Thumbs UP from me for the new A-Flex machine

[socknitster]

I have tried about 13 masks so far and here is my thought:

Exhalation ports in soft, rubbery material tends to be noisy.

Ex ports on hard plastic material is quieter.

I notice this the most on swift I, NAII, bravo, hans rudolph.

Quietest masks I've tried were: liberty and hybrid, swift II (ports are now on hard plastic) and I can't think of the others. Better hit the hay!

Am I imagining this, or is this a true observation?

Jen

[Snoredog]

.......You have to be able to breathe through your nose for cpap therapy to work effectively...........

Why is that?

[socknitster]

Snoredog,

I've been trying to train myself to keep the tongue seal, but my tongue is lazy! I've actually had a few tongue muscle cramps! The weakness of the muscle I'm experiencing could seriously be contributing to the problem. I really focused on this after my tonsilectomy for the first week that xpap wasn't possible.

I think that for me, developing this habit is critical: I have a severe underbite and large tongue. My oral surgeon wants me to consider MMA/GA but after the pain of the tonsilectomy, I don't think I will ever volunteer for that. I'm done with surgery. EVen the hope of complete cure won't persuade me to try something that radical.

It has been almost three weeks since the surgery and I still have to sleep in the recliner or I wake up unable to breath feeling like someone has a pillow on my face. The machine can't compensate for non-apnea obstruction. My palate is still swollen despite taking ibuprofin and the area has some blisters and rashes and some scabby material. The doc said this is nothing to worry about. All of this will resolve with time. He said the swelling is making the palate stiff and unable to function properly and is cutting off my nasal airway sometimes. So, the recliner it is. I might try using two wedges in bed--this is seriously not good for the marriage!

Snoredog, have you ever tried a bipap? Now that my pressure is down to 11/9 (original scrip was 16/12) and hopefully will continue to get better, and I'm going for another psg sometime in the next few months, I asked the RT yesterday about the possibility of switching to a-flex. She made it sound like it was likely a possiblitly. If it is easier to breath with than the bipap and maybe reduce my aerophagia, I'd be all for it. The only reason I needed the bipap was because at higher pressures (16 and above) I started "going central" as i like to put it. If my pressures are lower, I prob don't need it.

I'm also looking forward to seeing what the TAP device contributes to the mix later this month. Because I want to get pregnant and have big probs with aerophagia on my sides (even at these low pressures) I need to figure out what to do. Pregnant women are told to lay on their sides during the last trimester so the oxygen doesn't get cut off to the baby. There is a big aorta I think that runs right behind the uterus. I had a 10 lb baby last time, so this is a concern! Even if I reclined a little too much in my recliner I got lightheaded last time. I would hate to think I would have to spend three months or more sleeping sitting up so I don't blow up like a balloon!

I guess I'm hoping if TAP isn't the answer to this problem, maybe aflex will be. Being a mom is one of the most important things I have ever done. I wanted to have 3-4 kids spaced close together. Then all the health probs and weight and low energy. Now I am 35 with a 4 year old. I'm trying not to be disappointed with how things turned out, and just trying to optimize the future!

Any input you guys might have on this topic would go a long way to making me feel better informed!

jen

[roster]

..........
Can you train your tongue to maintain that seal? ........

James 3 (KJV)

3 Behold, we put bits in the horses' mouths, that they may obey us; and we turn about their whole body.

4 Behold also the ships, which though they be so great, and are driven of fierce winds, yet are they turned about with a very small helm, whithersoever the governor listeth.

7 For every kind of beasts, and of birds, and of serpents, and of things in the sea, is tamed, and hath been tamed of mankind:

8 But the tongue can no man tame; ..............

The way I have it figured, I can either lose my religion or just keep on using a full face mask.

I wonder if there is a Cesar Millan of tongues? If he whispered, it might not interfere with my sleep architecture.

BTW Snoredog, your physics of the airway lecture is convincing.

