Flow limitation advise

[mrkdilkington2]

Also just to add, I suffered from hypnic jerks on sleep onset just like OP, which I consider to be a smoking gun for UARS. In my case, the UARS was attributed to the nasal region according to my jaw surgeon. The upper jaw portion of my jaw surgery (segmented le fort 1 osteopath) has significantly improved my nasal breathing.

[mrkdilkington2]

*Osteomaty

[mrkdilkington2]

Dilkington, I agree with much of what you have said, especially for the younger (20 - 45) portion of the segment you mention.

Regarding Syvlia, at this point we don't know her age. And, she is in the beginning stage of using and optimizing her CPAP therapy. I am hopeful that she will soon reach a very good CPAP therapy.

If you care to, starting another thread about your experience with MMA would be appreciated.

Thanks I do plan on doing this after I'm healed and have done another sleep study.

[ChicagoGranny]

I do plan on doing this after I'm healed and have done another sleep study.

[Sylvia54]

Dilkington, I agree with much of what you have said, especially for the younger (20 - 45) portion of the segment you mention.

Regarding Syvlia, at this point we don't know her age. And, she is in the beginning stage of using and optimizing her CPAP therapy. I am hopeful that she will soon reach a very good CPAP therapy.

If you care to, starting another thread about your experience with MMA would be appreciated.

The numerical portion of my username will give you an idea of my age, yes I'm over the hill, lol, and feel fortunate that cpap didn't enter my life at a young age.
In fact I don't think sleep apnea treatment was even available until the late 1980's. Even if I continue to improve, I think I will look into a sleep dentistry option.
I've already seen an ENT doctor, gave him a cy of my sleep report. He listened to my story of orthodontic treatment and the ongoing insomnia,etc. that started up out of nowhere
in 2012. Said he saw some crowding at the back of my mouth and gave me a brochure for SomnoGuard SP Soft. Cost is about $500. Told me that cpap is still considered the best therapy and that
must be tried for several mos. before insurance will pick up any of the cost. For now I plan to continue with cpap.

[Sylvia54]

Also just to add, I suffered from hypnic jerks on sleep onset just like OP, which I consider to be a smoking gun for UARS. In my case, the UARS was attributed to the nasal region according to my jaw surgeon. The upper jaw portion of my jaw surgery (segmented le fort 1 osteopath) has significantly improved my nasal breathing.

There's a whole list of causes for hypnic jerks. First time I experienced them was side effect from pain medication Tramadol (3 yrs ago). The stuff worked good but found that half a pill was all I could tolerate. My sleep doctor told me sleep apnea can cause hypnic jerks and also the restless legs, numbness and tingling that came and went. I had chronic insomnia for two years when my entire nervous system started getting messed up. The jerks have almost disappeared, I can still have one or two while getting to sleep but they're very mild. I have no problem with nasal breathing and no plans for going under the knife, thank you very much!

[Sylvia54]

An excerpt from ONE source:

AutoCPAP
The aim of AutoCPAP is to adjust the pressure in response to respiratory events without adjustment to artifacts caused by
leak or other factors. AutoCPAP from different companies and different models by the same company have varying definitions of events, responses to obstructive events, and protocols for decreasing the pressure once the breathing stabilizes. These variations are important to understand for appropriate clinical care as they affect the patient’s tolerance of the devices and the clinical efficacy.12–14 If a patient enters REM sleep or changes position, the degree of obstruction may suddenly increase and by the time the device is able to adjust to the needed pressure the patient may have had desaturations or arousals. This is why most studies reporting the equivalence of AutoCPAP to in-lab titration recommend changing the EPAP minimum to the pressure the device is at or below 90–95% of the time.2,15 In our experience, many patients left on AutoCPAP 4–20 are undertreated and may present with awakenings a couple hours into sleep, residual symptoms, or difficulty tolerating PAP. Some patients are sensitive to the pressure changes, so if patients are not doing well with AutoCPAP, fixed CPAP should be tried.


Den

.

I spent just one night of disturbances on variable 4-20, waking up on my back when pressure shot up (I believe) and about blew off my nasal pillows. So much for the RT's advice to leave it wide open. Instead I went by my fixed prescribed settings, 7/7 and then 8/8, and by recommendations on here, (Pugsy I think), and tried 8/11 and 8/12. And so far I think that's the sweet spot.
's

[palerider]

OP it sounds like you have UARS like I did.

The old I-have-UARS-so-you-must-have-UARS approach.

And thrown in for free, the old I-had-MMA-surgery-so-you-need-MMA-surgery approach.

it's human nature to make oneself feel better about what one has done by getting others to do the same thing.

[MrKDilkington]

OP it sounds like you have UARS like I did.

The old I-have-UARS-so-you-must-have-UARS approach.

And thrown in for free, the old I-had-MMA-surgery-so-you-need-MMA-surgery approach.

it's human nature to make oneself feel better about what one has done by getting others to do the same thing.

I only wanted to let her know that I had very similar symptoms, and to share something that has worked for me. I'm happy for anyone that can treat their symptoms successfully however they choose to do so. Jaw surgery unfortunately has an age cutoff so it wouldn't be appropriate for her, but maybe others reading this thread can benefit from me sharing my experience.

