Settings adjustment suggestions for newbie?

Thank you so much Pugsy! That explanation of CAs is super interesting and really clarifies what is going on.

Turning off EPR last night didn't work very well - I just could't get to sleep without it. The pressure kept going up (mildly) with it on and seemed to cause some mild aerophagia. I turned EPR back on at a level of 2 after ~40 minutes and was able to sleep & had no aerophagia.

AHI last night was 2.09, with 13 CAs, 2 Hypopneas (before turning EPR back on), 1 OA, and 1 RE, so CAs are down by ~50%.

The settings on my machine are now at the original prescription settings, except the min pressure is lowered from 10 to 8 because 10 felt somewhat high. Should I try to bump it back up to 10, or just leave it at 8?

I'm still not feeling particularly refreshed when I wake up, and my poor nose is now cracked and bleeding from the P10 mask, despite using lanolin. Looking forward to the N30!

Do you know how to load your data into SleepHQ?

In SleepHQ we can zoom in on events and figure out if those centrals are asleep centrals or arousal/awake centrals.

I suspect that the bulk of your centrals are arousal related a if you have that many arousals it is going to impact your sleep quality and you won't feel so great during the day but not from apnea related stuff but instead awakenings which mess with your sleep stages and sleep architecture.
In other words I think the centrals are a symptom of poor sleep quality but not necessarily the cause of the poor sleep.

My first suspect is simple mask discomfort causing the arousals.

The nasal pillows shouldn't cause pain like you are experiencing nor should they cause abrasions of the skin and for sure no bleeding. Something is wrong somewhere with the mask fitting, size or maybe it simply isn't a good choice for you and your skin.

Unless you start seeing OAs or hyponeas in the numbers you are seeing the centrals I see no need to increase the minimum pressure beyond the 8.....heck, you could maybe even use less.

More pressure won't help the centrals at all.

Pugsy wrote: ↑

Sun Apr 09, 2023 10:01 am

Do you know how to load your data into SleepHQ?

In SleepHQ we can zoom in on events and figure out if those centrals are asleep centrals or arousal/awake centrals.

Thank you SO much Pugsy! I do now!

https://sleephq.com/public/f969eb12-749 ... 1bc2a61e3e

Pugsy wrote: ↑

Sun Apr 09, 2023 10:01 am

I suspect that the bulk of your centrals are arousal related a if you have that many arousals it is going to impact your sleep quality and you won't feel so great during the day but not from apnea related stuff but instead awakenings which mess with your sleep stages and sleep architecture.
In other words I think the centrals are a symptom of poor sleep quality but not necessarily the cause of the poor sleep.

My first suspect is simple mask discomfort causing the arousals.

The nasal pillows shouldn't cause pain like you are experiencing nor should they cause abrasions of the skin and for sure no bleeding. Something is wrong somewhere with the mask fitting, size or maybe it simply isn't a good choice for you and your skin.

You're probably right about this. I'm generally stressed out by my work and often wake up in the middle of the night worried about work issues. Also, I'm 6-weeks in to a knee replacement surgery recovery and these are notorious for messing with your sleep for a few months.

And the mask is unfortunately hitting me right under the nose where I have a keloid scar. I fell off my bike as a kid and landed on my face, which left a scar there and it is definitely extremely irritated by the mask.

Plus sometimes my cat likes to cuddle up next to me and purr at night, which while pleasant, it does make me wake up and smile (and also makes me stop worrying about work, which is a net benefit imo!)

I looked at all your "centrals" up close.....maybe one asleep central and that's a shaky/iffy maybe at that.
The rest of them were all so blatantly awake/arousal related a blind person could see it.

Quit worrying about centrals and instead work on sleep quality. When you sleep more soundly the centrals will reduce on their own. Use EPR at whatever setting you are most comfortable with...EPR isn't a trigger for your centrals....being awake is the trigger.

I had forgotten your mention of the keloid and it can sure muddy up your fitting comfort and for sure be a factor in the awakenings. If we aren't comfortable we sure don't sleep so great.
The N30 cushion is much softer in general...which is both good and bad sometimes. It tends to be more susceptible to minor mask movement. When do you anticipate getting the N30?
Though I do have a concern about the N30 frame itself (which is fairly rigid similar to the P10 frame) coming in contact with the keloid.
Won't know until you try it though. Cross that bridge if we come to it. There are other options out there if the N30 isn't comfortable enough.

As for the "worry" thing causing a difficulty falling asleep...if I ever get that figured out I will let you know. I have that problem myself sometimes. My brain just doesn't shut off like it should because it seems like it wants to solve all the world's problems in the middle of the night.

I sleep with dogs and cats....like you I find them a comforting factor and the wake ups caused by my pets aren't my main problem. My main problem is the fact the brain just wants to run 90 MPH and its hard to slow it down.

