm.

So in other words, when you were using the Ramp at 4cm, there was no pressure relief on exhalation: The pressure was a constant 4cm on both inhale and exhale. That could be why it felt harder to exhale fully at 4cm: The EPR relief is doing its job of making you feel like exhaling is easier even though your inhalation pressure is now 8 cm and your exhalation pressure is 5cm.

decker12 wrote: ↑

Tue Nov 01, 2022 11:41 am

Looking at last night's data it does seem that once I'm asleep I'm not dipping below that 8 which I changed in the machine. However looking at the charts from the past week or two, the lowest my dips go is actually around a 6.

If the min pressure is set at 8cm and the ramp pressure is set at 8cm, there's no way the machine is going to deliver less than 8cm pressure on inhalation, which is what SleepHQ is showing you.

Your exhalation pressure was dropping to around 5cm whenever your pressure setting was at 8cm during the night: That's because EPR = 3, and that means that every time you exhale, the pressure will be reduced by 3cm since your inhalation pressure is always greater than 7cm.

When you had your minimum pressure set to 5 or 6cm, there were occasional times when your inhalation pressure did drop to around 6. If EPR were set to 3, your inhalation pressure would have been reduced to 4cm, the minimum pressure the machine will deliver under any circumstances.

That seems to indicate that I should change the minimum to a 6 (and probably should have started at a 6 last night after all!)

Does that make sense?

Not necessarily. The lower your minimum pressure is as compared to what you typically need to prevent the worst clusters of your apneas from getting started, the greater the pressure swings will be. And the more likely the machine will find itself in a situation where it has to increase the pressure by 4, 5, 6 cm over a very short period of time (a minute or less). And those sudden pressure increases can cause some people to arouse. They can also cause some people to have problems with swallowing air. And, because the machine is now "chasing" events, rather than preventing them, more apneas and hypopneas might occur while the machine is ramping up the pressure to stabilize your airway.

Now starting the ramp pressure at 6cm might make some sense: If breathing at 6cm (with the exhalation pressure reduced to 4cm because of EPR = 3 being set) is more comfortable for you than starting at 8cm is and if you get to sleep more quickly with a starting ramp of 6cm than you do at 8cm, then using the AutoRamp feature with a beginning pressure of 6cm and leaving your minimum pressure setting at 8cm would be a reasonable idea to try.

And, because the machine is now "chasing" events, rather than preventing them, more apneas and hypopneas might occur while the machine is ramping up the pressure to stabilize your airway.

Makes perfect sense to me. You want the machine to react quickly to events, not "chase" the event a minute or two after the fact, you said. I've set my machine to Ramp 15 minutes, Ramp Pressure at 6cm, Pressure Min at 8cm. The Ramp Pressure at 6cm should give me 6 - 3 = 3 EPR so I'll notice that on exhales tonight, just like I did last night. I'm hoping the 6cm for 15 minutes will be a little more gradual for me than 8cm out of the gate.

Not that I would change it, but is there another setting that changes how quickly it's allowed to ramp up? I get that if I'm at 6cm, and I have an event, it needs to quickly jump up to 14cm to fix it. I assume the machine doesn't just flick a switch and start blasting 14cm air over the course of 5 seconds, and instead it takes a period of time to gradually (but quickly) increase it. I'm not interested in changing it, but curious what setting that may be under.

Looking at the SleepHQ data, I'm also seeing OA events clustered together.

Last night, 3 OA's within 11 minutes - 12:40, 12:48, 12:51, with an extra one at 12:33 AM.

3 more OA's close to each other again at 1:50, 1:52, and 1:56.

Is there any significance to these OAs being clustered together?

Also what does "CA" mean on SleepHQ? I only see a couple of those every night.

The machine never gets below 4. if you have it ramp at six, you will be able to take advantage of the fact that it will go down to four and then gives you an EPR of two during that time frame. you probably won’t notice the difference. that 15 minutes of ramp time at two is not gonna make her break your experience.

The reason 8 was suggested as a starting point was because it was something that will take a little time to get used to most likely. It won’t do you any good to have it up to 9 or 10 or whatever if you can’t fall asleep with that kind of pressure. in a few days at eight you will have a better idea of what your median is. It was all over the place before so the numbers are gonna give you a false answer to what you need.

The heated hose is your friend. It’s at least worth taking it out on a date. Set the climate control on auto if you’re having a hard time getting air into your body. It’s not as God awful as it sounds. it’s worth a try, maybe over the weekend. get used to the new pressure settings first.

