btbderek’s therapy thread

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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btbderek
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btbderek’s therapy thread

Post by btbderek » Tue Dec 20, 2022 11:09 am

Hello everyone, first post here. Have questions about last nights sleep with a Sleep HQ link below for my data. Figured I would give some background info 1st before moving on to that in the case it is helpful, and this will turn into my permanent thread if I need help in the future. If you don’t want to read this (I know it’s a lot, but wanted to leave a detailed history of my journey so far)skip to the Sleep HQ link and what I wrote afterwards.

Have been using my Resmed Airsense 10 Autoset on APAP 8.0-20.0 for about 4 months now since my diagnosis of Sleep Apnea with an ahi of 102. Towards end of first month I started to get full nights sleep with decent numbers according to the basic interface on my machine. I believe I was still having bad leak rate although it was enough for the green smiley face. Doctor set me up for a 2 month appointment after the 1st month because I was on track.

Next two months, I fell off the horse for a lack of better words. Many stressful things happened in that amount of time along with a lot of traveling and not sleeping in my own bed, I basically reverted to prior to CPAP usage. The nights I did get the mask on, I would usually only get an hour or so in before taking mask off in my sleep and finding it across the room the next morning. Got a few nights at 4 hours of sleep, but only a few. Other nights I would fall asleep waiting for mask to dry from sanitizing. The first month I was sitting with mask on during the day while watching tv or reading, I think this helped me get to the point of being able to sleep longer nights, I basically quit doing this after that first month. So of course, the doctor grilled me at the follow up for not using my machine enough, and although I had what I would consider a pretty bad couple of months in that time span, I know that I could have done a lot of things differently and could have made a much better effort to troubleshoot problems I was having, I deserved to be grilled by the doc. I left that appointment with a determination and better mindset that I was going to do everything in my power to keep up my end and use the machine and try to troubleshoot any issues I was having. Also wanted to educate myself more on CPAP therapy, so I started doing research and diving into YouTube videos from Lanky and Nick at Sleep HQ.

This brings us to the previous month up until today. Maybe a day after that visit, and I catch the flu, probably worse I have ever been sick, even worse than when I had COVID. Couldn’t breathe well with my machine, use an F30 full face hybrid, but basically normally I breathe through nose and mouth. My nose was of no use to me during this time, was either completely stopped up or having to blow it every 2 minutes. The pressure would shoot up almost immediately to the point it was too much for me to try and fall asleep with. Other nights I just had too many coughing fits and the air would tickle my throat even more. Finally get better over a week later and BAM! Catch a cold after couple of days of filling better. Same deal, throat and nose interferences kept me from getting my machine time in. Finally get better after that with less than a week til my next doctors visit. Start using the machine during the day while awake to get my self readjusted to the mask, and would get about 2 to 3 hours of sleep a night before taking mask off in my sleep unknowingly. Started transferring data to Sleep HQ so I could look at data and ask advice from a Facebook group I’m in. Noticed leak rates were high starting at around 30L, so I started working on that. I have now gotten to under 5L for two days in a row. Had Dr visit yesterday. Seemed understanding of my sickness(lots of sickness local to me for the past month or so, heard multiple people call and cancel appointment while waiting for visit). Dr just stated to keep on track with how I had been doing for the past week and really stressed getting usage up, understandably of course. Only thing that bothered me was I mentioned that after looking at data that I noticed my low end pressure never really drops below 15, but they said they would leave my pressure range where it was for now which is 8.0-20.0.

Last night I got the most sleep I’ve had with my machine in ages, almost accumulative of 7 hours over 3 separate sleeps. I describe it in better detail after my Sleep HQ link. Over this past week, I have been trying to work on all aspects of my therapy and issues with it. I have changed routine such as sanitizing mask earlier and putting on my mask before I even get in bed so that there’s no excuse for me to not fall asleep with it on. Trying taping my mask on my cheeks in hopes that it will wake me up when I pull my mask off, I have to be careful to put enough tape on my cheeks, noticed last night that I didn’t have enough tape contacting my face and it didn’t wake me when I pulled it off. Just trying to do this right and with the right attitude and mindset going forward, I know that this is crucial to my well being and am trying to take it as serious as I possibly can. Onto the data and last nights sleep. Props to you if you read all of that. I know I’m not the best at simplifying things so it’s just easier for me to type it out like I did.

https://sleephq.com/public/86503440-472 ... 283b4ffc51

Image

Wanted to share my chart from last night to get some feedback from anyone who would like to take a look. There’s three separate spreads of data there, but all of them are actual sleep.

