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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Okie bipap
 
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Re: Worst night yet

Postby Okie bipap on Fri Nov 10, 2017 8:45 pm

Changing your pressure setting is much like a diabetic taking charge of their treatment and adjusting their insulin as needed. Most of us have taken charge of our own therapy and have made adjustments we feel are necessary. My sleep specialist knows I change mine and she has never said anything since my results are better after I mad the adjustment.

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MoodyMolly
 
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Re: Worst night yet

Postby MoodyMolly on Sat Nov 11, 2017 11:36 am

I am at a loss. I decided to try a second night with the FFM and give it a chance. But today I woke up to an AHI of 17.5. That surpasses my worst AHI number. I don't think there were any significant leaks. And to top it off, I am getting horrible aerophagia in the middle of the night, stomach pain and gas. I think my problem is that my mouth opens but I'm not breathing through it, so I end up swallowing the air. I'm switching back to nasal pillows tonight, hopefully I'll get better numbers. But seriously? Why is my AHI so high with a FFM over nasal pillows? It doesn't seem like it's a huge well known problem, masks are supposed to be interchangeable without changing your pressure. I did increase my minimum pressure to 7, but apparently with the FFM it doesn't make any difference.
Here's my results from last night: https://imgur.com/a/fniTA

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Pugsy
 
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Re: Worst night yet

Postby Pugsy on Sat Nov 11, 2017 11:45 am

Do me a favor tonight.
Change the minimum to 10 (use the ramp if you aren't comfortable with 10) and go back to the nasal pillow mask.
See what happens.

Actually needing more pressure with a full face mask is quite common. Not sure why unless it's the mask straps on that full face mask maybe causing the jaw to come back a little and narrow the airway.

Until your pressure minimum is more optimal you don't stand a snowballs chance in hell of ever getting decent sleep or therapy.
Plus....sometimes when the minimum pressure is more optimal the maximum doesn't go so wildly up there (and that's likely the culprit on the aerophagia issues).

You may need more than 10 cm minimum but going from 7 to 10 is a sizeable jump....try 10 cm and see what happens.

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Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Backups..AirCurve 10 ST, S9 Adapt, PR S1 Bipap #760

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MoodyMolly
 
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Re: Worst night yet

Postby MoodyMolly on Sat Nov 11, 2017 12:27 pm

Pugsy wrote:Do me a favor tonight.
Change the minimum to 10 (use the ramp if you aren't comfortable with 10) and go back to the nasal pillow mask.
See what happens.

Actually needing more pressure with a full face mask is quite common. Not sure why unless it's the mask straps on that full face mask maybe causing the jaw to come back a little and narrow the airway.

Until your pressure minimum is more optimal you don't stand a snowballs chance in hell of ever getting decent sleep or therapy.
Plus....sometimes when the minimum pressure is more optimal the maximum doesn't go so wildly up there (and that's likely the culprit on the aerophagia issues).

You may need more than 10 cm minimum but going from 7 to 10 is a sizeable jump....try 10 cm and see what happens.


Changing the min to 10 and going back to the pillow? Do you think the 7cm min would be ok with the nasal pillow? With the FFM, I could hardly tell there was a difference in pressure from the 7cm min and when it started blowing at 15cm. With the nasal pillows, it feels like I'm not getting anything at 5cm, but feels like it's going at mach 10 when it gets to 14. But I'll try 10cm and the n pillow if you think it'll help.
Also, I saw the post on magnesium, and I do take a magnesium supplement. I'm thinking I'll go without for a few days and see if it makes any difference in my AHI.

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Pugsy
 
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Re: Worst night yet

Postby Pugsy on Sat Nov 11, 2017 12:39 pm

Use the mask that is the most comfortable for you but change the minimum to 10 cm.

