Sierra

I have no experience with a deviated septum. However, if you can breathe with your mouth closed a nasal or nasal pillow style mask should work. The secret of using the nasal mask is the ability to keep your mouth closed while you are asleep.

I use a nasal pillow type mask and was originally concerned what I would do when I got a cold and ended up with congested nasal passages. It has turned out to be a non issue for me. I find that if I can get one passage or the other open, there is no problem getting air during the night. The nasal mask seems to keep at least one passage open.

I have not heard of that name of machine before. However the 10 and EPR makes it sound like a ResMed. EPR stands for Expiratory Pressure Relief. It reduces the pressure when you exhale compared to when you inhale. Most people find it more comfortable when it is turned on.

It is a good idea to try out the machine and masks when you are awake during the day.

It kind of depends on your type of machine, but in general yes each obstructive event, hypopnea even, flow limitation, or snore will cause the pressure to increase. Clear airway or CA events should not cause pressure to increase. ResMed machines tend to raise the pressure fairly quickly and then slowly let it decay back down if there are no further events. The DreamStation machines like to bring the pressure down much more quickly. This sounds good, but through the night the pressure can keep going up and down.

See this sleep report with a ResMed machine. The red pressure trace shows the pressure going up and down during the night. You can see how this relates to the OA (obstructive apnea) events in the Events bar, as well as to the Snore, and Flow Limitation.

Since your CA events seem to have settled down a bit you could try increasing your minimum pressure to 8 cm, and also set your ramp start to 8 cm. The maximum pressure would have to be increased as well to do this, so I would suggest 9 cm max. This will allow the machine to increase pressure higher than it can now. You will be able to see if this helps with the breathing while going to sleep, and whether or not the increased maximum causes the CA events to go up. Depending on how this goes you may want to pick a pressure and go to the fixed pressure CPAP mode. As it looks now it would appear that 8 cm would be a good starting point. My thoughts would be to go to an 8 min and 9 max first to see if you can learn a bit more about what is impacted by pressure.

I have never used an O2 meter so can't really comment on your results from experience. However it looks like for the most part you are staying above 95% which is good.

Yes, leaving the EPR at 3 cm is fine for now. What you really need to do is collect some data and look at it with OSCAR. The first step would be to determine what is causing your pressure to go up.

Depending on how your machine has been set up, you may or may not have the ability to set your EPR from the user menu. You may have to go into the Clinical menu to do it. On the A11 my understanding is that you can do that by simply holding two fingers on the menu screen for 4 seconds or so. Here is a link to the Clinical Manual for the A11. It will explain the details and the options you have.

My wife has an AirSense 10 For Her and uses pressure up in the 15 cm range. Here is an example of what the Daily report screen looks like for her.

Her Min-Max is now 13.6-14.4 cm. It has been adjusted many times over the 6 years or so she has been on the CPAP. There is some advantage in adjusting up the minimum pressure as it actually prevents events from happening. When you have a low minimum pressure the events have to happen first and then the machine responds. And then after it responds with more pressure it slowly ramps down again until another event occurs. Her EPR is 2 cm and is set to full time. As a start I would suggest an EPR of 3 cm and full time as well.

If you look at the graph detail you will see that in this example she only had 1 OA (obstructive apnea) event and you can see the pressure respond up. This is because her minimum pressure is high enough that she does not have many OA events. The main factor that increases her pressure now is flow limitation and snore. A higher maximum would likely eliminate those too, but she has tried and dislike more pressure. So the current limit of 14.4 cm has been set based on her tolerance for more pressure. Since she got this For Her machine her average AHI has been 0.45 and there seems to be no reason to push the pressure higher when she finds it uncomfortable.

If you have any questions about OSCAR or the Daily report just ask. I find this daily report pulls the curtain back on what is actually happening during the night.

Pressure with a 5 minimum and 15 maximum is fairly standard. The 5 cm minimum might be a bit low for comfortable breathing while going to sleep though. It is hard to tell if the 15 maximum is too high or not. Your AHI is within the normal treatment range of <5.0.

Sometimes it is best to start with a maximum pressure that is lower than ideal until you get used to the pressure. Also on the A11 machine you can set the exhale pressure relief (EPR) to automatically reduce the pressure on exhale to make breathing easier. The reduction can be set from none to 3 cm. Starting out with 3 cm of EPR may be helpful in adjusting to the pressure.

To find out what is really going on during the night you can download a freeware program called OSCAR. It needs a Mac or PC with a SD card reader to use it. But it can tell you minute to minute during the night what the pressure is, and when you are having apnea events. It is really helpful in determining whether or not your machine is well set up for you or not. If you download it and can post the Daily report screen I can give you my thoughts on whether or not there is a potential for improvement. Your machine should have a SD card in it on the left side behind a flexible flap. If not you would have to get one. The one ResMed supplies with each machine is 4 GB.

What pressure is the A11 set at? Min? Max? What is the AHI score you are getting? It would seem that you should see your sleep clinic to have the maximum pressure reduced until you become used to the pressure.

Those are very long obstructive apnea events. However the bigger issue for that night are the frequent CA events.

Can you post that last image again in a full width window. I can't expand it enough to read the time scale. If you reply with the orange "Write a reply" button at the bottom you get a full width post window.