-The first portion, I fell asleep in my recliner for about 2 hours. Legs were out laying flat on the extension but I didn’t recline the back rest, so I was just very slightly leaning backward, but still upright/forward enough that when I woke up my head was tilted forward towards my chest. I noticed my pressure during this sleep really stays around 15 to high 17’s on the spikes upward.

-The other 2 portions of data were sleep in bed. I sleep on my back, with 2 pillows for my head and one in front of the two for a slight wedge effect, so my head and chest is slightly elevated from the rest of my body, but not by a large amount. Around 2 hours of sleep the first time, don’t know if I removed mask in sleep unknowingly or just not awake enough to notice, second time slept till wife woke me up, about 2.5 hours of sleep. Noticed somewhere around half way through both times my pressure jumps up to 20 and stays near that for rest of sleep in both cases. Could this be due to different angles I was sleeping at?

Overall I feel like I am pretty well rested. I usually wake up once a night anyways so that doesn’t bother me so much although I would love to get to the point of a continuous nights sleep. My goals as of right now is to continue to get a better understanding of my sleep data so that I can better communicate to the doctor the issues I’m having with my therapy and to try to get back to getting longer nights sleep with the mask staying on. Quality of sleep in terms of how I feel seems not to be an issue for me as of yet, even 4 hours of sleep with the mask makes me feel like a million bucks compared to without the machine. But I would love to get away from the 2 to 3 hour short bursts of sleep.

I apologize if these questions are super basic, I am new to looking at the charts and trying to get a basic understanding of what I’m looking at. I have been working at getting a good mask seal and trying to solve leak issues and I seem to be heading in the right direction there. Thank you everyone!

Using a Resmed Airsense 10 Autoset set to Autopap 8.0-20.0 using a Resmed F30 mask.
Last edited by btbderek on Sat Dec 31, 2022 10:08 am, edited 3 times in total.
APAP mode set to 10.0-20.0/No Ramp/Humidity maxed out

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Miss Emerita
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Re: Advice appreciated for a newer user of CPAP(and my journey so far)

Post by Miss Emerita » Tue Dec 20, 2022 12:00 pm

Welcome! Congratulations on your determination to make this work. It sounds as though you're on your way, so keep up the good work.

Your pressures are being driven up by your significant flow limitations. FLs are limitations in the airway that show up when you try to inhale. If you zoom in on your flow rate, you'll see that many of your inhalation traces are fairly flat on the top, instead of curved. That indicates FL. The source of the problem can be in the nose, where there's nothing much to do about it, or lower in the airway, in the pharynx. There, EPR can help by supporting inhalation. Unfortunately, you're maxed out on EPR.

One question in my mind is whether your FLs are caused by continuing nasal congestion or by something in your pharynx. Are you still feeling stuffy?

Another question is whether your FLs disturb your sleep. They may, or they may not.

And I'm curious: why do you elevate your head when you sleep?

And finally, there's the issue of keeping your mask on. I'm hoping it'll help to use longer pieces of tape. Another possibility is wearing some kind of lightweight cap that ties under your chin. If you put it on over your mask, you'll find it hard to remove the mask in your sleep. This will sounds weird, but try googling "medieval caps with ties" to see what I have in mind.
Oscar software is available at https://www.sleepfiles.com/OSCAR/

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btbderek
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Re: Advice appreciated for a newer user of CPAP(and my journey so far)

Post by btbderek » Tue Dec 20, 2022 12:45 pm

Hey, Thanks for the reply!

While I am still a bit stuffy, I am not so stuffy/stopped up that I can’t breathe through my nose at all, but breathing flow definitely feels somewhat restricted at the moment. My doctor suggested that I use something over the counter such as Flonase or Nasacort if I keep having issues with my nose.

I elevate my head due to a problem I used to have. Before starting CPAP, laying flat on my back would occasionally cause me to wake up gasping for air as if something blocked my airway completely. Basically I would set straight up gasping for air till my breathing powered through. I THINK this had some sort of correlation with Acid Reflux. If I ate anything too spicy within a few hours of sleep it would happen. I just hate the experience and I noticed that laying on my back slightly propped up with pillows seemed to eliminate that. I never did it laying on my side either but I didn’t love how sleeping on my side felt.