The minimum pressure is your main issue right now in terms of therapy effectiveness. You will stand a better chance of improved effectiveness with the change to 10 cm minimum with a nasal pillow mask but not at the expense of not being able to sleep at the higher pressure because of overall comfort.
So if you feel more comfortable with the FFM at 10 cm then use the FFM ..

The main thing I want you to do is get that minimum pressure starting point up closer to what your airway needs to better hold the airway open and thus prevent the collapse of the airway (which is what you are seeing with the high AHI and the high pressures where the machine is trying to fix a problem after it has happened).

These machines work best by preventing the airway from collapsing in the first place....hence the more optimal starting point or minimum.
You may well need even more than 10 cm but going from 7 to 10 is a big enough jump in terms of comfort as it is.
Start with 10 cm and see what happens and then we worry about maybe needing more.

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Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Backups..AirCurve 10 ST, S9 Adapt, PR S1 Bipap #760

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MoodyMolly
 
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Re: Worst night yet

Postby MoodyMolly on Sat Nov 11, 2017 12:44 pm

Pugsy wrote:Use the mask that is the most comfortable for you but change the minimum to 10 cm.

The minimum pressure is your main issue right now in terms of therapy effectiveness. You will stand a better chance of improved effectiveness with the change to 10 cm minimum with a nasal pillow mask but not at the expense of not being able to sleep at the higher pressure because of overall comfort.
So if you feel more comfortable with the FFM at 10 cm then use the FFM ..

The main thing I want you to do is get that minimum pressure starting point up closer to what your airway needs to better hold the airway open and thus prevent the collapse of the airway (which is what you are seeing with the high AHI and the high pressures where the machine is trying to fix a problem after it has happened).

These machines work best by preventing the airway from collapsing in the first place....hence the more optimal starting point or minimum.
You may well need even more than 10 cm but going from 7 to 10 is a big enough jump in terms of comfort as it is.
Start with 10 cm and see what happens and then we worry about maybe needing more.


Got it! I'll change it to 10 and try both masks tonight to see which feels more comfortable. Thank you for your tips!!! I hope it helps :)

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MoodyMolly
 
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Re: Worst night yet

Postby MoodyMolly on Sun Nov 12, 2017 11:50 am

I changed my minimum pressure to 10, and went back to the nasal pillow last night. My AHI went back to 7 Which is what I was getting half the nights with the n pillow. I was sleeping for a few hours without a chin strap, but woke up with a dry mouth, so I added my chin strap. As you can see on the data below, the first part of the night when I wasn't wearing a chin strap, I had horrible apneas, and it skewed my average. The nights I wore a chin strap before didn't give me any better results so I don't always use it. Tonight I'm going to wear the chinstrap all night and see if the combination of that and the higher pressure will give me a better result.

https://imgur.com/a/HBtr0

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Pugsy
 
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Re: Worst night yet

Postby Pugsy on Sun Nov 12, 2017 11:58 am

What position were you laying during that first part of the night without the chin strap?
On your back or on your side?

Your leak data doesn't support mouth breathing happening significantly so I am scratching my head as to why the big pressures being needed without chin strap.

Have you thought about wearing a cervical collar?

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Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Backups..AirCurve 10 ST, S9 Adapt, PR S1 Bipap #760

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MoodyMolly
 
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Re: Worst night yet

Postby MoodyMolly on Sun Nov 12, 2017 12:05 pm

Pugsy wrote:What position were you laying during that first part of the night without the chin strap?
On your back or on your side?

Your leak data doesn't support mouth breathing happening significantly so I am scratching my head as to why the big pressures being needed without chin strap.

Have you thought about wearing a cervical collar?


I think I was mostly on my back all night, I may have switched to my side for a little while, but I'm not certain. What would a cervical collar do? Is it for keeping the mouth closed, or positioning?
Curiously enough, now that you asked about sleeping position... I slept on my side 100% of the time up until a year ago, when I noticed I started wheezing laying on my side, and felt pressure on my throat, reducing my air supply. So now I mostly sleep on my back. Could the side sleeping be producing some sort of obstructive apnea? Except for the fact that I'm awake and completely aware of this feeling. Doctors couldn't figure it out.

