How Long Are Your Typical OSA's

Newbie still working on day 5. I found last night I really slept a few hours after a big day and my AHI went to 4.5 from the 1.5 it had been the previous days. Pressure increased quite a bit as well. Albeit, I think I was mostly awake on these days. Not really breathing like typical sleep. My OSA's can last up to 45 seconds. Is this typical for some? I guess it varies. Lots of info to digest early on.

My pressure at most of the times I slept was between 15 and my max setting of 16 with EPR of 3. I know some people have no problems with increasing pressures. However, it seems I'm having some really painful "air swallowing" at these levels. I know it's early, but I already have my bed raised 4 inches. The air comes in any position with it being worse on my sides. How many of you had this in the beginning and it dissipated as you settled in?

Also, I 've read on the posts that Bipap helped with this for some on higher pressures. What is the mechanism by which this might help? Is it just the lower exhale pressure keeps the total night's pressure lower or is it something in the mechanics of breathing?

I appreciate the thoughts. I really need this to work, as I can already tell the benefits, and it's really scary to think of what my body has been going through the last months, probably since my teens.

Best,

Mike

Have you tried lowering the pressure even by one # for 1-2 nights to see what effect it has on therapy? It's known to help with aerophagia (air 'swallowing' and bloating).

I ran lower pressures but had similar problems on the F10. I now use a P10 and get much less air but I'm also running lower APAP pressure (set at 10-20, averages about 12, peaks sometimes at 15).

Still a little new to try lowering the pressure. I haven't really slept enough to know what I'm going to settle in at. I'm guessing it's going to need to be on the higher side but who knows early on. I like breathing in, but the exhale thing is a whole different story.

englandsf- So you had the air swallowing with the F10 as well? I wonder if it's a function of FFM's in general? Maybe mouth breathing in my case. I know my mouth opens and that's the only real problem I have with the f10. My lower lip slips towards the bottom of the mask when this happens and can leak. I think they need a little optional chin strap attached to the mask bottom plastic to help hold the chin in place. I'm using a medium and maybe a large would be better. I didn't get to try a large, but it's fit guide looks like it would be hard for me to seal the top even if it helped the bottom. I guess we never really know until trying even considering the fit guides. I'd love to try a nasal pillow like you guys. Maybe someday down the road.

Best,

Mike

Macpage wrote:Also, I 've read on the posts that Bipap helped with this for some on higher pressures. What is the mechanism by which this might help? Is it just the lower exhale pressure keeps the total night's pressure lower or is it something in the mechanics of breathing?

Macpage wrote:My pressure at most of the times I slept was between 15 and my max setting of 16 with EPR of 3.

BiPap (Respironics term for a bilevel pressure machine) and VPAP (ResMed's term for a bilevel pressure machine) offer additional relief for aerophagia symptoms by lowering the pressure on exhale. The difference between inhale and exhale with bilevel pressure machines is called pressure support. In general the greater the difference the greater the ease in exhaling and in the case with aerophagia issues the reduction allows for less chance of the air sneaking into the digestive system. Sometimes there's a pressure point where above so and so pressure aerophagia rears its ugly head and just below that point it doesn't.

Your EPR setting of 3 lowers the pressure by 3 cm during exhale so it is working very similar to how a bilevel pressure machine would work. A bilevel machine will offer greater than 3 cm difference where your AutoSet is maxed out at 3 cm difference.
4 cm Pressure support offers a little more comfort than 3 cm and 3 cm offers a little more comfort than 2 cm.
I found that 4 or 5 cm difference between inhale and exhale was probably the most comfortable for me. YMMV but from what I have read 4 or 5 PS is probably the most common setting.