Pugsy wrote: ↑

Sun Apr 09, 2023 12:09 pm

I looked at all your "centrals" up close.....maybe one asleep central and that's a shaky/iffy maybe at that.
The rest of them were all so blatantly awake/arousal related a blind person could see it.

Thank you SO much for taking your time to help me Pugsy and look at all that information in detail on SleepHQ!

Knowing that it is a sleep quality issue rather than a central apnea issue makes me worry a lot less, which in turn helps with sleep quality!

Last night I forgot to put the SD card in the machine, so don't have the full details, but my AHI was 0.8 with 6h45min of use. 0.7 was CA and 0.1 was OA.

I think the improvement in numbers is due to better sleep quality which was due to the fact that I managed to get in a solid 2 mile hilly hike which was the first time in at least 6 months I've been able to do real exercise, and your info calming me down! (And maybe a little bit to do with the half a can of CBD sparkling water I drank, but jury is still out on whether or not those do anything.)

The new mask should arrive by Wednesday. I hope it'll work. Will post about it once it does.

Seems that worrying in the middle of the night to solve the world's problems is a big club! I'll let you know too if I figure out how to press the off button.

The N30 arrived & I've used it for the last 2 nights. It is MUCH better on the nose for me and the problem spots on the skin/scar under my nose are healing.

Both nights I only managed to keep the mask on for a little over 4 hours as I was extremely stressed out, both from work and from this new thing on my face. Didn't really get back to sleep after taking the mask off either because STRESS.

First night (4h40m) the AHI was 2.36 and it was more leaky than the P10, but only 1 large leak and that was when I readjusted the cushion.



2nd night (4h:15m) the AHI was just 0.71 and a pretty darn low leak rate. The gap is when I had to take off the mask from stress/inability to sleep and then cuddle my cat for awhile.



I constantly felt like it was leaking/not working well because I find it LOUD (hello Darth Vader!) and just gave up after a few hours, but looking at the chart data, it seems to be working just fine to my untrained eye. Hopefully tonight I can keep it on for a full 8 hours.

Any suggestions/thoughts on this? For those with more experience, does it look like it is working well?

Also, any recommendations for an even quieter mask if it comes to that?

I only lasted with the N30 for 2 nights. Friday night, looking at the results, you'd think it was a good night with an AHI of 1.14, kept it on for 7+ hours and a low leak rate. But there were constant small leaks throughout the night, especially when I turned on my sides, and every single little leak caused an arousal, so my sleep quality was horrible. Longest duration of unbroken sleep was 1h20m, the rest was extremely fragmented. Saturday was the first time I've ever felt unsafe to drive due to extreme sleepiness.

I ordered a Bleep from Amazon to be delivered overnight and I used it last night. Putting it on was fine, I didn't notice the ports once they were on, and when I turned on the cpap with ramp for 5 minutes and pressure of 6, I though yes! finally the mask solution for me. It was almost pleasant.

And then I kept getting aerophagia so bad that I sat bolt upright every 30 minutes or so to burp. This continued for nearly 2 hours of no sleep whatsoever and ever increasing anxiety, and I finally had to take it off. I was using mouth tape and I do not have GERD.

Looking at OSCAR data, the pressure was automatically raised waaaay up beyond what it was at on other nights. Should I lower the max pressure? Does anyone have any other suggestions?



Thanks for your help.

Did you happen to have very much nasal congestion last night?

Do you know where the line is in terms of pressure going to that level and it causes aerophagia at or above that level?

Limiting the maximum to prevent aerophagia issues is permissible...sometimes we have to make compromises.

Pugsy wrote: ↑

Mon Apr 17, 2023 9:51 am

Did you happen to have very much nasal congestion last night?

I didn't really have much of any as far as I can tell. When I put the ports on, there was no congestion at all. I did notice when I took the Bleep off, my left nostril was a little congested, but the right one was completely open. Generally I have very few congestion issues & can breathe easily - no allergies or anything.

Pugsy wrote: ↑

Mon Apr 17, 2023 9:51 am

Do you know where the line is in terms of pressure going to that level and it causes aerophagia at or above that level?

Limiting the maximum to prevent aerophagia issues is permissible...sometimes we have to make compromises.

I haven't played with the settings to determine that line. Perhaps that is the next step? Any suggestions on what I should set it at? Looking at the OSCAR statistics, my average pressure was 9.36 for the last week with an avg AHI of 1.43. Maybe set the max at 10?

Last night I did up the humidity 1->3 (in case the Bleeps made my nose dry) and lowered the EPR from 2->1. Maybe futz with those too?

Thank you SO very much for your help.

Leave your humidity at 3 for now.
Limit the max to 10 and let's see what happens in terms of therapy and aerophagia prevention.
Try to not make more than one change at a time when you go changing stuff. When you make more than one change we don't know which change might have to contributed to what result.
EPR is your friend when it comes to maybe helping reduce or omit aerophagia or helping with FLs.