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Pugsy
 
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Re: Worst night yet

Postby Pugsy on Sun Nov 12, 2017 12:18 pm

The cervical collar might help keep the chin up and prevent the drop that the chin strap is also trying to prevent.
Some people prefer a cervical collar to a chin strap. The collar will also help keep the airway more in an "open" position vs maybe crimped or bent.
I mention as something you might want to consider at some time in the future is you feel the need to use the chin strap.

I don't see the mouth breathing leak on the report...it's just not there. The leak never really changed all that much so I am really wondering why the significant pressure variations with and without a chin strap but if a chin strap works and keeps the pressure needs down and you can get by with what you did after you put the chin strap on then hey...wear the chin strap.

It's actually sleeping on your back that can usually make the OSA worse or cause significant pressure needs variations. I suppose it wouldn't be impossible for there to be something involved with side sleeping that might make the OSA worse but it isn't very common.

It looked like you were on your back and then ended up on your side....at least from the pressure line. That's why I asked what position you were maybe in during that first part of the night vs later in the night.

So for tonight....use the chin strap all night and sleep in whatever position you want that lets you sleep. We want sleep first and worry about position and pressure needs second. Keep the 10 cm minimum for now. I would also open up the max from the 15 to 20 just in case the chin strap comes off and the pressure wants to go higher.....let it go there and see what happens.

_________________
Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Backups..AirCurve 10 ST, S9 Adapt, PR S1 Bipap #760

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MoodyMolly
 
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Re: Worst night yet

Postby MoodyMolly on Sun Nov 12, 2017 12:38 pm

Pugsy wrote:The cervical collar might help keep the chin up and prevent the drop that the chin strap is also trying to prevent.
Some people prefer a cervical collar to a chin strap. The collar will also help keep the airway more in an "open" position vs maybe crimped or bent.
I mention as something you might want to consider at some time in the future is you feel the need to use the chin strap.

I don't see the mouth breathing leak on the report...it's just not there. The leak never really changed all that much so I am really wondering why the significant pressure variations with and without a chin strap but if a chin strap works and keeps the pressure needs down and you can get by with what you did after you put the chin strap on then hey...wear the chin strap.

It's actually sleeping on your back that can usually make the OSA worse or cause significant pressure needs variations. I suppose it wouldn't be impossible for there to be something involved with side sleeping that might make the OSA worse but it isn't very common.

It looked like you were on your back and then ended up on your side....at least from the pressure line. That's why I asked what position you were maybe in during that first part of the night vs later in the night.

So for tonight....use the chin strap all night and sleep in whatever position you want that lets you sleep. We want sleep first and worry about position and pressure needs second. Keep the 10 cm minimum for now. I would also open up the max from the 15 to 20 just in case the chin strap comes off and the pressure wants to go higher.....let it go there and see what happens.


I'll keep the cervical collar in mind, thank you!
Yes, there is definitely something about the first part of the night that was causing apneas and high pressure. But it wasn't leaks apparently. Maybe the chin strap is somehow positioning my mouth/throat in a different way that opens the airways better. No idea!
Thanks for the suggestions, hopefully one day I'll get everything figured out and get a good nights sleep :lol:

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Pugsy
 
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Re: Worst night yet

Postby Pugsy on Sun Nov 12, 2017 12:47 pm

MoodyMolly wrote:Maybe the chin strap is somehow positioning my mouth/throat in a different way that opens the airways better. No idea!


This would be my thought as well but I can't imagine how it does it. Usually it pulls the jaw back and makes things worse instead of better but if it enables you to use less pressure and you are okay with it....hey, go for it. Certainly isn't hurting anything apparently.

_________________
Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Backups..AirCurve 10 ST, S9 Adapt, PR S1 Bipap #760

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