You need to understand that when you have an OA or hyponea event the machine won't do anything at all during the actual event.
It can't/won't increase the pressure in an effort to blow open the collapsed airway.
None of the auto adjusting machines will increase the pressure DURING the event.
Instead it waits until the end of the collapse and the airway opens back up and then the machine will decide what to do in an effort to better PREVENT the next collapse based on what has happened recently in terms of other apnea events, flow limitations and snores.

The machine's purpose is to hold the airway open and PREVENT airway collapses...it can't fix them when they are happening.

These machine's can't generate enough pressure to blow past collapses airway tissues...or move the tissues. They just can't do it.
Even if they could go to 20 cm in the blink of an eye...it still isn't enough to actually move airway tissues at all.

Update on my journey. Here's the last 3 days of using my machine - any tips or observations would be appreciated!

https://sleephq.com/public/4ddd2379-735 ... bab4235cab

Here's last night:

https://sleephq.com/public/b1606281-092 ... 2554acdf1d

I started using the heated hose, set to Auto. It's fine. I noticed a minor difference in the "sharpness" of the air while trying to fall asleep, but no downsides, so I'll stick with it. Does having the heated hose plugged it make the machine do occasional electronic "dinging" type of noises? My wife woke up several times last night thinking she was hearing faint dings from getting text messages from her phone which is in another room.

Unfortunately, my back has been absolutely killing me all week, as per my description in the other thread I made. I had to gingerly roll out of bed today and wincing in pain bending down to get my clothes on. The pain goes away by about noon if I do some stretching, but it's always there when I wake up. There's something about the hose coming off the top of my head that's causing it. Last night I tested another idea by going even tighter my mask so it couldn't shift around on my face as I rolled over, and woke up with hurt / raw nostrils and still a sore back.

I didn't particularly sleep well last night either, and can distinctly remember waking up several times because my mask was too tight, so that kills the theory of my body being so ultra comfortable during sleep that my body stayed in the same position for 8 hours and that's why my back hurts. I guess I'll go back to the P10 which as mentioned before, leaves lines on my face and shifts around quite a bit when I sleep. Just discouraging.

decker12 wrote: ↑

Fri Nov 04, 2022 10:03 am

I guess I'll go back to the P10 which as mentioned before, leaves lines on my face and shifts around quite a bit when I sleep. Just discouraging.

Marks on the face from straps??? I call them "dents". I have them with the P10 as well. Improved/reduced by using strap pads from Padacheek or you can make your own if you (or the wife) is handy.

Have you tried them?
https://www.padacheek.com/airfit-p10

I am sorry but I don't have any idea about why the back pain just with a certain mask.

decker12 wrote: ↑

Fri Nov 04, 2022 10:03 am

Update on my journey. Here's the last 3 days of using my machine - any tips or observations would be appreciated!

https://sleephq.com/public/4ddd2379-735 ... bab4235cab

Here's last night:

https://sleephq.com/public/b1606281-092 ... 2554acdf1d

I started using the heated hose, set to Auto. It's fine. I noticed a minor difference in the "sharpness" of the air while trying to fall asleep, but no downsides, so I'll stick with it. Does having the heated hose plugged it make the machine do occasional electronic "dinging" type of noises? My wife woke up several times last night thinking she was hearing faint dings from getting text messages from her phone which is in another room.

Unfortunately, my back has been absolutely killing me all week, as per my description in the other thread I made. I had to gingerly roll out of bed today and wincing in pain bending down to get my clothes on. The pain goes away by about noon if I do some stretching, but it's always there when I wake up. There's something about the hose coming off the top of my head that's causing it. Last night I tested another idea by going even tighter my mask so it couldn't shift around on my face as I rolled over, and woke up with hurt / raw nostrils and still a sore back.

I didn't particularly sleep well last night either, and can distinctly remember waking up several times because my mask was too tight, so that kills the theory of my body being so ultra comfortable during sleep that my body stayed in the same position for 8 hours and that's why my back hurts. I guess I'll go back to the P10 which as mentioned before, leaves lines on my face and shifts around quite a bit when I sleep. Just discouraging.

The sound *might be the slightest pop from "rainout"? Not sure what she heard but occasionally the moisture in the tube can cause it. If the hose and mask were not wet when you got up then it probably wasn't that. I am not sure if that is what she heard or not. Maybe turn the humidity down to 4 if your mask was on the wet side. I think that your flow limits look less busy than they did last week so it seems to me like maybe your post halloween moldy leaf exposure and breathing passages might be getting clearer (or something like that.) Your leak lines look far less busy also.

The trend charts are good for trying to figure where your levels should be set but don't let us see your settings. The trend data you posted previously suggests that you should have your minimum closer to mid to upper 9 to 10 and if I recall you were kind of working your way up there gradually? Maybe time to raise it a bit more? I just see lots of high peaks on the pressure lines that suggest it settles at 8 and then has to blast off and just can't keep up.