Pugsy wrote: ↑

Mon Apr 17, 2023 11:52 am

Leave your humidity at 3 for now.
Limit the max to 10 and let's see what happens in terms of therapy and aerophagia prevention.
Try to not make more than one change at a time when you go changing stuff. When you make more than one change we don't know which change might have to contributed to what result.
EPR is your friend when it comes to maybe helping reduce or omit aerophagia or helping with FLs.

Thank you SO much Pugsy. I wanted to wait a little before replying so I had some data to show, and given the last few nights, I'm starting to suspect UARS given the reading I've been doing.

This is the most recent night with the Bleeps which I like SO MUCH more than the other 2 masks, but the flow limits are significantly higher and it hugs the upper pressure limit, which wasn't happening with the other 2 masks. Had to turn the humidifier off because I couldn't sleep with the warm air and had a bit of aerophagia if I slept on my side & none while on my back. I felt absolutely AWFUL the next day though.

Any suggestions for settings/pressure adjustments here?




More details on why I think it might be UARS:
My entire life I've been very sensitive to noises while I sleep to the point of intentionally moving to a remote area where there is little noise besides nature as I have to wear earplugs in cities to sleep at all - had to wear them for 12 years every single night in a city as I just couldn't get used to the noises. I can't stand sleeping in warm rooms or breathing warm air. I've been out camping in freezing weather and have to leave my nose exposed out the tiny hole in the mummy sleeping bag because sleeping with covers over my nose makes the air too warm to breathe. Also, I get very annoyed when wearing anything on my head like hats or headbands.

I was diagnosed with an anxiety disorder 2 years ago that I've been taking buspirone to help with (works great and no side effects), with ativan as needed to prevent/stop panic attacks, though I haven't needed ativan at all until starting with the CPAP therapy - I've had to take it 2x since starting. Every night before bed I feel my anxiety rising. The ativan or an OTC sleeping pill help, but then I feel exhausted the next day as side effects. (The OSCAR results above are with NO medication before bed.)

I feel like if my work wasn't so stressful (I work on safety-critical software which means that mistakes could kill people) and I could actually exercise (1 out of 2 knee replacements down that will allow that again, next one will be in late July) then I would be able to sleep well again. Exercise has always been my best anxiety & depression reducer and I always sleep well after a good hard workout.

Sorry for the novel. I'm just at my wits end here and feeling so much worse than before trying the CPAP therapy. I really want this to work tho and will keep trying. Next appointment with the sleep doc is on May 5th - earliest appointment I could get.

More pressure is likely to make the aerophagia worse but IMHO you don't need more pressure anyway.
More pressure won't fix/reduce the number of centrals.
While your FL graph is a little active it is far from horrible. Did you happen to have some nasal congestion on the above night that we might could blame the FLs on nasal congestion?

On the above night....did you wake often during the night or spend much time trying to go to sleep or back to sleep?
If you did...any idea why the poor sleep?

takver wrote: ↑

Thu Apr 06, 2023 8:39 pm

Symptoms:
With the P10 mask, my nostrils became extremely sore, red, and had oozing/flaking skin after 2 nights. I have a keloid scar under my left nostril that is very irritated. Switching from medium to small pillows helped little, but not much. A new N30 mask is on order to see if that helps.

Based on my experience, I think the Nuance & Nuance Pro Nasal Pillow CPAP Mask with Gel Nasal Pillows are much better than the P10. They have extremely soft cannulae that don't irritate the lining of my nose. When I used the P10, I had similar problems. + the Nuance & Nuance Pro Nasal Pillow CPAP Mask has a much better air ventilation system and nicer straps that touch the face. I also feel the heat from the cannulas of my nose pads so I had to lower the heat on my hose from 30 degrees to 24. When I'm on my back with the nose pads my soft palate can block my exhalation causing my cheeks to puff up chipmunk When I sleep on my side, this effect is almost absent.

Pugsy wrote: ↑

Sun Apr 23, 2023 12:13 pm

More pressure is likely to make the aerophagia worse but IMHO you don't need more pressure anyway.
More pressure won't fix/reduce the number of centrals.
While your FL graph is a little active it is far from horrible. Did you happen to have some nasal congestion on the above night that we might could blame the FLs on nasal congestion?

On the above night....did you wake often during the night or spend much time trying to go to sleep or back to sleep?
If you did...any idea why the poor sleep?

I did have some nasal congestion that night come to think of it & have been having a little bit lately. I did wake a few times apparently because I remember having a few very strange dreams, but don't think I spent much time trying to get back to sleep after waking. I was very exhausted and sleepy that night, so getting to sleep happened quickly.

Sounds like I should just stay the course for awhile! My ignorance made me think the FL graph was pretty crazy, especially in comparison to other's.

Thank you so much!