Your pressure settings on your AutoSet are 8 minimum and 16 maximum....is that correct? If so during exhale your pressure drops 3 cm so when it is at 8 cm the exhale drops to 5cm...when it is at 15 then the exhale is at 12. So it's working like a bilevel pressure machine already. There's a tiny difference in the timing of the reduction between using EPR and bilevel PS but for practical purposes it feels like a bilevel (I have used both EPR and bilevel PS to see how they feel).
If your machine wants to stay up around 15 cm or so most of the night to deal with the apnea events you may be in a catch 22 situation where you need that pressure but the pressure crosses that fine line where aerophagia rears its ugly head

Without seeing trend patterns for your pressure (those software detailed graphs) and event patterns it's hard to say what options you might have but a couple come to mind....limit the maximum so it can't go so high and see if the apnea events increase and/or the aerophagia issues decrease...or increase the minimum pressure a little in an effort to prevent the airway from collapsing in the first place and hope the pressure needs don't try to climb to 15 or 16. It all depends on how bad your aerophagia is and where that fine line happens to be where above it you have aerophagia issues and below it you don't. That line might be 14 or it might be 10. No way to know until some experiments are made.

FWIW....while I know that pressure should be the same no matter which mask is being used but I have seen too many people document the fact that they don't have to use as much pressure (2 to 3 cm less gives same results) with a nasal interface mask as they do with a full face mask and get the same therapy effectiveness. In other words you might be able to use a lower pressure with a nasal mask and get the same AHI results...please understand that I said "might"...it isn't a given and it doesn't work that way for everyone but I have seen it happen often enough to not pooh pooh it off. Worth a shot if you think you can keep your mouth shut and only breathe through your nose.

Also if you are seeing lots of OAs lasting 45 seconds...again a little increase in the minimum pressure might help deter them because it would be holding the airway open better to start with. Sometimes that EPR (which feels so good) drop allows the airway tissues to collapse during the drop or as a byproduct of the reduction. Might be that minimum of 8.5 or 9.0 with that EPR of 3 would better prevent the collapse of the airway in the first place and when it didn't...maybe wouldn't last so long.
90% of my OAs are between 10 to 20 seconds. Occasionally will see a 30 sec event...rare to see 45 seconds.

Thanks everyone. Yes, Pugsy, I'm set at 8-16. Last night I bumped up the start to 8.6. However, I still had a nasty start of OSA's and then a series of hypopneas before the pressure ramped up. The previous night I had a series start even with the pressure already ramped to 16. It does concern me that the OSA's can be around 45 seconds. Last night I had hypopneas of 86 seconds as well. All of this was in the supine. Perhaps, I'll just have to learn to start on my side. Not very comfortable with the FFM.

I certainly can understand everyone's love of the nasal pillows. The comfort and it does make sense to me that pressures might get by a little lower due to a more direct path to the airway. I may have to try when I get settled. Tape would be a must in my case. My problems star when I mouth breathe.

I'm concerned that the more I actually sleep with my therapy the worse my numbers will be. At AHI of 6.8, I'm concerned and I know that would be higher if I actually slept more than a few hours. This isn't much better than my home test, though my home test might have been worse if I had really slept good with it as well.

Any chance that people's pressure needs get lower as they settle in to therapy? I will keep slowly bumping up the minimum pressure to see if I can prevent events without making the "air swallowing" worse.

I appreciate your thoughts.

Best,

Mike

Macpage wrote:Any chance that people's pressure needs get lower as they settle in to therapy?

Not much chance of that unless the bulk of any events seen are centrals which might be related to SWJ and with a lot of awakenings.
Or sleeping position change which isn't always so easy to maintain. Meaning OSA and pressure needs can vary a lot for some people when supine sleeping vs side sleeping. I know of one person who needs pressure of 19 when on his back and only 9 when on his side so guess what he learned to do? yep...he figured out how to stay off his back all night...and he uses a full face mask.
Not everyone will see a marked difference in pressure needs with supine sleeping vs side sleeping though. For some it might be a 1 or 2 cm difference...others might see a greater difference..some might not see a difference at all. Hurts nothing to try to sleep on a person's side though if they can do it. Not so easy with a full face mask but people get it done quite successfully. People even sleep on their stomachs with full face masks. The key is bed pillow and face placement. So it can be done and you don't have to stay on your back all night but it does take some work to sort out mask placement, leaks and general comfort issues.
Perhaps a different full face mask would work out better for sleeping position.