[socknitster]

Rooster, you crack me up! I'm going to have to haul out my bible and look that verse up--I'm not a big King James Fan, but I'm not going to get into a religious debate here!

I have a very similar pic (to your new avatar) of my husband and son. Gotta love daddies sleepin with babies!

jen

[Snoredog]

Snoredog,

I've been trying to train myself to keep the tongue seal, but my tongue is lazy! I've actually had a few tongue muscle cramps! The weakness of the muscle I'm experiencing could seriously be contributing to the problem. I really focused on this after my tonsilectomy for the first week that xpap wasn't possible.

I think that for me, developing this habit is critical: I have a severe underbite and large tongue. My oral surgeon wants me to consider MMA/GA but after the pain of the tonsilectomy, I don't think I will ever volunteer for that. I'm done with surgery. EVen the hope of complete cure won't persuade me to try something that radical.

you mean a overbite? where the upper teeth are over the bottom teeth? think they refer to that as a Class II overbite, most people are Class I, but hey you have a better smile from a Class II. While the MMA/GA may help with that, it still requires about a year's worth of ortho for the teeth to match back up, you just won't have that far go to move those teeth after the mandible is moved forward, you'll probably end up with a Class I.

Next you have a main nerve that runs through the mandible bone on each side, it exits at the front at the mental (yellow see below) that nerve is the one all the nerves of your teeth branch to, cut that nerve and its like one big root canal. So far with the MMA procedure I haven't read exactly what they do about that nerve, they must cut it and suture it back, but that nerve gives you all the feeling in the mandible. Do you like that feeling after your dentist numbs you up? If you have like endosseous implants put in, surgeons avoid that nerve at all costs even drilling for the implant, but with MMA it seems they must cut that never and stitch it back together, my understanding is nerves can take some time to heal, I guess that is why so many report they have no feeling in the mandible after that procedure (makes sense to me).

It has been almost three weeks since the surgery and I still have to sleep in the recliner or I wake up unable to breath feeling like someone has a pillow on my face. The machine can't compensate for non-apnea obstruction. My palate is still swollen despite taking ibuprofin and the area has some blisters and rashes and some scabby material. The doc said this is nothing to worry about. All of this will resolve with time. He said the swelling is making the palate stiff and unable to function properly and is cutting off my nasal airway sometimes. So, the recliner it is. I might try using two wedges in bed--this is seriously not good for the marriage!

Snoredog, have you ever tried a bipap? Now that my pressure is down to 11/9 (original scrip was 16/12) and hopefully will continue to get better, and I'm going for another psg sometime in the next few months, I asked the RT yesterday about the possibility of switching to a-flex. She made it sound like it was likely a possiblitly. If it is easier to breath with than the bipap and maybe reduce my aerophagia, I'd be all for it. The only reason I needed the bipap was because at higher pressures (16 and above) I started "going central" as i like to put it. If my pressures are lower, I prob don't need it.

Yes I have, my much younger ex brother in-law has OSA, he loaned me his, it was the Bipap Pro, I didn't know what I was doing with it at the time with setup but it was very similar to A-Flex. His friend died in his sleep from OSA at age 31, so I helped him get started on therapy (his father also had OSA and used CPAP but found out way too late, he died of a cornary). He's a bit overweight so he uses like 17 or 18 cm pressure.

If it has been 3 weeks you can probably start back on your Bipap, but I would put the pressure down much lower than you mention for a while. You can put the EPAP down to 6.0 cm if you want and will still gain therapy at that level. But if you can't tolerate it that low, try EPAP at 8.0, IPAP will land at 10 cm on startup, if you set PS=3 and BiFlex=2, you will be very close as with the A-Flex, you will still have a maximum separation of 1 cm more than A-Flex offers. For the most flexibility your Bipap Auto still offers the most therapy options. A-Flex is nothing more than the BiFlex feature, does basically the same thing.

I keep telling you nibbling on saltine crackers will help you heal faster, the roughness of the saltine crackers cleans away the scabs from the stitches and it heals faster.

