New Member Indroduction

[MAINEGUY]

New member here but have been lurking for a few months trying to gather as much understanding of all the variables, and there are many, as I could before introducing myself and asking for help/input.

Here is a little background:
I am a 50-year-old male who was diagnosed with severe sleep apnea in late August 2020. I was told my apnea rate was ~40 per hour via home sleep study and again via my in-lab titration study in early October. I was however prescribed CPAP almost immediately after my home study. That said, I have been using CPAP since 9/1/20. I take two prescriptions, one for high cholesterol and one antidepressant. Cholesterol seems to be under control, and I have experimented dropping the antidepressant with pretty good luck over the years, I just find it works well to level out the peaks so to speak, so I stay on it. Other than that, I take some over the counter Claritin, a daily multi vitamin and a fiber supplement. Oops….I take singular at night per my pulmonologist as my sleep study also revealed my oxygen levels were dropping lower than they should during sleep. Went through multiple tests and pulmonologist was not of the opinion there was anything serious to worry about.

When I was first diagnosed, I told myself I was going to do everything I could to make my therapy successful. Despite costing a small fortune, I have invested in several masks from FF, hybrid to nasal with mild success on all. I believe I have all but mastered the perils of sleeping with a mask just fine and have no problem with wearing the device for an entire night. I have struggled with leak rates due to having a goatee and my pressure setting I was prescribed after my titration study. I have come to find that maintaining my beard at around 1/8” has helped. My pressures were adjusted to 16 after titration and I was having an awful time keeping any mask on my face and after several complaints to my sleep doctor, they finally lowered my pressure to a range of 12 to 15 but I do feel I struggle with leaks no matter the pressure or mask type. To add to the leak issue, I have determined that I mouth breath after a few hours and chin straps don’t help but mouth taping does a little with my beard trimmed down.

I feel like I am blathering on but in reading a lot of the posts by new members the recurring message I was seeing was not providing enough background detail.

I have attached some of my Oscar data from a couple of nights in hopes of getting some feedback, positive or negative. I can say that I have definitely noticed an improvement in focus and in my level of afternoon fatigue but have still not come to that “ahah” moment in my therapy…….

Not quite sure what happened last night with my AHI but I suspect it may have had to do with an experimental 3mg dosage of a melatonin supplement??

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[SleepGeek]

Welcome to the zoo.

You do need to work on leaks which is normal when starting. Couple of thoughts. Either shave the facial hair or try using nasal pillows - or both. Even at your pressures you will get used to it and soon won't feel it.
Also consider using a sports mouth guard for the mouth breathing. It may help you keep your mouth closed if you have something in it.

Do you breath thru your mouth while awake? If not you will have to work on that in order to be successful with pillows. Take a minute now to focus on your breathing and pay attn. to see IF you are breathing thru your nose.

Your sleeping thru the nite with a mask on your face and that is a major accomplishment. So don't give up now.

[MAINEGUY]

I do feel that during the day I breath predominantly through my nose, but at night, perhaps in deep sleep, my jaw slips back and I get the classic lips flapping.

I had a single row dental devise I have used periodically prior to CPAP that I tried last night with my P30i until about 2am when I awoke to dry mouth and lips flapping. This was actually better than I recall when using the P30i alone. After 2am I switched to some mouth tape and the leaks appear worse with the tape. I have ordered a double row moldable mouthpiece and am going to try that. I actually prefer the pillows mask I was just never able to keep my mouth closed.

Thank you for your input and here is my graph from last night.

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[SleepGeek]

Glad it helped. Keep a bottle with something just to wet your mouth - I use propel but it can be anything. Try to find something Ph balanced. With the mouth piece you can keep your facial hair or you can shave it and see if that helps, it will grow back so no reason to panic.
Do you keep a notebook by the bed to make notes in when you wake up? How you felt? What went good? Things to improve on? What to try next? Get to bed 30 min. early to get things ready?

This therapy takes time to master, so don't give up. Once you get things working you won't sleep without it.