I really believe with no proof whatsoever that the mask is probably not the source of the pain in your back. The mask doesn't need to be super tight either. You just need to fit it with some air coming back at you and maybe you will benefit from one of nasal gels or lanolin that was suggested to help keep the seal snug and tacky.

I think someone more knowing will be sure to correct me but pretty sure everything I suggested was sage advice.

Maybe time to raise it a bit more? I just see lots of high peaks on the pressure lines that suggest it settles at 8 and then has to blast off and just can't keep up.

That was my thought as well! I am going to turn it up to a 9 tonight and see how that goes. Also going to switch my mask to the P10 and use the little snuggie sleeves up on the bands to see if that reduces my facial marks. Here's hoping I wake up without a sore back!

Also, any advice for sleeping with the hose out the nose (har har). I still have my elevated hose-hanging contraption as well.

decker12 wrote: ↑

Fri Nov 04, 2022 3:43 pm

Maybe time to raise it a bit more? I just see lots of high peaks on the pressure lines that suggest it settles at 8 and then has to blast off and just can't keep up.

That was my thought as well! I am going to turn it up to a 9 tonight and see how that goes. Also going to switch my mask to the P10 and use the little snuggie sleeves up on the bands to see if that reduces my facial marks. Here's hoping I wake up without a sore back!

Also, any advice for sleeping with the hose out the nose (har har). I still have my elevated hose-hanging contraption as well.

I like my hose out the nose and I resemble that remark! The contraption is good and from there I have enough slack in the hose that the junction of small and large hoses usually meets around the bottom corner of my pillow (near my shoulders ).

I noticed the cheek marks during last two previous weeks. It correlated with the timing of my inflammed sinuses/stuffy nose week. It’s gone away since my face isn’t swollen anymore. Maybe you have something similar going on. Or pad them cheeks!

Have you tried any gobbledygoop yet? Definitely helps with leaks. It might become more important as you increase pressure.

I think it's less about the leaks for me and more about the shifting of the nose pillows away from my nostrils when I roll over. When using the P10, the friction of the back of the head strap "scraping" against my pillows slides the whole thing askew, and pushes the nose pillows out of my nose, which wakes me up and forces me to reposition them. The only fix for that is to lock down the head strap more, which pushes the nose pillows deeper into my nose and my beard, and of course gives me the lines on my face. I'm willing to try lotion or other items on my nostrils, but to be honest I don't think that'll make a big enough of a difference - the issue isn't making or keeping a seal, the issue is keeping the pillows from sliding out of my nose when I turn my head. The N30 - with it's heavier facial tubing and more secure mounting method - doesn't shift out of my nose when I roll over, but again it gives me the back problems.

Anyway I appreciate all the tips and advice, and I'll swap from my N30 to the P30 for a couple of days and see how I do. Really, I'm much more concerned with the back pain at this point, because it just ruins me for hours when I wake up. Today for the first time in weeks, I had to skip my daily workout because I just still feel so damn sore, and I know that losing weight and getting in shape is the thing I need to do to maybe possibly someday help my apnea. I'd rather have bad/sloppy sleep with the N30 then get better sleep but be in pain for hours with the P30.

I apologize but I think I am getting your masks confused?

I didn’t think you were using the N30?

I thought the P10 moves and wakes and P10i is more back pain? (same mask basically with teletubby or snufalufagus?)

Forgive my confusion.

And the p10 causes marks across the cheeks?

No dinging noises from any heated hose ever at least not with S9's and AS10.

Pugsy wrote: ↑

Fri Nov 04, 2022 10:24 am

decker12 wrote: ↑

Fri Nov 04, 2022 10:03 am

I guess I'll go back to the P10 which as mentioned before, leaves lines on my face and shifts around quite a bit when I sleep. Just discouraging.

Marks on the face from straps??? I call them "dents". I have them with the P10 as well. Improved/reduced by using strap pads from Padacheek or you can make your own if you (or the wife) is handy.

Have you tried them?
https://www.padacheek.com/airfit-p10

Same here.
And, being a side sleeper, I get them even with strap pads - but they're not as bad, and the materials padacheek [she used to be a cpaptalk member] uses are very soft and pleasant. As long as you're using the right size nasal pillows, you really can play around with the placement of the straps on your head to make the mask as loose as possible without having it leak - it shouldn't shift around at all.
I've recently been switching between the P10 and the Bleep since the latter sometime digs into my upper lip....
With the P10 being so narrow on the side I prefer both it and the Bleep with a non-CPAP-dedicated head pillow - one that is soft, but resilient that is, still gives my head support. It's worth investing the time in finding one that will be comfortable for you.