Hi everyone,

I started my CPAP treatments yesterday

I'm a 47 man, I am overweight and, I have been showing symptoms of Apnea since my twenties, apart from a couple of years around 2014, when I started jogging and lost a bunch of weight. I regained the weight since and, age not helping, the impacts on my daily activities has really worsened.

So, I went to a local sleep clinic/DME who was greatly reccommended. They only offered at home test but, I knew the test limitations and, ticking so many of the Apnea symptoms boxes, I was fairly confident that it would be enough to diagnose OSA.

Sure enough, the result of the 1 night was 34.2 AHI per hour and, the consulting doctor wrote me a prescription for an auto CPAP.

So, I went to the clinic/DME yesterday. I chose the Resmed S10 Auto as my machine. As for the mask, I loved the fact that the respiratory therapist was on board with what Jason said in one of his videos: Although I reported that I was a mouth breather, she said that, having OSA, it was pretty normal that I would breath through my mouth. She asked me if anything was preventing me from breathing through my nose only and, although I kinda feel some obstruction in one of my nostril (compounded I think by my weight), I could go by my day breathing only through my nose and felt that, getting air pushed in would only help. The last 3 nights I tried to be self conscious about doing the same in bed, instead of simply letting go as I had always done before.

So, she said that she prefered to test a nasal mask first, to confirm if I mouth breath before going with a FFM and, she showed me some and I selected the Resmed P10

She setup the machine as the physician had said: range of 6-20. She also added a ramp of 20 minutes starting at 4 but, told me to change it as I see fit.

I know Jason's thought about such a range but, as he stated, I will make sure it is not used long term but, for now, seeing the physician is not affiliated with the clinic (that I know of), the DME didn't have much choice and couldn't well decide they knew better...

All of this brings me to my first night...

I don't have OSCAR set up yet, seeing that I am waiting on my SD card to arrive but, I still have a question I'd love for someone to confirm if it makes sense.

I had a night that seemed typical of the last few weeks: lots of awakenings and trouble getting to sleep again. But, whereas in the past I could sometimes feel I was waking up because of my snoring, last nights awakening were mostly times where I had air bubbles coming through my mouth getting me awake. I read this is pretty normal and that first step is to train my tongue to stay on my palate so, I'll look out for that.

I also remember 2 times waking up because I felt my jaw dropping open as I lay on my back.

Mostly I slept on my side with surpringingly no apparent issues with the mask.

Looking at my numbers, I was kinda surprised and, this is why I'd love your initial thinking on this:

- I used the CPCP for 9 hours during the night
- The machine reported no leaks at all, even though I coughed some (air is getting dry as we started electrical heating) and the mouth bubbles. I assume the machine has a threshold before saying a leak occured?
- I only removed the mask once, to go to the bathroom
- The machine is showing a pressure of 7.7 in the summary. I don't know if this is an night average or the highest it got during the night.
- The machine recorded an AHI of 1.7!!!

This last number has me dumbfounded.

Could this make sense? Could it be that I awoke so much because of other reasons that I never achieved the state where I normally have "events"?

Also, I woke up with the feeling that my eyes had, for the lack of better words to explain it, moisture in them, They are looking normal but, again for lack of a better way to explain, they feel sore. Seeing the machine indicates no leaks, could it be the air coming out of the vents that could get to my eyes all night long?

Thanks a bunch.

The pressure shown on the machine LCD screen is what we call a 95% number and all that means is you were AT OR BELOW that number for 95% of the night.

It is entirely possible that brief leaks from coughing or whatever simply aren't prolonged enough to show up as a leak on the machine's LCD screen. If you were just looking at Mr Smiley as leak management indicator...he is rather forgiving. He doesn't become Mr Frowny until you spend 30% or more of the night above 24 L/min excess leak. If you see a leak number shown on the LCD screen...it again is a 95% number which is at or below that number.

The AHI on the machine are the ones that slipped past the defenses...that weren't prevented and it is entirely possible that your rather low AHI is because the machine simply prevented all those other apnea events from happening. That is, after all, what the machine is supposed to do.

It's common to wake up often from various things when we first start cpap therapy. It is a new sensation for the brain to have to deal with.
Mouth leaks and such...common.

As for your eye issues...the P10 venting is downward and not upward and it's unlikely that the venting is making it to the eyes. For one thing at your pressures you probably have to put your finger tip about 1 inch from the vent holes to just barely feel the air being vented out. There's just no physical way for it to go upwards and make it to the eyes.
Now there is a way for the air pressure to affect the eyes a bit via the lacrimal ducts but usually the main complaint is dry eyes when that happens and it's not all that common.

Don't worry so much about the pressure range at this point. The machine will only go where it needs to go and the maximum becomes a moot point if it is never reached. Probably if we looked at your OSCAR reports the pressure doesn't vary all that much. We expect some variation due to maybe being on our back at times or during REM stage sleep. I know Jason doesn't care for auto adjusting pressures all that much but there are times where it comes in handy. I need 6 to 8 cm more pressure only during REM stage sleep than in the other sleep stages. REM makes up about 20% of the night. I would sure hate to use a fixed pressure all night just to deal with what happens in REM. That would mean using 15 cm all night instead of maybe 8 cm for the bulk of the night.

You may need to do something to remind the mouth to stay shut. It's got in the habit of dropping open and mouth breathing a bit. I know I had to when I first started cpap therapy. I thought I was a mouth breather as well but it was more out of habit of gasping for breaths than it was a physical need to mouth breathe because of nasal congestion. It took a little while to unlearn that habit and replace it with a "keep lips shut" habit.

_________________
I may have to rise but I refuse to shine.

Thank you for the comments Pugsy; much appreciated.

I can't wait to be able to use Oscar (and actually learn how to read it to better control my therapy). MyAir app states the the leak was actually 0l/min. so, maybe the times I noticed a leak were really the only times it occured and, it was really too low to be accounted as a leak. I'll confirm on future nights.

As for the pressure, I hear what you are saying. I will see in the coming nights when I can actually be asleep for more than an hour at a time how I fare. Right now, when the ramp at 4cm start, I feel like I get less air than without the mask so, I might need to reduce the 20 minutes ramp time, raise the number to 5 or, simply do without. But I'll give myself more than 1 night to evaluate.

Thanks again!

Turn off the ramp. Most people will feel air starved at 4 cm starting point for the ramp. We won't suffocated but it sure feels like it.

_________________
I may have to rise but I refuse to shine.