[elsueno]

x

[Sleeprider]

Maineguy, you have a lot of flow limitations that usually respond to the pressure support from EPR, and of course there are the clusters of OA that suggest a chin-tucking problem. I recommend you turn your EPR up to 3 and that should improve the flow limitations which drive your pressure. Take a look at this article and look at the examples of Oscar charts with the clusters of apnea like yours. If this is a common occurrence for you, a soft cervical collar can help control the clusters of apnea and prevent leaks by stabilizing your jaw.

[MAINEGUY]

Maineguy, you have a lot of flow limitations that usually respond to the pressure support from EPR, and of course there are the clusters of OA that suggest a chin-tucking problem. I recommend you turn your EPR up to 3 and that should improve the flow limitations which drive your pressure. Take a look at this article and look at the examples of Oscar charts with the clusters of apnea like yours. If this is a common occurrence for you, a soft cervical collar can help control the clusters of apnea and prevent leaks by stabilizing your jaw.

It's interesting you say that as last night I raised my min pressure from 12 to 13 and my EPR from 2 to 3. I am still struggling with leaks with the F30i and after looking at some of the better days I've had controlling leaks in the past, I was wearing my F20 FFM. That being said I am going to try the F20 again for the next week or two and see what happens. Ironically I was also researching a cervical collar that someone wrote about in some other posts as I am certain my jaw is dropping and I'd like to see if one would help.

Thank you to everyone that has responded and I will post some data over the next couple days.

Eric

[MAINEGUY]

So the last couple of nights going back to the F20 FFM seem to have helped with the leak rates. I seem to be having a ton of events in the first hour and a half and then things level off. Any thoughts? Should I try raising my max pressure from 15 to 16 since during those periods of several events I am running at max pressure?

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[Pugsy]

Yes...raise your max pressure to 20 and see what happens.
You might end up needing a little more minimum but I would give the machine a chance to better do its job without its little hands tied with the restriction on the max.

[MAINEGUY]

Yes...raise your max pressure to 20 and see what happens.
You might end up needing a little more minimum but I would give the machine a chance to better do its job without its little hands tied with the restriction on the max.

I will try that for the next couple nights and see what happens.

Thank you for your input!

[MAINEGUY]

I still had a fair amount of obstructions which seem to be right around the time I actually fell asleep but going back to the F20 seems to be grounding my leak problems a lot better. I have a cervical collar ordered and should be here in a couple days. Still holding out hope I can get back to a my nasal pillows setup as when it didn't leak I felt I got the best therapy.

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[Pugsy]

Another reason to try to make nasal pillow mask work...often less pressure is needed to hold the airway open when nasal masks are used vs full face mask. I think it is because the lower straps on full face masks tend to pull the lower jaw back a little and restrict the airway a bit or alter airway position a bit and that all makes a person need more pressure to hold the airway open.

Also...remember the common reasons for the machine seeming to need much higher pressures part of the night and not so much other parts of the night which are supine sleeping or REM stage sleep or combination of both. Both are well known to make OSA worse and cause a need for more pressure.

Are you using auto ramp or regular ramp?

Were you by chance on your back when the machine increased the pressure markedly?

[MAINEGUY]

Are you using auto ramp or regular ramp?

Were you by chance on your back when the machine increased the pressure markedly?

Not sure what the difference is between Auto vs Regular ramp but I will research that and report back.

I believe I may have been on my back at that point. I tend to start out on my back and eventually move to one side or the other after repositioning a few times. I have always felt I take longer than most to fall asleep which was why I experimented one night with the Melatonin. I may eventually go back to trying it but want to limit my variables for the time being.

Thank you again Pugsy!

[Pugsy]

Your pressure graph looks more like auto ramp than just regular ramp.
The difference explained here. If you are using auto ramp then the machine increases the pressure fairly dramatically when it thinks you are asleep OR after 30 minutes whichever comes first.

Explained in the manual.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

[MAINEGUY]

I looked at my settings last night and Ramp is set to Auto.

Here is my graph from last night. It's not quite what I expected to see as I felt I slept very well and went right to sleep.

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