[MrKDilkington]

Also just to add, I suffered from hypnic jerks on sleep onset just like OP, which I consider to be a smoking gun for UARS. In my case, the UARS was attributed to the nasal region according to my jaw surgeon. The upper jaw portion of my jaw surgery (segmented le fort 1 osteopath) has significantly improved my nasal breathing.

There's a whole list of causes for hypnic jerks. First time I experienced them was side effect from pain medication Tramadol (3 yrs ago). The stuff worked good but found that half a pill was all I could tolerate. My sleep doctor told me sleep apnea can cause hypnic jerks and also the restless legs, numbness and tingling that came and went. I had chronic insomnia for two years when my entire nervous system started getting messed up. The jerks have almost disappeared, I can still have one or two while getting to sleep but they're very mild. I have no problem with nasal breathing and no plans for going under the knife, thank you very much!

Thanks for this info. It actually makes perfect sense that Tramadol would cause hypnic jerks as opioid drugs cause respiratory depression, which in a way mirrors the effects of UARS or vice versa. I'm glad you were able to take care of your hypnic jerks - I know how irritating they can be.

[ChicagoGranny]

it's human nature to make oneself feel better about what one has done by getting others to do the same thing.

... as long as the others don't get better results or a lower price.

[49er]

OP it sounds like you have UARS like I did.

The old I-have-UARS-so-you-must-have-UARS approach.

And thrown in for free, the old I-had-MMA-surgery-so-you-need-MMA-surgery approach.

it's human nature to make oneself feel better about what one has done by getting others to do the same thing.

I only wanted to let her know that I had very similar symptoms, and to share something that has worked for me. I'm happy for anyone that can treat their symptoms successfully however they choose to do so. Jaw surgery unfortunately has an age cutoff so it wouldn't be appropriate for her, but maybe others reading this thread can benefit from me sharing my experience.

Actually, Kasey Li, one of the top experts in the MMA procedure has said for him in an interview with Dr. Park, he will not do the procedure on people past their early 60s. Sorry, I don't remember the exact age he specified. His reasoning was that he found that at that age, the airway became more floppy which greatly increased the risk of having MMA surgery making it not a viable option.

Interestingly, an oral surgeon who had done the procedure said he operated on someone who was 65 who had great success. Obviously, one case does not prove anything but I guess if one was desperate to have the procedure at that age, they could find someone to do it.

Anyway, sorry for the OT response but I wanted to chime in case someone was reading this thread who might be considering the MMA who has been unable to make pap therapy work in spite of their best efforts. I know, this board is for people on pap therapy but you don't know who might be reading posts.

Back to regularly scheduled programming.

49er

[MrKDilkington]

OP it sounds like you have UARS like I did.

The old I-have-UARS-so-you-must-have-UARS approach.

And thrown in for free, the old I-had-MMA-surgery-so-you-need-MMA-surgery approach.

it's human nature to make oneself feel better about what one has done by getting others to do the same thing.

I only wanted to let her know that I had very similar symptoms, and to share something that has worked for me. I'm happy for anyone that can treat their symptoms successfully however they choose to do so. Jaw surgery unfortunately has an age cutoff so it wouldn't be appropriate for her, but maybe others reading this thread can benefit from me sharing my experience.

Actually, Kasey Li, one of the top experts in the MMA procedure has said for him in an interview with Dr. Park, he will not do the procedure on people past their early 60s. Sorry, I don't remember the exact age he specified. His reasoning was that he found that at that age, the airway became more floppy which greatly increased the risk of having MMA surgery making it not a viable option.

Interestingly, an oral surgeon who had done the procedure said he operated on someone who was 65 who had great success. Obviously, one case does not prove anything but I guess if one was desperate to have the procedure at that age, they could find someone to do it.

Anyway, sorry for the OT response but I wanted to chime in case someone was reading this thread who might be considering the MMA who has been unable to make pap therapy work in spite of their best efforts. I know, this board is for people on pap therapy but you don't know who might be reading posts.

Back to regularly scheduled programming.

49er

Thanks for clarifying 49er; Dr. Park's interview with Dr. Li was indeed the source I was referencing when I brought up the upper limit earlier. The other factor that limits age most is healing.

[tan]

some folks here think that slowly changing pressures during the night are a big bugaboo...

they can be IF such higher pressures cause loss of proper seal. If not, then I rather think, it ain't a big deal

the rants against the evils of auto machines aren't about leaks caused by high pressures, which, really, are a separate issue, the assertion is that the slowly changing pressures, over the course of minutes, somehow jolts everybody out of their 'deep sleep stages' and into lighter ones

I tolerate well such pressure "bumps" until the seal breaks, which has affected my sleep the most in the past. Not sure how to configure the straps to handle pressure changes. I have happily settled on 13/9 I-E straight and have no desire to experiment any further

[palerider]

I have happily settled on 13/9 I-E straight and have no desire to experiment any further

can pressure that varies from 9 to 13 every breath be reasonably called "straight pressure"?

I'm glad you've arrived at something that works for you, and hope you're sleeping well with it.