I understand exactly what you are saying with the cap. I will have to try that out. Thanks!
APAP mode set to 10.0-20.0/No Ramp/Humidity maxed out

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ChicagoGranny
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Re: Advice appreciated for a newer user of CPAP(and my journey so far)

Post by ChicagoGranny » Tue Dec 20, 2022 12:57 pm

btbderek wrote:
Tue Dec 20, 2022 11:09 am
I sleep on my back, with 2 pillows for my head and one in front of the two for a slight wedge effect ...
I'm having trouble visualizing this. Does this position cause your chin to drop toward your chest? This can crimp your airway and make it more susceptible to collapse (apnea). In fact, a good many of us wear foam cervical collars to keep the chin up and the spine aligned straight. In my case, this significantly reduces my pressure needs and AHI.
Only thing that bothered me was I mentioned that after looking at data that I noticed my low end pressure never really drops below 15, but they said they would leave my pressure range where it was for now which is 8.0-20.0.
Right, your minimum (8.0) is set too low. If those were my charts, I would immediately set the minimum to 14.0. The machine is not running significantly below 14 anyway.

Also, your pressure is bumping up against 20.0 for much of the night. Making sure the neck/chin position is not crimping the airway should be a priority. This might also help with the FLs. If you need help with neck position, here is an example of the collars some of us use - https://www.amazon.com/Cervical-Collar- ... _sspa?th=1. They come in different widths. 3-inch is about the middle of the range. That size is a good starting point for trying the fit.

You seem to be approaching this in a manner that will lead to success. 👍
Next two months, I fell off the horse for a lack of better words.
After you have been here for a couple of weeks, you will use the term, "fell off the hose".

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btbderek
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Re: Advice appreciated for a newer user of CPAP(and my journey so far)

Post by btbderek » Tue Dec 20, 2022 1:39 pm

I'm having trouble visualizing this. Does this position cause your chin to drop toward your chest? This can crimp your airway and make it more susceptible to collapse (apnea). In fact, a good many of us wear foam cervical collars to keep the chin up and the spine aligned straight. In my case, this significantly reduces my pressure needs and AHI.
So basically I have three of these pillows.

https://www.amazon.com/Sleep-Innovation ... PDKIKX0DER

I have two stacked on top of each other. One that sits on the bed is flat side up, and then I put one on top of it flat side down/contour side up, my head rests on this top pillow. I also have one more contour pillow in front of that stack, flat side up/contour side down that my shoulders/upper back lays on. This creates a slight wedge/incline effect. It just felt comfortable to me. BUT, sure enough, after reading your comment, I went and layed down, and it does cause my chin to drop to my chest significantly more than if I used only one pillow! Never thought of it all to be perfectly honest, so I will definitely try one pillow tonight to see what that does for me.
Right, your minimum (8.0) is set too low. If those were my charts, I would immediately set the minimum to 14.0. The machine is not running significantly below 14 anyway.
This is inline with what I was thinking. I’m curious as to why they didn’t want to change it. The only reasoning I could think of was that she wanted more data than a couple days before making those changes?
Also, your pressure is bumping up against 20.0 for much of the night. Making sure the neck/chin position is not crimping the airway should be a priority. This might also help with the FLs. If you need help with neck position, here is an example of the collars some of us use - https://www.amazon.com/Cervical-Collar- ... _sspa?th=1. They come in different widths. 3-inch is about the middle of the range. That size is a good starting point for trying the fit.
I have been contemplating a chin strap or collar after all of the recommendations, I do believe I will give this one a try that you sent a link of. Especially knowing that the chin position is an issue. I also don’t love the idea of adding another piece of equipment to my head, the collar seems less invasive in my mind.
You seem to be approaching this in a manner that will lead to success. 👍


Thank you! I am striving to do the best I can. I will be honest that I was starting to grow frustrated with CPAP, but read in another group on Facebook where members had lost loved ones too young that had OSA but decided not to use their machines, and even had looked at their machines after passing seeing only a few hours of usage. I think it was the wake up call I needed. I just turned 30 and I have a lot of people around me that I want to be there for for along time to come.
After you have been here for a couple of weeks, you will use the term, "fell off the hose".
:lol: That’s hilarious! That should have came to mind when writing that :lol: :lol:

Thank you for your help and bringing that chin position to my attention. I really wouldn’t have given that a second thought!
APAP mode set to 10.0-20.0/No Ramp/Humidity maxed out

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btbderek
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Re: Advice appreciated for a newer user of CPAP(updated with OSCAR screencaps)

Post by btbderek » Fri Dec 23, 2022 11:32 pm

In getting acclimated with the forums, stumbled upon Pugsy's thread on sharing OSCAR data which was a great help, along with other information that was resourceful in me getting OSCAR set up and ready to go. So thank you to Pugsy and everyone who has contributed all the helpful information to get the newbies up and running.