I'm also looking forward to seeing what the TAP device contributes to the mix later this month. Because I want to get pregnant and have big probs with aerophagia on my sides (even at these low pressures) I need to figure out what to do. Pregnant women are told to lay on their sides during the last trimester so the oxygen doesn't get cut off to the baby. There is a big aorta I think that runs right behind the uterus. I had a 10 lb baby last time, so this is a concern! Even if I reclined a little too much in my recliner I got lightheaded last time. I would hate to think I would have to spend three months or more sleeping sitting up so I don't blow up like a balloon!

I guess I'm hoping if TAP isn't the answer to this problem, maybe aflex will be. Being a mom is one of the most important things I have ever done. I wanted to have 3-4 kids spaced close together. Then all the health probs and weight and low energy. Now I am 35 with a 4 year old. I'm trying not to be disappointed with how things turned out, and just trying to optimize the future!

Any input you guys might have on this topic would go a long way to making me feel better informed!

jen

I would just keep the machine you have and lower the pressure down and not worry about your AHI. To avoid the aerophagia, drop that thing way down and use the Auto mode where it is more comfortable and quieter.

If you suspect onset centrals, keep those EPAP pressures down below 9.0cm, it will help with aerophagia and avoid them. Set EPAP=7, IPAP=11 and PS=3, BiFlex=2.

When you turn on the machine it will start with EPAP at 7.0cm, IPAP will be 2 cm higher at 9.0cm and allow 2 cm's higher movement upward to 11/9. Then you'll never rise above 9.0 cm pressure, I bet your AHI even goes down.

Using the machine even at non-optimal pressures will be better for you than nothing at all. As for the pregnancy concerns, you would need to talk to your doctor about that, but there are ways around it even adding supplemental oxygen if needed.

I once studied Hematology and blood clotting disorders such as factor V Leiden, some of the lectures discussed patients diagnosed with factor V Leiden which greatly increases the risk as you can imagine with the placenta.

But even with that disorder, patients were able to have successful full term pregnancy without complications.

Just make sure all your doctors know about your condition. I think you'll be fine if you've already had one child, second one should slip right out Have your doctor consult with your sleep specialist when that time comes. Borrow a pulse oximeter and monitor your oxygen levels, even 5 cm pressure can keep you up to near normal levels. A dental device won't "force" any oxygen laden air into your lungs, cpap will.

[socknitster]

Snoredog,

You are such a sweetheart! Thank you for all your input. I'm back to a normal diet now including chips, crackers, fried chicken lol! I'm trying hard to minimize my caloric input so I don't gain the 15 lbs back, but I'm finding it hard because my body is just RAVENOUS! LOL! Too much deprivation for too long I guess.

I'm not sure what they call my jaw thing. I should have written it down--but the oral surgeon says that my jaw is pushed so far back it makes my mouth very small--teamed with a big tongue and that can cause problems. They said something about my lower jaw is too far back and then my upper teeth come down at an inward angle so that when my mouth is closed completely with teeth tog that pushes my lower jaw back even more. That is all I can remember. My wisdom teeth never came in properly--they were in there sideways and had to be removed because they were endangering my molars!

I am breathing much better even during the day now. Goodbye tonsils!

I've been using my bipap similar to what you mentioned since about a week after surgery. After my surgeon cleared me on monday I put the auto mode back on. I'm titrating much lower than before the surgery--even with all the swelling still there. There is still some scabby stuff in there but no pain anymore really, even upon wakeup in the morning. What a relief!

Good advice about the pregnancy. I didn't think of the supplemental oxygen. Now to get a doc to agree it is medically necessary! But I'll go there when I come to it!

Thank you for the comparison to the bipap pro. That really helps me get an idea of what it does. Having the bipap makes my treatment more versatile--so I should really keep it, just in case my needs go up during pregnancy or something!

Thank you once again for your very thoughtful response. I always look forward to reading your posts. Full of juicy info!

Jen