Stayed up late watching a Christmas movie with the wife Tuesday night, should have had the mask on to get extra compliance hours but didn't and what do you know, I fell asleep without it.

Wednesday night managed to get about three hours sleep. After discussing here, thought about my sleeping position a lot that day. Decided on trying just one pillow out and laying on my side instead of my back. Flow Limits didn't look to different on the data, but interesting to see that my pressure stuck around 15 for the first 2 hours of sleep, then shoots up to 20 then dances around between there and 17 for that next hour before waking. Loosened my mask a little, leak rates were good before, but it was just a little too tight for my face. Need to get it dialed in, looks like my leak rate bounced back up. I had turned of smart/autostart on my machine so that if I remove my mask in the night, it would wake me up. it actually did! Unfortunately I got up for a few minutes, and got back in bed to get warm and fell asleep before putting it back on, I have to break this habit asap.

Wednesday nights data
Image

Still felt great the next day even with only 3 hours of mask time.

Thursday night was uneventful again. I DID manage to put my mask on and get in bed. Got comfortable on my side, tried to make sure I was in a good position as far as how my head was positioned trying to stay away from getting my chin too close to my chest. Couldn't breathe through my right nostril, but tried to power through. After 10 minutes, I wondered why it felt like the machine wasn't giving me the air I needed. Forgot to start the machine. Only had autostart turned off for previous day so wasn't used to hitting the button to start the machine. Got up to clear my nose, same story as Tuesday night. I have changed my routine to putting my mask on before even getting in bed, so I really need to make sure this translates to waking up during the night. Gotta do better than that.

About to get to bed soon now. Going to keep trying side sleeping instead of back sleeping to see how it changes things data wise. Gotta make sure that I put on mask after waking up during the night. Really hope by start of next week I will be in better rhythm and seeing more along the lines of 6 and 7 hours of sleep through the night. Ordered soft cervical collar that Granny recommended, comes in Tuesday. Can't wait to see how that changes things,may even have to try out my dreamware nasal mask that I have lying around.

Feel like this is turning into a Journal. have never been good at keeping things short and sweet lol. If I need to shorten this thing up, please feel free to call me out on it.
APAP mode set to 10.0-20.0/No Ramp/Humidity maxed out

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Re: Advice appreciated for a newer user of CPAP(updated with OSCAR screencaps)

Post by lynninnj » Sat Dec 24, 2022 9:30 am

Pretty sure auto start and auto stop are separate. I would keep auto start on if it were me.

You know you can just unhook the hise easily and leave the mask on your face if you have to get up and use the loo? Just remember to plug back in.

gl!

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Re: Advice appreciated for a newer user of CPAP(updated with OSCAR screencaps)

Post by Julie » Sat Dec 24, 2022 10:01 am

And whenever you make changes, try them individually for a few days so you'll be sure about which change made a difference (or not).

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Re: Advice appreciated for a newer user of CPAP(updated with OSCAR screencaps)

Post by Dog Slobber » Sat Dec 24, 2022 10:50 am

lynninnj wrote:
Sat Dec 24, 2022 9:30 am
Pretty sure auto start and auto stop are separate. I would keep auto start on if it were me.
Smart Start (auto start) and Smart Stop (auto stop) are separate on the Air 11. On Air 10's, they are not separately configurable, both are on or both are off.

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Re: Advice appreciated for a newer user of CPAP(updated with OSCAR screencaps)

Post by lynninnj » Sat Dec 24, 2022 12:42 pm

Dog Slobber wrote:
Sat Dec 24, 2022 10:50 am
lynninnj wrote:
Sat Dec 24, 2022 9:30 am
Pretty sure auto start and auto stop are separate. I would keep auto start on if it were me.
Smart Start (auto start) and Smart Stop (auto stop) are separate on the Air 11. On Air 10's, they are not separately configurable, both are on or both are off.
Oh I see. Thank you for the clarification.

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Re: Advice appreciated for a newer user of CPAP(updated with OSCAR screencaps)

Post by palerider » Sat Dec 24, 2022 1:37 pm

lynninnj wrote:
Sat Dec 24, 2022 9:30 am
Pretty sure auto start and auto stop are separate. I would keep auto start on if it were me.
This is incorrect, there is only one setting.

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Re: Advice appreciated for a newer user of CPAP(updated with OSCAR screencaps)

Post by btbderek » Sat Dec 24, 2022 5:35 pm

lynninnj wrote:
Sat Dec 24, 2022 9:30 am
Pretty sure auto start and auto stop are separate. I would keep auto start on if it were me.

You know you can just unhook the hise easily and leave the mask on your face if you have to get up and use the loo? Just remember to plug back in.

gl!
Yeah, if it were two separate functions I would definitely leave auto start on and auto off off. But since they are just one function on my machine I just decided to leave it off, so far after 2 nights the sound of the air coming out of the hose has woken me up just as well as taping my mask strap/face, if not even better than that.

And yes, I need to unhook the hose and leave the mask on like you are saying, that’s what I will try to start doing. In most cases in these past few weeks, I woke up with the mask off already. Probably should just put it right back on then, unhook from the hose and do what I need to do, then hook back up to the hose and sleep instead of waiting to put the mask on after all of thaw. Just lots of retraining and getting rid of bad habits when it comes to waking up in the middle of the night and even going to bed the first time lol. Thanks for the advice!
APAP mode set to 10.0-20.0/No Ramp/Humidity maxed out

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Re: Advice appreciated for a newer user of CPAP(updated with OSCAR screencaps)

Post by btbderek » Sat Dec 24, 2022 5:43 pm

Julie wrote:
Sat Dec 24, 2022 10:01 am
And whenever you make changes, try them individually for a few days so you'll be sure about which change made a difference (or not).
Yes! That’s a very good point and has been an adjustment I’ve been trying to make. Early on, I was trying to change or try too many things at once instead of making one single change and giving a few days to get a better picture of how it effected data and how I feel overall. I think it’s easy to get lost in trying every little thing you can and wanting to get to 100% effectiveness out of therapy when you are just working against yourself when doing that. I’ve really learned a lot looking through these forums and searching through older posts this past week.Thanks!
APAP mode set to 10.0-20.0/No Ramp/Humidity maxed out

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Re: Advice appreciated for a newer user of CPAP(updated with OSCAR screencaps)

Post by DaveMunson » Sat Dec 24, 2022 5:48 pm

I don't let my machine minimum pressure be real low. I know what works for me and I have a minimum pressure of like 18ish. Its actually lower but at 18 I am quieter (snoring). I've been doing this a while and comfortable. Years ago, if you let the machine auto set pressure and a huge range, the machine got it wrong at times. Set your minimum at what you are thinking (15) and whatever works long term. I still adjust humidity for the different seasons( its very dry now so higher water temp for more humidity. In the rainy spring less. In the hot summer humidity heat off).

After you set higher pressure... If you get stuffed up the high pressure will clear your sinus. But, you need to be able to breath when you mask up. At the worst times, get a nasaline and use it before bed plus medicate with any drug that works.

If you continue to have leaks or blowouts go for a different mask designed for higher pressures. Find a DME, resp. tech that understands certain masks work better at high pressures and others blow out above a certain pressure. Usually the fat guy resp tech understands and lives this life too.

Finally, rather than a lengthy sanitization give a squirt with dawn powerwash spray and massage to remove face oil and set the mask on a house fan on high to dry or blot with a towel. You can get it clean and mostly dry in a couple minutes. Masks with face oil will leak at edges at this pressure so learn that this is negative reinforcement to keep the mask-face seal working.

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Re: Advice appreciated for a newer user of CPAP(updated with OSCAR screencaps)

Post by btbderek » Sun Dec 25, 2022 2:37 pm

DaveMunson wrote:
Sat Dec 24, 2022 5:48 pm

After you set higher pressure... If you get stuffed up the high pressure will clear your sinus. But, you need to be able to breathe when you mask up. At the worst times, get a nasaline and use it before bed plus medicate with any drug that works.
I’ve got one more visit til I go to 6 month visits, if doctor doesn’t bump up minimum pressure this coming visit I’m going to do it myself. I think it could be causing issues too. Definitely going to have to use the nasaline, seems I’m more often stopped up than not anymore. I have noticed when waking up and pressure is around 17 or 18 it really helps power through a stopped up nose.

I seem to have found a pretty good mask that fits well, just dialing in strap tightness to keep leaks under 5, seem to be at an average of under 10/over 5 this past week. I have that power wash at home so i will definitely give that a try. Thanks!
APAP mode set to 10.0-20.0/No Ramp/Humidity maxed out